Prenatal & Nursing Supplementation

3 year old Jett and Mommy's growing tummy

As for prenatal supplementation--there's a lot you can do and need to do as a mom carrying a baby with Down syndrome (referred to as "you" "us" or "we"). I wrote this while 6 months pregnant with my second child and acted as if the baby I carried may have DS as well, just in case. And, once I had my baby and was breastfeeding, I continued with these supplements.
 
Which prenatal multivitamin is best?

The prenatal vitamins for the typical population won't work as well for you for many reasons. There are only a few prenatals that we have to choose from.

Reviews of Prenatal Supplements for Us:

Seeking Health Optimal Prenatal 

I was using this brand's non-prenatal multi as a prenatal, but they have since come out with this version. It has high-quality types of vitamins, minerals and enzymes. It does have a little bit of spirulina in it, which I'm willing to forgive since everything else is good. (Spirulina is great for typical people because it increases SOD, but not so great for those with DS who often have high SOD. See Increased superoxide dismutase and Down's syndrome for details.) It includes EGCG (green tea extract)-- which is great for our kids, research from Tufts Medical Center shows the benefits to the baby when Moms take EGCG during pregnancy (see below for details). But EGCG can interfere w/folate absorption. To combat this possibility, I take an extra amount of both kinds of good folate (calcium folinate and l-5-methyltetrahydrofolate). Bonus: it has two of the good kinds of B12!

Honest Company's Whole Food Prenatal 

The newest prenatal on this list has naturally occurring folate, both methyltetrahydrofolate and folinic as well as the correct type of B12! (I'd also add in VeganSafe's B12 blend.) It's made without gluten, soy, yeast, wheat, casein, gelatin, sodium, dairy, eggs, shellfish, sweeteners/HFCS, artificial flavors, starch, dyes, or preservatives. Bonus of brain-boosting choline and tummy-saving ginger. It does have raw spinach, spirulina and iron, which may or may not be problematic. (I'd really try to avoid the iron.) I prefer food-based supplements vs. synthetic when possible. If this had been available to me, I would have tried this one.

NuTriVene's Prenatal Formula  

This multivitamin is supposedly specially formulated for us, but it contains folic acid rather than just folinic acid or folate. 45% of the typical population has the MTHFR variation so should not take folic acid and 60% of our population (moms of children with DS) has the MTHFR variation so should not take it. If you are sure that you do not have the MTHFR variation, then it would be a fine product to use. If you don't know whether you have it or not, ask your physician to be tested. For more information on MTHFR and how it relates to having a child with DS, go to the How to Prevent DS in Your Next Child in 60% of Moms post. 

It also has the wrong kind of B12. And a vitamin A that often causes issues in children with DS.

Another issue with NTV is that it has iron; see below for why this may cause a problem.

The only plus I can see is that it has a lot of choline. But all the ingredients are synthetic, another draw back.

Neevo DHA   

You'll need a prescription for this prenatal vitamin that has the correct folate. It's good for those with insurance since it will probably be covered. For more information, check out this article at voices.yahoo.com. However, it does contain synthetic dyes with propylene glycol and soy which are items you might want to avoid. Read the package insert with the ingredient list.

Thorne Research Basic Prenatal 

TR is a trustworthy brand since it does regular batch testing to make sure of low heavy metals and has the correct folate, but it has iron in it, which we don't need since our children are sensitive to metals. Too much iron can cause problems in our children. See Anemia Causes & Cures for an explanation as to why iron is an issue. If low iron is a concern, take a look at the above posts. I was able to get Jett's iron levels up just with taking extra Vitamin C since it helps the body process iron better. (See the Vitamin C Plays Important Role in Brain Function post for details on how this works and what to take.) 

Emerald Labs Prenatal   

ELP has the correct folate, but it has the wrong kind of vitamin C (no big deal) more importantly, it has spirulina in it which is great for the typical population, but our kids need to avoid it because of increased SOD. The amount of spirulina is small so it might not cause a problem. It also has iron... see note above.

The Vitamin Code Raw Prenatal 

This brand has naturally occurring folate, but you would need to supplement with Folapro (l-5-methyltetrahydrofolate). It's gluten free but has raw spinach (in our kids, at least, to be avoided since it's a goitrogen and may interfere with thyroid function. See Raw Spinach and the Thyroid). I did take it for a couple of years while breastfeeding Jett. It also has iron.

MegaFood Baby and Me Whole Food Multivitamin & Mineral

This product has naturally occurring folate, but you would also need to supplement with Folapro (l-5-methyltetrahydrofolate). It's gluten, diary, soy, pesticides herbicides, corn and wheat free. It does have raw spinach (which may or may not be a problem). I have taken it while breastfeeding Jett's baby brother. It also has iron.

Additional Supplementation

In addition to supporting overall health, our treatment goals are to address the problems particular to our situation. 

We need to:

• lower homocysteine and increase methylation (See Maternal homocysteine level and markers used in first-trimester screening for fetal Down syndrome.)
• address the MTHFR variation (see study on MTHFR and Down syndrome pregnancy)
• support brain growth and formation
• reduce oxidative stress (since our kids experience this even in the womb!) See Oxidative stress occurs early in Down syndrome pregnancy: A redox proteomics analysis of amniotic fluid)

Lower homocysteine and increase methylation with:

L-methylfolate 1 mg (check out how much to take and side effects)
Methylcobalamin 2 mg (B12) sublingually or through a shot
Betaine or trimethylglycine (TMG)
Vitamin B6 as P5P
Magnesium
 
The MTHFR Prenatal vitamin protocol

For those of you with the MTHFR variation, you may want to consider this list:
a good prenatal (see options above)
additional 1mg 5-L-MTHF 2x/day (see folate recommendations below)
baby aspirin 1x/day (I didn't do this -- omegas thin blood as well)
omega 3s 2x/day
B12 1x/day
Vitamin D (5-10,000 iu 1x/day) (controversially large dose)
Learn more at mthfr.net and speak with a doctor who understands the variation.

Folate recommendations

In addition to the prenatals above, extra folate is needed. The best type is the active form of folate called L-5-methyltetrahydrofolate as Metafolin. Unlike folic acid, this active form of folate requires no additional metabolic steps for the body to use it, making it a preferred choice for many moms. Folate is an essential nutrient for many body processes, including hormone metabolism, DNA synthesis, homocysteine metabolism, and nervous system function. Folate also effects heart formation in your baby. Be sure to check out these articles on how much to take and side effects.
 
Folate 

Source Naturals MegaFolinic™ -- 800 mcg - 120 Tablets $8.07
and Metagenics FolaPro® -- 60 Tablets $19
other suggestions (or ones that I've bought as well)
Thorne Research 5-Methyl-tetrahydrofolate
Jarrows Methyl Folate
Life Extension Optimized Folate
These are the best over the counter choices, but see if your doctor will prescribe Deplin (l-methylfolate) or Metanx at your next appointment so your insurance can cover it.

VeganSafe B12 (or from amazon)
(See: Why B12 & Folinic Acid for the B12 forms that are acceptable.)

 Jarrow brand TMG

Vitacost brand B6 or P5P

LifeExtension Neur-Mag (magnesium L-threonate)
 
Also look into iodine supplementation to support proper hormone function. It's common for those with a child w/DS to have thyroid issues.

Ubiquinol (Coenzyme Q10)

Support Brain Growth and Formation
Click links to find out more information.


Choline
 
DHA For DHA/EPA/fish oil, etc. I trust green pastures the most. You can look into Prime Force's Omega Rejuvenol as well. Many like Carlsons DHA.

Vitamin C

Tveden-Nyborg P, Vogt L, Schjoldager JG, Jeannet N, Hasselholt S, Paidi MD, Christen S, Lykkesfeldt J.

Maternal Vitamin C Deficiency during Pregnancy Persistently Impairs Hippocampal Neurogenesis in Offspring of Guinea Pigs. PMID: 23119033 

EGCG  

See: 
Green Tea Polyphenols Rescue of Brain Defects Induced by Overexpression of DYRK1A).

And:  Modelling and rescuing neurodevelopmental defect of Down syndrome using induced pluripotent stem cells from monozygotic twins discordant for trisomy 21
But since EGCG can interfere w/folate absorption, take an extra amount of both kinds of good folate (calcium folinate and l-5-methyltetrahydrofolate).

Gotu Kola

This herb is not commonly given in relation to one of our pregnancies--I took it during my pregnancy with Jett to prevent varicose veins and only later found out about the great benefits to the brain. In the first month Jett has been taking it, we saw great results (better mood, increased sociability, increased sentence length) and I have just started taking it during this pregnancy. Jett has continued taking it since 3.5 years old.

Antioxidants

Ginger

It has many therapeutic qualities including antioxidant effects, an ability to inhibit the formation of inflammatory compounds, and direct anti-inflammatory effects.  Added bonus for pregnant moms: Ginger reduces the nausea and vomiting of pregnancy, even the most severe form, hyperemesis gravidum, a condition which usually requires hospitalization. There are many forms you can use. I like Gin-gins. Or there's Ginger Juice that you can add to anything from soups/broth, baked goods to Asia dishes.

Pick your favorite that is okay to take while pregnant. Another great antioxidant is ubiquinol.

For products I use, check out the DS Day to Day Store.

Be sure to get $10 off your first Vitacost vitamin order.
 
If you are a vegetarian…
 
Unfortunately, B12, often found in meat, is a key nutrient that you need a lot of… So, take the most bioavailable forms of B12 supplementation you can find and try to eat foods high in B12. Some safe foods for those during pregnancy would be the smaller fish (less toxins) like herring (312% DV) and sardines (149%). Eggs are a great source, for choline as well. (Barely cooked yolks w/fully cooked whites from organic pasture raised chickens is what we eat.) And cheeses such as Swiss cheese provide 3.34μg (56% DV) per 100g serving, followed by Gjetost (40% DV) -- one of my favorite cheeses!, Mozzarella (39% DV), Parmesan (38% DV) and Tilsit (35% DV). (No, I've never tried Tilsit.)


If you are vegan... 
 
Consider VeganSafe B12 (also from amazon) and folate/folinic acid.
 

Related Posts

Coenzyme Q10
Pregnant and Nursing Moms Need Extra Choline
Achieving Iron Balance with Diet 
Vitamin C Plays Important Role in Brain Function
How to Prevent DS in Your Next Child in 60% of Moms
EGCG Green Tea Extract For Memory