Expert Interview: Vitamins and Minerals During Pregnancy and Breastfeeding

Interview with Prof. Dr. Ekkehard Schleußner

Today, the issue of ensuring an adequate supply of micronutrients during pregnancy and breastfeeding is more relevant than ever. In addition to a nutrient-rich diet for both mother and child, a basic supply of vitamins and minerals also plays a crucial role. Depending on dietary habits, the focus may be on other micronutrients such as vitamin B12, omega-3 fatty acids, and others.

Critical Vitamins and Minerals During Pregnancy

Prof. Dr. Schleußner, in your experience, which vitamins and minerals are particularly critical for the health of mother and child during pregnancy?

Prof. Dr. E. Schleußner: There is virtually conclusive evidence and research showing that folic acid plays a central role. Antioxidants and the vitamin B complex are also important. Vitamin E plays an important role in early pregnancy for the implantation of the fetus: the micronutrient scavenges oxygen radicals as the placenta develops. Iron is also very important, alongside folic acid. Omega-3 fatty acids, in turn, play a role in fetal and neural development—for example, for the CNS (central nervous system).

Vitamin A is contraindicated, though not when consumed through a normal diet. In the spirit of “the dose makes the poison,” I consider additional supplementation to be risky. I also do not consider excessive calcium or a vitamin D overdose to be advisable. Reportedly, one in two people today has a vitamin D deficiency, but in my view, too high a dose is also problematic. Supplementation that far exceeds the physiological norm is not advisable, but I do not view anything consumed through a normal diet as risky.

Nutrient Recommendations for Breastfeeding

Are there specific nutrients that you frequently recommend in your clinical practice to prevent deficiency symptoms during breastfeeding?

Prof. Dr. E. Schleußner: In my view, the recommendations are no different from those for pregnancy, because nutrition during breastfeeding should not be better or worse. The necessary intake depends on the individual mother. Therefore, I recommend continuing to take standard prenatal supplements during breastfeeding as well, since these generally cover the daily requirement.

Long-term consequences of insufficient vitamin and mineral intake during pregnancy

In your opinion, what long-term consequences can an insufficient intake of certain vitamins and minerals during pregnancy have?

Prof. Dr. E. Schleußner: There is also good data on this topic: Iron deficiency and folic acid deficiency can lead to maternal anemia and reduced fetal growth, as well as a higher rate of preterm births. The same applies to a poorer start in life, as the child’s development is impaired as a result of folic acid deficiency. Folic acid deficiency during pregnancy can lead to severe fetal malformations such as neural tube defects (e.g., spina bifida), heart defects, and cleft palate and cleft lip.

In the case of a calcium deficiency, the old saying “Every child costs a tooth” may come true for the mother. That is why I consider a calcium-rich diet without supplementation to be necessary: a dairy-based diet with quark and yogurt. With a vegan diet, the risk of deficiency is increased, so I definitely recommend a dietary supplement.

Personally, I view a vegan diet as malnutrition or poor nutrition. In my opinion, everything being said about it today is wrong. A vegan diet, in my view, poses a high risk to the child during pregnancy because it lacks essential amino acids and vitamin B12. I consider it critical to use vitamin B12-fortified toothpaste and to take additional vitamin B12 supplements. In my view, all essential vitamins and minerals should be obtained through diet to ensure the child’s health.

Iron Supplements and Their Dosage for Pregnant Women

Based on your daily clinical practice, can you describe how effective iron supplements are for pregnant women and what dosage recommendations you provide?

Prof. Dr. E. Schleußner: Iron supplementation during pregnancy is necessary because intestinal iron absorption is limited (approx. 1.65 mg/day). Although the “more is better” approach does not apply here, supplementation is required in cases of iron-deficiency anemia, as the hemoglobin level (Hb level) alone does not provide sufficient information. A serum iron level below 15 μg/L justifies iron supplementation, as oral intake is often insufficient to correct the iron deficiency.

The Role of Vitamin D in a Child’s Bone Health

How do you assess the role of vitamin D in relation to the bone health of an unborn child, and what recommendations do you give to pregnant women?

Prof. Dr. E. Schleußner: Yes, the micronutrient vitamin D has a significant impact on the baby’s bone development. A vitamin D deficiency—which is being observed with increasing frequency—impairs the classic, fundamental function of the vitamin for bone health. A vitamin D deficiency can indicate subsequent hypocalcemia (low calcium levels). Based on recent study results, there are also links between vitamin D deficiency and reduced fertility, as well as the risk of pregnancy complications, preterm births, and low bone mass in children (Nutritions 22 Jose).

Furthermore, vitamin D is important for women because maternal calcium reserves are mobilized for the benefit of the child, leading to demineralization in the mother. This is because during pregnancy, the priority is ensuring the child receives adequate nourishment.

The Importance of Omega-3 Fatty Acids During Pregnancy and Breastfeeding

Based on your clinical experience, what significance do you attribute to omega-3 fatty acids, and what benefits do you see specifically during pregnancy and breastfeeding?

Prof. Dr. E. Schleußner: Many years ago, we studied breast milk and the placenta in the placenta laboratory. Our experience has shown us that the anti-inflammatory properties of omega-3, when consumed instead of omega-6, have the potential to suppress inflammatory processes that can lead to preterm birth. Our scientific studies also indicate that omega-3 fatty acids are needed to build neural structures—especially in the second half of pregnancy and during the first year of life.

Years ago, there were large-scale biological studies from Norway involving women who regularly ate fresh fish: fewer preterm births were observed, and after three to six years, the children demonstrated a demonstrably higher IQ. However, these findings apply only to women who consumed seawater fish and not to omega-3 supplementation. The studies from ten years ago were unable to demonstrate that supplements produce the same positive effects.

New Research Findings and Nutritional Trends in Obstetrics

Are there any new research findings or trends in obstetrics regarding nutrition that you consider particularly relevant?

Prof. Dr. E. Schleußner: No, not really. There are constant new reports these days claiming that supposedly every second woman is affected by a vitamin D deficiency, which I personally cannot imagine, however. It is clear that living conditions have changed: In the past, many people were exposed to the sun much more—for example, while doing farm work. Today, many of us sit in front of a computer in a dark room, so vitamin D production naturally declines. Despite the changed living conditions, which play a role, I am personally undecided as to whether vitamin D supplementation makes sense for everyone. There’s a new trend where many people (25 to 30%) follow a vegetarian diet. As long as it’s a lacto-vegetarian diet, I consider it acceptable. I’m unsure about other dietary trends.

Finally, here’s a tip: These days, everything has to be completely natural. In my view, women often say, “No, I won’t take those nasty pills.” My clear recommendation is to eat a balanced diet and take a standard prenatal multivitamin. Some women take five different—and often expensive—supplements, which I don’t think is necessary. The standard supplements labeled “suitable for pregnancy” meet the recommendations of the German Society for Nutritional Medicine. In my view, the recommended daily dose of omega-3 should definitely be adhered to during phases 1 and 3. Taking folic acid alone is not sufficient, in my opinion.

Although the cost of multivitamin supplements is not covered by health insurance, they are not so expensive that they are unaffordable. I believe it is important to take additional supplements, as multivitamins, in my view, have a positive effect on the placenta—even in early pregnancy and especially in women with a history of frequent premature births or miscarriages. If necessary, I think it makes sense to start taking supplements as soon as you’re planning to conceive, so that your body’s stores are full when pregnancy begins.

Furthermore, there are studies showing that in Germany, we don’t get enough micronutrients from our daily diet. I believe it is a misconception to think that one can obtain all essential vitamins and minerals through diet alone. In my opinion, we all do not consume enough micronutrients such as zinc. I recommend that women planning to conceive ensure an adequate supply of micronutrients for the child’s needs—not only before pregnancy, but also during pregnancy and while breastfeeding.