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The question

I'm a healthy woman in my mid thirties, hoping to have kids in the next couple of years. What vitamins and supplements should I be taking - if any?

The answer

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Congratulations on planning ahead for a healthy pregnancy. While vitamins and minerals should ideally come from a balanced and healthy diet, there are four key nutrient supplements that you may want to consider:

Folic acid: Women who increase their intake of folic acid can reduce the rate of neural tube defects (NTDs) in their children by more than 50 per cent. NTDs are birth defects that can lead to abnormalities of the skull, brain, and spinal cord and facial deformities such as cleft lip and palate. Certain foods are rich in folic acid including fortified grains, spinach, lentils, and chickpeas. That said, diet alone is unlikely to provide sufficient amounts of folic acid so supplementation is recommended.

For those wiith no personal health risks, the recommended dose of folic acid is 0.4-1.0mg daily starting 3 months prior to conception. If you have a personal history of conditions such as epilepsy, diabetes, have a family history of NTD, or are from a high risk ethnic group for NTD (i.e. Sikh, Celtic) - a higher dose of folic acid is recommended, so discuss this with your doctor.

Calcium and vitamin D: I recommend both of these supplements for everyone, regardless of whether you are planning for pregnancy or not. Calcium and vitamin D are important for maintaining bone density which starts to decrease in our late teens to early twenties. This is especially important for women considering pregnancy because of an increased risk of bone density probelms during pregnancy and breastfeeding (her calcium supply goes towards helping the growing fetus's bone growth.)

Optimize your bone density prior to pregnancy by taking the recommended calcium and vitamin D intake for women of childbearing age with 1,000 mg/day and 400-1000IU/day respectively.

Iron: A vital element that helps maintain blood stores and is involved in carrying oxygen to muscles and organs. Many women of childbearing age are iron deficient, so checking this prior to pregnancy may be helpful to know if you need to supplement prior to and during pregnancy.

I recommend checking in with your family doctor to review your medical history as there may be additional suggestions to prepare for a healthy pregnancy. Remember: in addition to supplements and vitamins, optimize your pre-pregnancy self by maintaining a healthy body weight with good diet and exercise choices, limiting alcohol use, and quitting smoking and drug use.

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Send family doctor Sheila Wijayasinghe your questions at doctor@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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