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Prenatal Vitamins


ktgrok
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So, DH has moved from "no way, no more kids" to "well, I'm not opposed to the idea.....if some things work out financially." So I'm researching prenatal vitamins in case this really does happen. In the past I've had Rainbow Light, which I always end up finding disgusting (smell mostly) and find too big to swallow, so I don't take them, Then I end up anemic. Then I take iron, hemagenics worked well. But I still don't take the prenatal vitamins like I should. I want to avoid that cycle next time!

 

Since having weight loss surgery I've become very sensitive to various vitamins. Before surgery I could take any brand, but afterwards they made me want to puke. I currently take https://www1.bariatricadvantage.com/catalog/group/110373/Advanced_Multi_EA which I enjoy the taste of and have zero nausea from. They also really do make me have more energy...I'm betting the iron and b vitamins? The high thiamine is supposed to really help with nausea (according to my nutritionist.) I'd love to stay on them while pregnant but can't, because the vitamin E level is so high, and also the vitamin A. Vitamin E that high has been linked to low birth weight (although after having a 10 lb baby that doesn't sound so bad, lol) and heart defects, and I would worry about bleeding/clotting at that high. When I contacted the company that makes them they advised switching to their regular multivitamin, not the EA, and adding in their chewable 30mg iron. I got some samples, and although I stomach the iron just fine, the vitamin makes me nauseas as soon as I start chewing it. Which makes no sense to me, but it is what it is.

 

So my nutritionist says to just pick a prenatal, and add the extra iron. Iron is an issue after bariatric surgery, and I've gotten really anemic in all my pregnancies...each worst than the last. My 3rd I was borderline blood transfusion level. It took a double dose of hemagenics to get it up. I found that the company that makes both my bariatric vitamin and hemagenics has a prenatal vitamin package, but it's super expensive (60 bucks a month) and it is 7 pills a day. So um, yeah, I'm looking for something else. I'll use their brand of chewable iron, because I know I tolerate it well and respond well to it, and will just pick a more inexpensive prenatal. Hopefully one that is either chewable or doesn't smell weird and isn't huge. 

 

Edited to Add that high vitamin E is linked to heart defects. 

Edited by ktgrok
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I would just keep taking the one you like, it looks pretty decent nutrient-wise. Maybe add more folic acid if the levels are not as high as in prenatal vitamins?

 

The one I like has too much vitamin E to keep taking. Possibly too much vitamin A, although most of it is the safe beta carotene form, so that is probably fine. But the vitamin E is 500% RDA. This article talks about how high vitamin E, even at 100% RDA, is linked to heart defects. http://www.dailymail.co.uk/health/article-1167885/Could-taking-Vitamin-E-harm-babys-heart.html

Edited by ktgrok
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That's what I do. I keep taking my mineral supplement (magnesium, potassium, calcium, and dry D), my b complex, my extra folic acid, my chromium and acetyl carnitine, and eating my diet of oily fish and green leafies. My outcomes have been great. I usually have to supplement iron because I am very anemic but I don't recommend starting that without a serum draw to confirm, even if it is a common problem post surgery. Unless you know you're deficient, too much iron can cause issues - but it's a cheap draw to check :)

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This won't help you since they don't taste any better but if the size was the only concern Rainbow light does make a "petite" version that is a smaller tablet, three a day.

 

If I think of the name of another one that I heard that was smaller I will post it. Good luck with everything!

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That's what I do. I keep taking my mineral supplement (magnesium, potassium, calcium, and dry D), my b complex, my extra folic acid, my chromium and acetyl carnitine, and eating my diet of oily fish and green leafies. My outcomes have been great. I usually have to supplement iron because I am very anemic but I don't recommend starting that without a serum draw to confirm, even if it is a common problem post surgery. Unless you know you're deficient, too much iron can cause issues - but it's a cheap draw to check :)

 

Do you mind sharing how much folic acid you take? And which B complex?

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This won't help you since they don't taste any better but if the size was the only concern Rainbow light does make a "petite" version that is a smaller tablet, three a day.

 

If I think of the name of another one that I heard that was smaller I will post it. Good luck with everything!

 

Yes, I saw those, but the smell alone was enough to make me gag. I can actually taste them right now, just thinking about them. 

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I don't know how much weight to give this, but there are lots of articles on the importance of folate as opposed to folic acid in vitamins. So if I were to start taking prenatals I would look for folate. Dd had tongue and lip tie and it is supposedly linked to lack of folate /shrug. I don't know if I could have prevented it with a different set of prenatals. It's also genetic. Just tossing this out there as something to think about.

 

ETA: that is just one example of folate vs. folic acid reasoning. There are others. I was quite disappointed to realize my "organic" prenatals used a synthetic ingredient. Folic acid is synthetic.

Edited by heartlikealion
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Do you mind sharing how much folic acid you take? And which B complex?

Two folates, these are my faves:

http://m.vitacost.com/products/doctors-best-fully-active-folate-featuring-quatrefolic-400-mcg-90-vegetarian-capsules-1

 

B complex:

http://m.vitacost.com/products/thorne-research-methylguard-plus-90-vegetarian-capsules-1

 

ETA - I'm rereading the ingredients on my methylguard, which I took after my last pregnancy. It has enough folate you could comfortably drop the extra folate tabs. Last pregnancy I took a different b complex (Twin Labs) which had much less folic acid. It worked but I favor this new one.

Edited by Arctic Mama
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Truthfully my melaleuca supplements worked much better but my MTHFR issues stopped me from taking them longer, and I'm allergic to one of the ingredients in the peak performance pack I used to love. Stupid adult onset allergies :(

 

These two brands are the next best thing. I've tried other pricy ones like metagenics but haven't felt results as noticeably and they nauseated me horribly in the first trimester. Neither Thorne nor Dr's Best have done that, I can take them on an empty stomach with no problems (though with food is better).

Edited by Arctic Mama
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Two folates, these are my faves:

http://m.vitacost.com/products/doctors-best-fully-active-folate-featuring-quatrefolic-400-mcg-90-vegetarian-capsules-1

 

B complex:

http://m.vitacost.com/products/thorne-research-methylguard-plus-90-vegetarian-capsules-1

 

ETA - I'm rereading the ingredients on my methylguard, which I took after my last pregnancy. It has enough folate you could comfortably drop the extra folate tabs. Last pregnancy I took a different b complex (Twin Labs) which had much less folic acid. It worked but I favor this new one.

 

Hmm, they have a prenatal that looks good...might kill a few birds with one stone. I don't want to go without iron after the severe anemia I've had, so this would add that too. https://www.thorne.com/products/endocrine-support/dp/basic-prenatal

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I found that the cheapest prenatal vitamins left me very tired--I assume that my iron absorbsion wasn't good enough from, for instance, the Kaiser ones.  The ones that made a noticeable different in how I felt were Stuart's Prenatal Vitamins, and I took them throughout BFing and then through perimenopause (heavy heavy Aunt Flo issues.)  If I ran out, I could tell within a week or less that I needed to go grab another bottle.  Now that I'm through menopause I don't need them, so I switched to a regular multivitamin that doesn't have iron.

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If iron can make you nauseous or constipated I've had good luck with ferrous gluconate being more gentle. I tend to take irk anyway because I haven't not been anemic yet, but it's a standard disclaimer for safety :lol:

 

If you take the Thorne and like them let us know :). I got the recommendation from Gardenmom and have really thought they were good. Not the best I've taken but for us MTHFR peeps they work great.

Edited by Arctic Mama
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So, reading reviews it seems the Thorne ones make a LOT of people nauseaus. Even the good reviews say that it upset their stomach. I did request a sample, so we will see if they will send one. This brand was recommended by a midwife friend, she's trying to conceive herself and has been very happy with them. And almost all the reviews say that they don't upset your stomach and that they really feel better on them. Anyone try these? http://www.amazon.com/MegaFood-Supports-Strength-Balance-Pregnancy/dp/B002N0H2HY/ref=cm_cr_pr_product_top?ie=UTF8

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I highly recommend XFactor.  It isn't specifically a pre-natal, but it is a great multi-vitamin. It contains New Zealand Black Currant, a very powerful antioxidant, which also has iron in it.  (I know it's helped some people with anemia.) Plus, The aloe in XFactor helps your body absorb more nutrients from the foods you eat. They have a 60 day money-back guarantee, so if you can't tolerate it, for one reason or another, you can get your money back. 

 

I hope you can find something that works for you.  I always have the hardest time taking a multi-vitamin the first three months of pregnancy. :( And that's when it's so important, but I think I could handle this one.

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One thing to keep in mind is just because the pill contains a high amount of a vitamin doesn't mean that your body is absorbing that high amount and if your body isn't absorbing it, then there is absolutely no way for it to be toxic to baby.  I take 40,000 IU of Vitamin A a day and I'm just in the low range on my blood tests.  I usually have to increase my A when pregnant.because I get too low otherwise.  My doctors understand that when you are dealing with malabsorbtion than you can't simply look at the RDA numbers and assume they apply because that's for a person with normal absorbtion rates

 

Have you had your blood level tested on those two areas that you are concerned about?  If your levels are not high on the vitamin now,then baby isn't going to get an overdose because your body isn't absorbing enough to do that.

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One thing to keep in mind is just because the pill contains a high amount of a vitamin doesn't mean that your body is absorbing that high amount and if your body isn't absorbing it, then there is absolutely no way for it to be toxic to baby.  I take 40,000 IU of Vitamin A a day and I'm just in the low range on my blood tests.  I usually have to increase my A when pregnant.because I get too low otherwise.  My doctors understand that when you are dealing with malabsorbtion than you can't simply look at the RDA numbers and assume they apply because that's for a person with normal absorbtion rates

 

Have you had your blood level tested on those two areas that you are concerned about?  If your levels are not high on the vitamin now,then baby isn't going to get an overdose because your body isn't absorbing enough to do that.

 

My blood work a few months ago was perfect, all vitamin levels normal, but I'm going to test again before we start trying. All the articles say to check early in pregnancy but that seems silly to me. Makes more sense to check before trying to conceive, so I can address any issues. Because I had the sleeve gastrectomy and not a malabsorptive procedure I should be okay, but better to check. 

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My blood work a few months ago was perfect, all vitamin levels normal, but I'm going to test again before we start trying. All the articles say to check early in pregnancy but that seems silly to me. Makes more sense to check before trying to conceive, so I can address any issues. Because I had the sleeve gastrectomy and not a malabsorptive procedure I should be okay, but better to check. 

 

Sorry for some reason I was thinking you had the Roux En Y which I knew had some malabsorption.  Actually I think testing at both point is important.  Important to go into healthy and important to check early on since vitamins are such an important part of growing a healthy baby.  I think they tested most of my vitamins every 2-3 months during pregnancy with the exception of iron after 20 weeks were checked every month.

 

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Sorry for some reason I was thinking you had the Roux En Y which I knew had some malabsorption.  Actually I think testing at both point is important.  Important to go into healthy and important to check early on since vitamins are such an important part of growing a healthy baby.  I think they tested most of my vitamins every 2-3 months during pregnancy with the exception of iron after 20 weeks were checked every month.

 

 

OH, I do think they will want to check during pregnancy as well, I think it's every trimester? But I don't want to wait until then. I've actually already got the script for the lab work, but I need to call and have them add one for folate, as they didn't put that one on there. 

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The one I like has too much vitamin E to keep taking. Possibly too much vitamin A, although most of it is the safe beta carotene form, so that is probably fine. But the vitamin E is 500% RDA. This article talks about how high vitamin E, even at 100% RDA, is linked to heart defects. http://www.dailymail.co.uk/health/article-1167885/Could-taking-Vitamin-E-harm-babys-heart.html

 

I never heard of vitamin E being linked to heart defects, but my last pregnancy my midwife told me not to take extra because it has been linked to retained placenta, which I had two times before.  I know I took a lot of E with my earlier pregnancies because I had heard it was good for stretch marks.  I'm not sure if there was a connection with that and the retained placenta, but I sure would not risk it again. It was not fun.

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I never heard of vitamin E being linked to heart defects, but my last pregnancy my midwife told me not to take extra because it has been linked to retained placenta, which I had two times before.  I know I took a lot of E with my earlier pregnancies because I had heard it was good for stretch marks.  I'm not sure if there was a connection with that and the retained placenta, but I sure would not risk it again. It was not fun.

 

Yikes, I bet not. One more reason to be careful with over supplementation. And some of the prenatal I see have a lot of vitamin E! 

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I had the same problem with the huge nasty prenatals.  I also had 22-hour morning sickness, so keeping the pill down was important.  I took a chewable prenatal and added in where I needed extra or the prenatal didn't have.  The one I picked didn't have much Folic Acid or DHA.  The folic acid pill was really tiny and therefore easy to take during my one meal a day.  I got the DHA which vaguely like Nutella in ketchup-type packets.  For my RLS, I need extra potassium and magnesium, so I took that as needed.  Also, Iron when I was feeling... well, I've had anemia so I know the low-iron feeling.  

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I think I will end up taking a few different things. Which is fine, I'm used to that. I have an iron i like and can take, I have calcium/magnesium/D that I like and take. Will probably end up taking a sublingual B12 or B complex and then whatever prenatal doesn't make me puke!

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  • 1 month later...

Truthfully my melaleuca supplements worked much better but my MTHFR issues stopped me from taking them longer, and I'm allergic to one of the ingredients in the peak performance pack I used to love. Stupid adult onset allergies :(

 

These two brands are the next best thing. I've tried other pricy ones like metagenics but haven't felt results as noticeably and they nauseated me horribly in the first trimester. Neither Thorne nor Dr's Best have done that, I can take them on an empty stomach with no problems (though with food is better).

 

Arctic Mama, how big are the Thorne prenatal capsules? Small capsules? Giant horse pills? I did end up being heterozygous for one of the MTHFR mutations, so need to switch vitamins anyway, figured i'd try these. But three capsules a day scares me a bit...

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I didn't take prenatals. Made me feel sick and I couldn't find any strong evidence that they were needed provided I was getting enough folic acid:

 

http://formularyjournal.modernmedicine.com/formulary-journal/RC/clinical/clinical-pharmacology/prenatal-vitamins-review-literature-benefits-a

 

Not saying don't but I think a flintstones or other kids' vitamin is fine.

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Make sure to take vitamins with food. I always get sick if I take them on an empty stomach and sometimes with just a light snack. Right after breakfast and lunch works best for me. I can't take vitamins after noon or they affect my sleep.

Edited by ifIonlyhadabrain
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They're not what I'd consider huge, but still a decent sized cap. Maybe an inch in length?

Check down in the user images on the Amazon reviews for a picture:

http://www.amazon.com/Thorne-Research-Prenatal-Multivitamin-Vegetarian/dp/B00O59SH3E

Thank you! I found the picture, those don't look awful. I went ahead and ordered them. If I can't handle them I'll donate them to someone else. I'm in ICAN so I always have pregnant women to donate such things to. 

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I didn't take prenatals. Made me feel sick and I couldn't find any strong evidence that they were needed provided I was getting enough folic acid:

 

http://formularyjournal.modernmedicine.com/formulary-journal/RC/clinical/clinical-pharmacology/prenatal-vitamins-review-literature-benefits-a

 

Not saying don't but I think a flintstones or other kids' vitamin is fine.

 

Because I've had bariatric surgery I need to be more careful of my vitamins in general, and I tend towards anemia so need iron for sure even before I had surgery, but otherwise I'd agree with you. I just don't want to have to hash together a million things if I don't have to. As it is I'd be taken the Prenatal, plus cal/mag/D twice a day, plus probably extra B12 sublingually because bariatric patients don't absorb it well in the stomach due to low intrinsic factor. 

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Make sure to take vitamins with food. I always get sick if I take them on an empty stomach and sometimes with just a light snack. Right after breakfast and lunch works best for me. I can't take vitamins after noon or they affect my sleep.

 

Agreed. Although I've come to realize it is the size of the pill that triggers nausea more than anything for me, it's a reaction as it hits my throat or something. And the flavorings in some chewables do it too. It' weird. 

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My blood work a few months ago was perfect, all vitamin levels normal, but I'm going to test again before we start trying. All the articles say to check early in pregnancy but that seems silly to me. Makes more sense to check before trying to conceive, so I can address any issues. Because I had the sleeve gastrectomy and not a malabsorptive procedure I should be okay, but better to check.

You should check BOTH before pregnancy and in early pregnancy.

 

I had to work hard to keep my numbers in the good range when not pregnant and even just one month into a pregnancy all my numbers would plummet.

 

Hypermesis will trash any pre pregnancy numbers in record time.

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One thing to keep in mind is just because the pill contains a high amount of a vitamin doesn't mean that your body is absorbing that high amount and if your body isn't absorbing it, then there is absolutely no way for it to be toxic to baby. I take 40,000 IU of Vitamin A a day and I'm just in the low range on my blood tests. I usually have to increase my A when pregnant.because I get too low otherwise. My doctors understand that when you are dealing with malabsorbtion than you can't simply look at the RDA numbers and assume they apply because that's for a person with normal absorbtion rates

 

Have you had your blood level tested on those two areas that you are concerned about? If your levels are not high on the vitamin now,then baby isn't going to get an overdose because your body isn't absorbing enough to do that.

This is me. Even not pregnant I have taken prenatals almost my entire adult life and during my teen years bc my numbers have always been in the low side even when taking high dosages. No Dr seems to know or care why that is, but it is. I eat very healthy. I'm more active than most but not going to win a triathlon in this lifetime. And all my babies have been healthy except for one who has some dental issues most likely related to zofran.

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You should check BOTH before pregnancy and in early pregnancy.

 

I had to work hard to keep my numbers in the good range when not pregnant and even just one month into a pregnancy all my numbers would plummet.

 

Hypermesis will trash any pre pregnancy numbers in record time.

 

Yes, that's what I mean, sorry if that wasn't clear. My plan is to check at least once a trimester, more often if things look at all wonky or I feel poorly. I've seen ranges of once a trimester to once every 6-8 weeks. 

 

I did just have them checked, and everything was great, so that's good! Now, to keep it that way!

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Agreed. Although I've come to realize it is the size of the pill that triggers nausea more than anything for me, it's a reaction as it hits my throat or something. And the flavorings in some chewables do it too. It' weird.

I think you'll just have to try several samples and see how it goes. Even if you like it now, doesn't mean baby will like it later.

 

The smell is what always sent me hurling. Like rotten spinach and spoiled milk. Why must they all smell like that?!

 

And I couldn't eat them with food. It took everything I had to hold anything down. Multiple things was not going to happen.

 

I hazard I puked more vitamins than I actually absorbed. I always tried to take them right before going to bed in the hopes I'd sleep through the worst and be able to absorb at least some of it.

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Ugh, you poor thing! And times 10 kids!  I had very little vomiting with my kids, just nausea. But I am REALLY bad at puking....i start to heave and then my throat closes up and nothing comes up. My poor DH says I sound like a cat trying (and failing) to get a hairball up. And knock on wood, zero vomiting after the weight loss surgery. But two different brand of chewable made me come very close. 

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I have not heard of this correlation. Can you please elaborate?

Zofran was originally intended to help chemo and radiation patients cope with the severe sickness.

 

But it was used for the off label purpose of helping pregnant women with "morning sickness".

 

After many years there started to show some correlations because it's uses and thise mothers have babies with mild or severe deficits in development. Mostly mouth or heart related.

 

However, for me, bad though I feel about doing anything that might harm my babies, it was and still is necessary for some pregnant women. It is not an exaggeration to say that for some women with severe hypermesis, zofran made the difference between being able to keep a pregnancy and the mother from suffering what could be permanent organ damage. For me, it meant I only lost 25 pounds that pregnancy and my esophagus burns were greatly lessened and my kidneys were no longer struggling. Thanks to zofran, I have perfectly healthy kidneys today and other than horrid teeth (similiar to what bulimic have from the damage if near constant stomach acid in their teeth) I am very healthy. And for my baby, the only obvious issue has been terribly fragile teeth (she had more dental work done by age 4 than most people will in their lifetime) and her frenulum will need some surgical work at some point, likely before we get braces for her. Granted it could have been worse for her and we had no idea of these side effects at the time. But honestly, I don't know if we would have not used it even if we had known. I was pretty bad off with that pregnancy.

 

And it's not a foregone effect either. Most babies seem to have not had any effects. There's some speculation that it acts more like a genetic trigger.

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Ugh, you poor thing! And times 10 kids! I had very little vomiting with my kids, just nausea. But I am REALLY bad at puking....i start to heave and then my throat closes up and nothing comes up. My poor DH says I sound like a cat trying (and failing) to get a hairball up. And knock on wood, zero vomiting after the weight loss surgery. But two different brand of chewable made me come very close.

Well don't feel too bad for me. I got 10 really awesome kids out of it.

 

Sure beats the flu for puke rewards.

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And for my baby, the only obvious issue has been terribly fragile teeth (she had more dental work done by age 4 than most people will in their lifetime) and her frenulum will need some surgical work at some point, likely before we get braces for her. Granted it could have been worse for her and we had no idea of these side effects at the time. But honestly, I don't know if we would have not used it even if we had known. I was pretty bad off with that pregnancy.

 

And it's not a foregone effect either. Most babies seem to have not had any effects. There's some speculation that it acts more like a genetic trigger.

 

 

I've used Zophran in every pregnancy except my first since it wasn't readily available then.  For one of the pregnancies I had to use it every day of the pregnancy and for about a week after delivery because I was so sick without it.  So I've always advocated for using it when necessary because I really hate to think of the state I'd have been in without it.  I was just curious about the relationship with dental issues because I had never heard of there being risks to baby from it (after googling I see lots of links the cleft palate and lips though).  My youngest has teeth issues.  He had brown spots appearing on his teeth shortly after his first birthday.  They have progressed to cavities that we will have to get filled soon.  The dentist blames it on night nursing but I'm skeptical because my other kids night nursed without complications.  The kid has never had a bottle in his life.  So that's why I was curious why kind of dental issues you were experiencing.

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I've also wondered if it is the Zofran causing the problem, or just the lack of nutrition from having hyperemesis that causes the problem. I don't know if they have been able to tell.

I've also wondered if it is the Zofran causing the problem, or just the lack of nutrition from having hyperemesis that causes the problem. I don't know if they have been able to tell.

Idk. Nutritionally and otherwise, I was healthier when I got pregnant with that child and during that pregnancy (thanks to zofran meaning I could actually hold some food down) than several others. And also there some theory that in children predisposed to these things, the zofran simply makes it worse. But really, it wasn't much of an option for me to not have it anyways. I think the FDA has still ruled that it's okay for pregnant women but only if they clearly have severe hypermesis and understand the risks. I could be wrong tho. I have not needed to find out in several years. I think I'm aging out of the baby making phase of life. Ă°Å¸ËœÅ 

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I've used Zophran in every pregnancy except my first since it wasn't readily available then. For one of the pregnancies I had to use it every day of the pregnancy and for about a week after delivery because I was so sick without it. So I've always advocated for using it when necessary because I really hate to think of the state I'd have been in without it. I was just curious about the relationship with dental issues because I had never heard of there being risks to baby from it (after googling I see lots of links the cleft palate and lips though). My youngest has teeth issues. He had brown spots appearing on his teeth shortly after his first birthday. They have progressed to cavities that we will have to get filled soon. The dentist blames it on night nursing but I'm skeptical because my other kids night nursed without complications. The kid has never had a bottle in his life. So that's why I was curious why kind of dental issues you were experiencing.

Yeah. Don't even get me started on dentists blaming mothers. What a load of crap. If breastfeeding caused bottle rot on baby teeth then every third and second world child would be toothless by age five.

 

I have ten kids and 8 of them have never had a single cavity.

 

2 of them make up for the other 8.

 

I think it sensible to presume it isn't because I decided for some inexplicable reason to give crappier care to my 2nd and 9th born. grrr.

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Please don't take folic acid but take folate instead. I take Jarrow brand methyl-folate. Folate is so much better.

For my prenatal I take New Chapter brand. I'm also taking a vitamin B complex with folate (not with folic acid). I think the brand is Freeda.

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Yeah. Don't even get me started on dentists blaming mothers. What a load of crap. If breastfeeding caused bottle rot on baby teeth then every third and second world child would be toothless by age five.

 

I have ten kids and 8 of them have never had a single cavity.

 

2 of them make up for the other 8.

 

I think it sensible to presume it isn't because I decided for some inexplicable reason to give crappier care to my 2nd and 9th born. grrr.

 

Yup. My third has awful teeth, he had cavities before he was 18 months old. The dentist refuses to believe it was either the high fever he had at 2 weeks old, or the lip tie that caused it. Nope, had to be from night nursing. Except the other two kids nursed all night too and no cavities ever. 

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Please don't take folic acid but take folate instead. I take Jarrow brand methyl-folate. Folate is so much better.

For my prenatal I take New Chapter brand. I'm also taking a vitamin B complex with folate (not with folic acid). I think the brand is Freeda.

 

The ones I've been looking at all have the methylfolate, not folic acid. The mutation I have is the "least bad" so I'm probably fine either way, but better safe than sorry. 

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