Pregnancy Supplements in Singapore: What You Really Need

Most pregnant women in Singapore need only a few supplements: folic acid from before conception to about week 12, then a prenatal multivitamin, with iron, calcium, DHA (fish oil) or vitamin D added if your doctor thinks you need them. You do not need a cupboard full of bottles, and taking more is not better, especially for vitamin A.

Here is what each supplement does, what gynaes and polyclinics typically prescribe, how to take them so they actually work, and what to be careful with, including traditional tonics and products bought online.

The typical Singapore supplement plan

HealthHub’s guidance on antenatal supplements, and what most public and private clinics prescribe, follows a similar pattern. Your own plan may differ depending on your blood tests, diet and medical history.

If you are under subsidised care, many of these are dispensed at the hospital or polyclinic pharmacy at subsidised prices. Private gynaes often sell supplements at the clinic too. You are free to ask for a prescription and compare prices elsewhere, as long as you take an equivalent product.

Folic acid

Folic acid is the one supplement virtually every doctor agrees on. The baby’s neural tube, which becomes the brain and spinal cord, closes in the first four weeks after conception, often before you know you are pregnant. That is why it is best started before you try to conceive.

A daily 400 micrograms is generally enough for a low-risk pregnancy. In practice, many Singapore doctors prescribe a higher 5 mg tablet, and a higher dose is specifically recommended for women with diabetes, a previous baby with a neural tube defect, epilepsy medication or a high BMI. Follow the dose your doctor gives you. If you only find out you are pregnant at week 6, start straight away; it still helps. Our first trimester guide covers the other early steps.

Iron

Your blood volume rises by around half during pregnancy, so iron needs go up sharply, and anaemia is common. Symptoms include tiredness, breathlessness, dizziness and looking pale, although mild anaemia often has no symptoms at all, which is why your blood count is checked at booking and again later in pregnancy.

Thalassaemia traits are relatively common in Singapore and can also cause small red blood cells. Your doctor will interpret your results with this in mind, since iron does not help thalassaemia and too much can be harmful. Do not start high-dose iron on your own.

How to take iron so it works

• Take it at least two hours apart from tea, coffee, milk, dairy and calcium tablets, which block absorption. (Iron polymaltose products are an exception; check the label.)
• A glass of orange juice or a vitamin C-rich fruit such as guava helps absorption.
• Expect dark or black stools; this is harmless.
• If constipation is a problem, drink more water, eat more fibre and ask your doctor about a different formulation.

Iodine

Iodine is needed to make thyroid hormones, which drive your baby’s brain development. The World Health Organization suggests pregnant and breastfeeding women need about 250 micrograms a day from all sources. Good food sources include seafood, milk, eggs and iodised salt, but not all salt sold here is iodised and hawker cooks rarely say what they use, so a prenatal vitamin containing iodine is a sensible safety net.

Check your multivitamin label for iodine. If you have a thyroid condition, speak to your doctor first. Avoid kelp or seaweed supplements, which can contain very large and variable amounts.

DHA, calcium and vitamin D

DHA (omega-3 fish oil)

DHA builds your baby’s brain and retina, especially in the second half of pregnancy. Two to three servings a week of low-mercury oily fish such as salmon, sardines or saba give you a good amount. If you rarely eat fish or are vegetarian, your doctor may suggest a fish oil or algae-based DHA supplement. Choose one made for pregnancy, as some fish liver oils, such as cod liver oil, also contain vitamin A.

Calcium

If you drink milk, eat yoghurt, calcium-set tofu or calcium-fortified soya milk every day, you may not need extra. Many Asian women eat little dairy, though, so calcium supplements are commonly prescribed in Singapore. Take them apart from iron, and expect some constipation.

Vitamin D

Sunny Singapore does not guarantee good vitamin D levels, since most of us spend our days indoors and cover up or use sunscreen outside. Some doctors check your level and prescribe vitamin D if it is low; others include it in the multivitamin. Take the dose you are given rather than adding high-dose products.

For how to get all of these nutrients from everyday meals, see our guide to what to eat during pregnancy. If cravings are pulling your diet off course, our guide to handling pregnancy cravings can help.

What to be careful with

• Herbal and traditional remedies. Many Chinese herbs, jamu and Ayurvedic preparations have not been tested in pregnancy, and some, such as dang gui (angelica), are traditionally avoided in pregnancy or may affect bleeding. Tell your doctor about any tonic, soup herb or pill your family suggests. Our list of foods to avoid during pregnancy covers common food items.
• Products bought online. Slimming, “detox” or herbal products sold online have been found to contain undeclared medicines. Stick to reputable pharmacies and brands, and check the Health Sciences Authority’s product alerts if unsure.
• Doubling up. Taking a prenatal vitamin plus a separate folic acid, iron and vitamin D product can push some nutrients too high. Bring everything to your next appointment in a bag and ask.
• Maternal milk powders often add vitamins and minerals too. They are optional; count them in the total.

Supplements during breastfeeding

Many doctors suggest continuing your prenatal multivitamin, DHA and calcium while you breastfeed, and iron if you lost a lot of blood at delivery. Iodine needs stay high while breastfeeding. Our guide to the breastfeeding diet explains how to eat well in those months, including during confinement.

The bottom line

Take folic acid early, switch to a pregnancy-specific multivitamin with iodine from around week 12, and let your doctor decide on iron, calcium, DHA and vitamin D based on your blood tests and diet. Avoid high-dose vitamin A and check every herbal tonic first. HealthHub’s page on antenatal supplements is a useful official reference.