I am frequently asked, "When should a child start receiving nutritional supplements?” At first I would reply, "In the womb,” but I now say, "Before the mother becomes pregnant.”

A developing child in the womb is totally dependent upon his or her mother for all sustenance. Therefore, if the expectant mother is deficient in essential nutrients the infant cannot possibly obtain them. The most dramatic developmental steps occur during the first 6 to 8 weeks of life, immediately following conception. If a woman waits until she knows that she is pregnant to begin supplementation it is too late to provide the baby with optimum nutrients during this critical time.

Neural tube defects are a prime example of this principle. If adequate levels of folic acid, a B vitamin, are not present during the first 3 to 4 weeks of pregnancy when the spinal cord is being formed severely disabling birth defects such as spina bifida can occur. Prenatal vitamins contain 1 mg. of folic acid, but since they are typically prescribed after a pregnancy has been confirmed they are rarely started early enough to prevent defects from occurring.

Campaigns encouraging women of childbearing age to take folic acid supplements were attempted, but were largely unsuccessful. Three years ago the US Food and Drug Administration mandated that grain foods — cereals, breads, pasta, flour — be fortified with folic acid. The result has been a dramatic decrease in the incidence of birth defects.

Folic acid, however, is only one of nearly one hundred vitamins and minerals required by the body to produce optimum health. It is only because the effects of folate deficiency are so obvious and so devastating that the problem has been addressed. Unfortunately, the consequences of other nutritional deficiencies continue to plague mothers, infants and children.

From a nutritional standpoint prenatal vitamins are pathetically inadequate. That they are promoted to women as the ultimate supplement for pregnancy is inexcusable. Were it not for the tragic consequences attached to this myth it would be laughable.

Prenatal vitamins typically contain between 12 and 20 nutrients including vitamin A, vitamin D, folic acid and several other B vitamins, iron, and calcium. Other vitamins and minerals may be present, but these vary from formulation to formulation. Of these nutrients only vitamin D and folic acid are typically present at optimum levels.

I recommend that expectant mothers continue the same broad based supplementation that all adults should be taking. These include vitamins A, B, C, D, & E, along with all 72 major and trace minerals. These should be taken in optimum amounts, as I discussed in the May, 2000 issue.

B vitamins should be taken in greater amounts during pregnancy. I recommend that a B-complex supplement be taken twice daily. If morning sickness or persistent nausea is present additional B-6 should be taken, beginning with 100 mg. two or three times daily.

I cannot explain exactly how each of the vitamins and minerals contributes to a healthy pregnancy and a robust newborn ready to take on the world, but studies do support my contention that broad-based supplementation is of value. The incidence of a wide range of birth defects is much lower in women taking multivitamin/mineral supplements. Heart defects, kidney and other urinary tract defects, nervous system defects and cleft lip and palate occur at a significantly lower incidence when broad supplements are taken.

Some specific benefits are known, however. Toxemia is one of the most serious complications of pregnancy. It is a condition characterized initially by significant increases in blood pressure, edema, and loss of protein. Seizures and death can potentially occur. The incidence of toxemia is dramatically reduced when optimum nutrient levels are present.

Women with riboflavin deficiencies are nearly five times more likely to develop toxemia than those with normal riboflavin levels. Riboflavin is vitamin B-2. While the optimum amount of supplemental riboflavin is in the range of 50 to 60 milligrams daily, the typical prenatal vitamin provides less than 2 mg. That this is inadequate is demonstrated by the fact that one study found that while 27 % of women were deficient at their first prenatal visit, 53 % were deficient in the last weeks of pregnancy when toxemia presents.

Homocysteine is a substance that increases when adequate levels of B-6, B-12, and folic acid are low. Elevated homocysteine levels are associated with an increased risk of preeclampsia, the first stage of toxemia. They are also associated with prematurity, low birth weight, neural tube defects, and clubfoot deformities.

Toxemia is believed to result, at least in part, from irregularities in placental attachment and function. Damaging particles called free radicals interfere with placental function at the cellular level. One of the most harmful is the lipid peroxyl radical. Lipid peroxide levels are increased in toxemia, while levels of vitamin C, vitamin E, and vitamin A tend to be significantly diminished. Since the antioxidant vitamins work as a team supplementing only one will not achieve the same results as supplementing all three.

Calcium supplementation at the level of 1500 mg. daily has been shown to decrease the risk of preeclampsia by a third. The typical prenatal vitamin, however, contains only 250 mg. Magnesium, given at optimum levels has lowered the incidence of toxemia by 75 % and selenium supplementation has likewise been shown to prevent preeclampsia.

One of the leading causes of premature delivery is rupture of the membranes or "bag of water.” Mineral deficiencies, particularly copper, are associated with this complication of pregnancy. Fortunately a number of prenatal vitamins now include copper.

Essential fatty acids should also be supplemented. These are predominantly the omega-3 oils found in fish and certain vegetable oils such as flax, evening primrose, and borage. Fish oil supplementation was shown to lower the risk of preeclampsia fifty years ago, but to my knowledge this finding has never been followed up. More importantly, essential fatty acids are critical to development of the brain and nervous system.

Once a healthy baby has been born supplementation should continue via breast milk. This means that breast-feeding mothers should continue to take supplements to be able to pass on optimum levels of vitamins and minerals to their infants. An example of the importance of continual supplementation before, during and after pregnancy is the current rise of rickets in United States children. Rickets arises from vitamin D deficiency. We know most adults are chronically deficient in vitamin D. If a mother is deficient she cannot provide it to her child either during pregnancy or while breast-feeding.

As mentioned previously, essential fatty acids are required for optimum development of the brain and nervous system. Infant formulas do not contain the levels of fatty acids found in breast milk. Studies have shown that, as a group, breast fed infants score higher than formula fed infants on IQ testing all the way into their teens. The quality of fats in breast milk reflects to a great degree the quality of circulating fats in the mother’s system. Therefore supplementation of quality oils should continue during breast-feeding.

The benefits of breast-feeding seem endless. Breast-fed infants have a much lower incidence of colds, ear infections, diarrhea, and rashes. Developmental milestones such as grasping objects, crawling, walking, and talking are reached more quickly and consistently. Blood pressure is lower in later life suggesting that there is a lower risk of high blood pressure and other vascular disease in individuals who are breast-fed.

Breast-feeding should be continue for a minimum of six months whenever possible; the duration beyond that point is an individual matter. Once the infant has been weaned supplementation with a quality children’s vitamin should be initiated. As a general guide I recommend one tablet per year of age, but this will vary somewhat depending upon the formulation of the manufacturer. Since toddlers can be picky eaters I suggest giving a phytochemical (vegetable) supplement as well. Flaxseed oil, 1 teaspoon per 30 pounds of body weight daily will continue to provide the good fats necessary for ongoing maturation and development.

The most important supplement of all, however, is the same in children as in adults – pure water. Other beverages have become so engrained in our society that many people are astounded when I suggest that the primary beverage for infants and children should be water. "No milk? How about juice? What can I use to flavor the water?” are common responses.

Children take naturally to water that has been purified using a system such as reverse osmosis. While adults should strive to drink half their body weight in ounces of water daily (a 150 pound person would drink 75 ounces daily), children require relatively more water for their size. One to 1 ½ times their body weight in ounces of water daily is not unreasonable.

Before I began studying nutrition I advised new parents, "Childhood is a time of sickness as much as a time of wellness.” I expected to see a never-ending series of colds, ear infections, diarrhea episodes and other maladies. I no longer believe that this is the norm. Given a good start children can excel and achieve more that we can imagine.

My daughter had been on a quality supplement regimen and had good dietary and activity habits before she became pregnant. She continued her regimen during pregnancy and while breast-feeding. My granddaughter, who is now 26 months old, has been sick only 3 times. Her first cold lasted 24 hours, diarrhea obtained by sucking on some rocks at Lake Havasu 48 hours, and her second cold about a day and a half. She walked at 9 months and is well on her way to becoming a conversationalist like her mother and grandmother.

I write this not simply as a proud grandfather, although I must confess I fit the role very well, but as an example of what should be the norm for children in the 21^st century. We know how to maximize maternal and child health, we simply need to put the principles into practice.

Addendum 2014:  I now have 5 granddaughters aged 4 - 15.  Both of my daughters experienced uncomplicated pregnancies.  Four out of five were delivered at home.  All of the children have remained healthy throughout their lives and the rare cold continues to be gone within 36 - 48 hours.  For examples of comprehensive nutritional regimens in pregnancy see Prenatal Supplementation