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What Are The Best Iron And Calcium Supplements Taken During Pregnancy?

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Posted on Thu, 23 Jul 2015
Question: hello dr,
im 16 weeks pregnant. i m currently on folvite, and metadoze 500 ipr (3 times daily) and pregavyte prenatal, vominos(twice a day). im not put on iron and calcium yet. please advise which are the best iron and calcium supplements given during pregnancy which cause least nausea or constipation. also i worry about catching gastro.if so can i take vibact-ds daily to help alongwith ors sachets? do i need to take any other anti-diarrhoea tablet? also, i have frequent headaches in evening, and very few times extreme palpitations and uneasiness. is this normal? thanks for attending to my questions.
doctor
Answered by Dr. Nishikant Shrotri (3 hours later)
Brief Answer:
You can now start iron and calcium

Detailed Answer:
Hallow Mrs. XXXXX,

Welcome to HCM. I have gone through your complete question and have understood your concern.

Yes, during pregnancy, iron and calcium - both are very important minerals which do need supplementation through medicines since practically it is not possible to consume the required doses of these salts in required quantity.

Usually, during first three months, the woman suffers from nausea and vomiting of pregnancy; hence we try to avoid prescribing medicines during this phase. Usually all the required medicines are prescribed after 3 months or 12-14 weeks of pregnancy. So by this time you will get the prescriptions of these medicines. Iron available in spansule forms is having minimal side effects since it contains time released iron. You may try this. Also there are many calcium preparations in market and they are very good. You may get prescription for it from your obstetrician.

Folvite and Pregnavit are folic acid and vitamin preparations which are also needed during pregnancy for better development of your baby and also for your own health.

Are you diabetic? Why are you prescribed Metadoze, which is Metformin preparation? Though it has got some other indications, it is commonly used to control diabetes. I would appreciate if you upload your blood, urine and all other reports for my review. Also I would like you to upload your report about haemoglobin levels, urine routine examination in addition to investigations for diabetes.

Why are you so much concerned about diarrhoea? Is this your common problem or you are just worried about it. Diarrhoea without infection can very well be managed by ORS only. However, I would like to know more in details about your concern for diarrhoea.

Coming back to your main query, I feel now it is high time you are put on iron and calcium. You may suggest your obstetrician about it. Meanwhile, please consume as mush of these minerals as possible. You get iron from jaggery, chillies, green leafy vegetables, fresh fruits and calcium from milk and milk products, eggs, fruits (particularly figs). Consume them liberally.

At this juncture, I would like to clarify that on this forum we cannot prescribe any medicines due to the restrictions, rules and regulations of FDA. However, I can always advise you which type of medicines (with their contents) are indicated.

You should not take frequent headaches and palpitations lightly. What is your blood pressure? Do you have any heart problem? Considering that you are on Metformin, having head ache and palpitations, I would indeed be interested in having all the reports in details. Also ask your doctor whether you need to undergo cardiogram.

Mrs.XXXX, currently I have provided you with some of the answers about your queries, particularly your iron and calcium requirement. If you provide me the rest of the information I have asked for, I can give you further more advice.

I am awaiting for your further communication.



Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Nishikant Shrotri (1 hour later)
Hello Dr. Nishikant,
thank You for replying in a very detailed manner. no im not diabetic. my previous doctor who is no more, put me on these since over a year as pcod treatment.he recommended i continue this until 5th month when we can do the blood tests again to see if im prone to gestational diabetes, or he will stop. also, he says there is a good chance of preventing miscarriage through this drug.

my blood reports are all normal, but i will upload them for your perusal. i had a bout of severe gastro in the first month of pregnancy.i didnt take any medications except for vibact-ds only one, ORS as needed and yoghurt as a probiotic nourishment. my queries may sound unusual considering i have a doctor right now, im just rethinking on switching to someone else for the very reason that he dismisses my headaches and palpitation issues. i have been having hypertension for the past 3 years for which i was under amplodipine first then put on clinidipine. since i conceived i stopped and sometime i feel like my bp does rise although i havent checked at home. i had it checked at the clinic under insistence when it was found 155/98. he dismissed it saying it happens to most women.this is my first pregnancy, but when i have those attacks i break in a sweat and cannot focus or stay awake for long. im not aware of this being normal in pregnancy but feel awkward now to mention about any discomfort that im feeling, which isnt right in a patient-doctor relationship. hence i was just looking for facts before i can make an informed decision before switching.i do not have any other health problems other than essential hypertension.no history of diabetes, or anything else in either side of my family.
doctor
Answered by Dr. Nishikant Shrotri (1 hour later)
Brief Answer:
Please do not neglect your BP and urinary infection

Detailed Answer:
Hallow Mrs. XXXXX,

Thank you for uploading your reports.

Your haemogramme is almost normal, except your haemoglobin is slightly on a lower side. I would appreciate if you can maintain it above 12.5 gms%. For this only iron will not suffice. Haemoglobin is made of two components - Haem and Globin. Haem is formed from iron while Globin from protein. Hence, along with iron, you should take proteins. Eggs, legumes, pulses, nuts, meat are all good sources of proteins. If you are from XXXXXXX XXXX will give you good amount of quality proteins. Also if you can, take XXXXX XXXX which will give you good proteins as well as iron. Along with, please start medicinal iron. 200 mg tablets daily should be ok for you. Iron if taken on full stomach does not get absorbed due to loss of acidic medium. Hence you will have to take iron tablets on empty stomach and half an hour after that have your food. This gives a lot of gastric discomfort due to acidity. Hence, take time released iron spansules (they look like multi coloured granules in a capsule) which do not causes gastric problems and have very good results..

Your reports show that you do not have diabetes. Good.

Your stools report does not show any major abnormality; however, minor indigestion is evident. You may take enzyme preparations for few days and it will be fine.

Your urine report is borderline showing some elements of minor infections. The pus cells are in higher range of normal. However, the epithelial cells are high suggesting some infection in the kidney. To support this, bacteria are also present 1+. You may get your urine examined for culture and sensitivity which will throw light on the presence or absence of infection. Also then your doctor can choose which antibiotics to be given.

And now I have to come to your blood pressure problem. Please do not ignore it neither take it lightly. During normal pregnancy, blood pressure never rises. There is a condition called as Pregnancy Induced Hypertension in which the blood pressure rises after 20 weeks of pregnancy. You are just 16 weeks, however you have a history of high blood pressure for last three years. Now blood pressure to the range of 155/98 mm of Hg during pregnancy is definitely alarmingly raised blood pressure. Urinary infection may make it still worse. Moreover, you are having palpitations, perspiration and so on. How can you take your blood pressure so lightly. Due to high blood pressure, apart from the risk to your own health, there is a risk to the growth of the baby also. Please report to your Obstetrician and start a due treatment if needed. These risks do increase at your age of 35 years.

After few weeks, you will start feeling the movements of the baby. To monitor the safety of the baby, I would advice you to keep a record of your baby's movements. But there is time for that. Probably later in your pregnancy if you contact me and/or ask me a direct question or see me, I can advice you more in details about monitoring your baby's health. Also keep a watch on the swelling on your feet. Press at the ankle with your thumb for half a minute. After releasing if there is a dimple, it is swelling. You will have to report this also to your doctor.

Are you undergoing routine ultrasonography? It is required for your baby's development and health.

Metformin was started for the treatment of your PCOS. It seems it is successful and so you are pregnant now. You may discontinue this medicine with the advice of your Gynaecologist.


Now let us talk about your doctor. I am indeed sorry to learn that your previous doctor is no more now. For managing your pregnancy please choose an Obstetrician only who is M.D., M.S. or such equivalent or higher qualifications. Explain him/her your complete case, you may show my advice to him/her and get the required treatment.


I feel in this setting, this much advice would be too much for you. Please try to digest this all. Then if you have got any further queries (which I am sure you are going to have) please ask me or see me. I am there to guide you - always.




Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Nishikant Shrotri (15 hours later)
hello Dr.Nishikant,
thank you, You're right, i should not neglect the issues. that is very much the reason for my concern over my present OB/GYN. i needed to ask, if fefol-z spansule good during pregnancy? please advise. and regarding fruit enzymes, can i take citro-soda sachets?
doctor
Answered by Dr. Nishikant Shrotri (1 hour later)
Brief Answer:
Take care of BP and Urine issues.

Detailed Answer:
Dear XXXXX,

Yes, Fefol-Z spansule is very good preparation; in fact it is a spansule type of a preparation and will not cause gastric problems. Please consume it on empty stomach. Have no antacids which hamper the absorption of the iron. Along with have good quality and amount of proteins.

Please consume fresh fruits and not the canned fruits or sachets.

As far as enzymes are concerned get some enzyme tablets or syrups available with the chemists. Citro-soda is I believe just a carminative preparation. You should not require enzyme preparations for more than a week or so.

And please do take good care of your hypertension. I am more worried about it. The other problems are trivial comparatively.

Also have your urine issue sorted out thoroughly lest the serious complications.

If you need any further advice or information, I am there for you XXXXX!
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Nishikant Shrotri (5 hours later)
thank you dr. Nishikant. you've been very helpful. i would like to ask which of the following calcium brnad sare good. calcimax forte or shelcal. also do i need to take any DHA? do i need to take calcium and fefol-z separately to aid in proper absorption of iron? should i stop with the pregavyte prenatal with onset of iron and calcium?
doctor
Answered by Dr. Nishikant Shrotri (43 minutes later)
Brief Answer:
You have very good concepts of Medicine

Detailed Answer:
Dear XXXXX,

I must appreciate your good concepts of medicines.

Both the brands of Calcium are good. I usually prescribe Shelcal to many of my patients.

Please do not take iron and Calcium tablets at the same time. As you have very rightly mentioned, calcium comes in the way of iron absorption. In fact Calcium tablets are to be taken on empty stomach in the morning and after that for one hour you have to remain nil by mouth. So best way is to take Calcium tablet when you have to get up early in the morning for some natural calls and then sleep again.

Iron should ideally be taken half to one hour before dinner so that if at all any gastric discomfort, you do not feel in sleep.

Taking DHA is your option. It can have side effects.

You have to take some multivitamin preparation; you may opt for Pregnavite or Becozinc or any other standard preparation as prescribed by your Obstetrician.

And dear XXXXXX, please tell me about the current reading of your blood pressure and what are you taking to control it?

I hope I have guided you properly and you are happy about my advices. If so, I would appreciate your good review and five starts rating from you.

Please keep in touch and give me the update of your health. Also tell me when your metformin is discontinued.

If you want any further information, I am always available for you.

Wish you safe pregnancy and happy motherhood!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Nishikant Shrotri (26 minutes later)
Dear Dr. Nishikanth,
im very humbly flattered by your appreciation. i do try to keep myself informed thanks to the vast web of internet knowledge. thank you for your insights, they are so assuring at a time like this. i do appreciate it.my bp readings as of today were 142 / 81 pulse 80. im currently not taking anything for my bp.but im going to visit my family cardiologist/physician about the same. about the enzyme tablts.. can i take unienzyme? i read it contains papain..isnt that the papaya enzyme? will it be safe during pregnancy? your diagnosis about my indigested food in stool is so right, as since pregnancy im having floating stools or tablets and food going in full form. i mentioned this to my current OBGYN. how often should i take the tablets? with food or before or after? and you say a week will suffice? i will most definitely be consulting you directly during my entire pregnancy for sure. this is just what i needed, a thorough and definitive diagnosis and one to one interest in patient health. thank you.
doctor
Answered by Dr. Nishikant Shrotri (15 minutes later)
Brief Answer:
Bring your Systolic blood pressure upto 120 mm of Hg

Detailed Answer:
Dear XXXXX,

I assure you that I shall always be available for you for the medical advice throughout and even after your pregnancy.

Unienzyme is a very good preparation. You can take one tablet each after lunch and dinner. I feel a week's course should suffice in your case. However, if needed you may continue for few more days. Please remove the misconception from your mind that papaya is contraindicated during pregnancy. In fact it is very good digestive fruit. If you eat unripe papaya then it is difficult to digest and may cause some gastric pain however, no harm to the pregnancy. :)

I am somewhat happy to note that your diastolic (lower) blood pressure is 81 (previously it was almost touching 100), however, I am not happy about the systolic (higher) blood pressure. Your Obstetrician will prescribe you medicine for it, cardiologist may not be necessary. Try to bring and settle it below 130 (preferably 120) mm of Hg.

If you are happy about my advices, I would appreciate your good review and five starts rating from you on this Health Care Magic forum.

Keep me informed.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Nishikant Shrotri (21 hours later)
thanks You for your reply and compassionate approach. i will do the needful to lower my bp and get it within normal range. my current height and weight are 5.6 feet and weighing 78 kgs currently. i am maintaining a healthy diet since past 1 year. i hardly eat fried foods, or fast foods, sweets or unnecessary snackings in between. my weight spiked within 2 years of marriage and has been at that since. earlier it was always at 68kgs. im still trying to get it to that. but now being pregnant im aware that wouldnt be advisable. right now im beginning to crave for sweet things, but i reach for a fruit or some dates or some dried fruits instead. i dont have tea and stopped completely comfee. very rarely do i eat dark chocolate especially during my menses. i wnated to ask you if having sucralose or stevia would be advisable. i;ve read its approved by fda for pregnant women, but im not sure if the benefits outweigh any cons. please do advise. i need to at least maintain my weight healthily, if any such options in natural sweeteners help and are healthy and safe i would consider it.. do advise. thank you again
doctor
Answered by Dr. Nishikant Shrotri (1 hour later)
Brief Answer:
Weight reduction later, not now!

Detailed Answer:
Hi XXXXX,

It was nice to get message from you again. I am happy to understand that you are seriously working on getting your blood pressure within normal range.

Your concern about your weight is absolutely valid. You had PCOS. This condition is related to overweight problem. Now that you have conceived, you should not attempt to reduce the weight during the pregnancy lest the risk of baby getting starved. However, take care not to put on lot of weight. Average rise in weight should be about 1 kg per month of pregnancy and total weight gain during pregnancy is 11 kg. Please do not cross this limit. Once you wean your child from the breast, then you start actively working on the weight reduction. Your BMI is too high. If you do not bring it within normal range, there is a risk of PCOS, high blood pressure and cardiac risk again. We will discuss about your weight reduction strategies after you stop breast feeding your child.

Sweeteners like sucralose can be taken during pregnancy. However, get a tip from my own experience. I take tea without sugar and even without sweetener. It tastes far better than with sugar.:) Try it that way. Avoiding sugar definitely helps controlling weight. However, your baby needs sugar from you.

I would like to warn you XXXXX about sugar free preparations available in the market; e.g. Ice creams, chocolates, sweets, etc. They do not contain sugar, however what about the fats! They are the same. So they do put on weight. Please keep this in mind. Avoiding fast foods is a very good habit. Keep it up.

And before I close this message, let me thank you for such a nice encouraging review you have posted to Health Care Magic forum. I would have appreciated 5 star rating also from you. I believe I deserve that from you.

Take care XXXXX and keep me informed about your pregnancy progress, delivery outcome and blood pressure. For any more information, I am always available for you XXXXX.

Happy Motherhood to you!


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. Nishikant Shrotri

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What Are The Best Iron And Calcium Supplements Taken During Pregnancy?

Brief Answer: You can now start iron and calcium Detailed Answer: Hallow Mrs. XXXXX, Welcome to HCM. I have gone through your complete question and have understood your concern. Yes, during pregnancy, iron and calcium - both are very important minerals which do need supplementation through medicines since practically it is not possible to consume the required doses of these salts in required quantity. Usually, during first three months, the woman suffers from nausea and vomiting of pregnancy; hence we try to avoid prescribing medicines during this phase. Usually all the required medicines are prescribed after 3 months or 12-14 weeks of pregnancy. So by this time you will get the prescriptions of these medicines. Iron available in spansule forms is having minimal side effects since it contains time released iron. You may try this. Also there are many calcium preparations in market and they are very good. You may get prescription for it from your obstetrician. Folvite and Pregnavit are folic acid and vitamin preparations which are also needed during pregnancy for better development of your baby and also for your own health. Are you diabetic? Why are you prescribed Metadoze, which is Metformin preparation? Though it has got some other indications, it is commonly used to control diabetes. I would appreciate if you upload your blood, urine and all other reports for my review. Also I would like you to upload your report about haemoglobin levels, urine routine examination in addition to investigations for diabetes. Why are you so much concerned about diarrhoea? Is this your common problem or you are just worried about it. Diarrhoea without infection can very well be managed by ORS only. However, I would like to know more in details about your concern for diarrhoea. Coming back to your main query, I feel now it is high time you are put on iron and calcium. You may suggest your obstetrician about it. Meanwhile, please consume as mush of these minerals as possible. You get iron from jaggery, chillies, green leafy vegetables, fresh fruits and calcium from milk and milk products, eggs, fruits (particularly figs). Consume them liberally. At this juncture, I would like to clarify that on this forum we cannot prescribe any medicines due to the restrictions, rules and regulations of FDA. However, I can always advise you which type of medicines (with their contents) are indicated. You should not take frequent headaches and palpitations lightly. What is your blood pressure? Do you have any heart problem? Considering that you are on Metformin, having head ache and palpitations, I would indeed be interested in having all the reports in details. Also ask your doctor whether you need to undergo cardiogram. Mrs.XXXX, currently I have provided you with some of the answers about your queries, particularly your iron and calcium requirement. If you provide me the rest of the information I have asked for, I can give you further more advice. I am awaiting for your further communication.