Prenatal vitamins and pregnancy supplements in Singapore: what to take, when, and what the extras do

Most healthy pregnancies in Singapore need only a few supplements: folic acid from before you conceive until week 12, then a prenatal multivitamin with iron and calcium, plus fish oil if you eat little fish. KKH's doctors, writing for SingHealth, put the daily amounts at 400 micrograms of folic acid, 27mg of iron and 1,000mg of calcium, and say to avoid taking more than 100% of any nutrient unless your doctor is supervising it. Other pregnancy supplements sold here, such as magnesium, vitamin B6, probiotics and collagen, treat particular problems rather than every pregnancy, vitamin A is the one to check on every label, and herbal products such as ginseng and dang gui need your doctor's say-so first. This guide sets out what to take and when, what the evidence says about the extras, and how to choose a product.

What to take, and when

HealthHub's leaflet on antenatal supplements, written by Singapore's hospital and retail pharmacists, describes the ones doctors usually prescribe. The amounts in the last column are KKH's daily figures.

Folic acid

Folic acid helps your baby's neural tube, the early brain and spinal cord, close properly. SingHealth says the neural tube forms in the first 28 days after conception, often before you know you're pregnant, which is why KKH advises starting prenatal supplements at least three months before you try. Some women need a higher dose, for example if they have epilepsy, so tell your doctor about any condition you have. If your pregnancy was a surprise, start as soon as you find out.

Fish oil and DHA

DHA is an omega-3 fat that helps your baby's brain and eyes develop. Not every prenatal multivitamin contains it, SingHealth notes, so if you rarely eat fish, look for one that does or ask about a separate capsule. HealthXchange's pregnancy nutrition advice is two servings a week of lower-mercury fish such as salmon, sardines or canned light tuna, and none of shark, king mackerel (batang), swordfish or tilefish. Vegetarians can ask about DHA made from algae. Our guide to foods to avoid during pregnancy in Singapore has the full fish list.

Iron

Your blood volume rises in pregnancy, and iron is what your body uses to make the extra red blood cells. Low blood counts are common, SingHealth says. Your doctor checks for anaemia with blood tests and prescribes iron if you need it; our guide to iron during pregnancy lists the best local foods. HealthHub says to take most iron tablets at least 2 hours apart from coffee, tea, milk, dairy and calcium tablets; iron polymaltose is the exception. Dark stools are expected and harmless.

Calcium and vitamin D

Calcium builds your baby's bones and protects yours, because your baby draws calcium from you if your intake is low. HealthXchange says two glasses of low-fat high-calcium milk, at about 500mg a glass, cover the 1,000mg you need a day. Vitamin D helps you absorb calcium, but HealthHub lists it as needed only when your doctor says so. Keep calcium 2 hours away from iron.

Iodine

Iodine supports your thyroid and your baby's brain. Many prenatal multivitamins already include it. If you use non-iodised salt and eat little seafood, eggs or dairy, mention it to your doctor.

Other supplements: what the evidence says

Pharmacy shelves in Singapore also carry magnesium, extra B vitamins, probiotics, collagen drinks and multivitamins that list manganese. None of the Singapore hospital or HealthHub pages we checked recommends any of them for every pregnancy. Here is what they do say.

Magnesium

Magnesium is sold for cramps and constipation, and it is also an ingredient in some laxatives and antacids, HealthHub notes. For leg cramps, KKH's doctors say it isn't clear that calcium or magnesium salts help, and KKH's dietitians say there is no firm evidence linking cramps to diet. Stretch the calf instead (more in our guide to pregnancy aches and pains), and ask your doctor before adding magnesium, because HealthHub tells pregnant women to check first and some antacids already contain it.

Vitamin A

Too much vitamin A in the retinol form can harm a baby's development, SingHealth's KKH doctors warn, and HealthHub says some multivitamins contain more than is safe in pregnancy. Changi General Hospital's pharmacists put the adult recommended amount in Singapore at 2,500 IU (750 micrograms of retinol) a day, and say many supplements contain 2,500 to 10,000 IU. A pregnancy multivitamin should keep within the limit. Don't add a separate vitamin A or cod liver oil product, and go easy on liver, which is high in retinol.

Vitamin B6

Pyridoxine, vitamin B6, is one of the medicines HealthHub's pharmacists list for nausea and vomiting in pregnancy, either alone or combined with doxylamine. It is generally well tolerated, though the combined tablet makes you drowsy. Ask a pharmacist or your doctor about the dose rather than taking a high-strength B complex. Our morning sickness guide covers the other options.

Manganese

Manganese is a trace mineral found in many foods, and it appears on some multivitamin labels. We found no Singapore hospital or HealthHub advice to take extra manganese in pregnancy. SingHealth's general warning applies: combining supplements can push you over the safe amount of a nutrient without you noticing.

Probiotics

Probiotics contain live bacteria, such as Lactobacillus and Bifidobacterium, and HealthHub's pharmacists list them for diarrhoea, bloating and constipation, and for vaginal and urinary health too. They don't recommend them for every pregnancy, and they say to tell your healthcare professional if you're pregnant or breastfeeding. If constipation is the problem, fluids, fibre and walking come first, and your doctor can prescribe a stool softener.

Collagen

Collagen drinks and powders promise firmer skin and fewer stretch marks. The Health Promotion Board points out that collagen is too large to be absorbed whole: your gut breaks it into amino acids, the same building blocks you get from any protein, and most experts don't support the claim that eating it raises collagen in your skin. There's no Singapore guidance on collagen in pregnancy. Check any product for added herbs or vitamin A, and remember that regular meals with fish, eggs, tofu or meat give you the same amino acids.

Herbal and natural supplements: what to check

"Natural" doesn't mean safe in pregnancy. HealthHub's article from the Health Sciences Authority (HSA) says natural ingredients don't mean no risk, and that an overdose, several supplements taken together, or a supplement mixed with some medicines can do you harm. SingHealth's guide to traditional Chinese medicine (TCM) in pregnancy warns that herbs used wrongly can cause miscarriage or harm the baby, and that Chinese medicine should only be used on your doctor's advice. Here is what Singapore sources say about the ones mums are most often offered:

SingHealth's guide also says some TCM herbs are toxic or strongly stimulate the womb and are strictly prohibited in pregnancy, while others should only be prescribed by experienced TCM physicians. If you want TCM in pregnancy, see a registered TCM practitioner, tell them you're pregnant and how many weeks, and tell your gynae what they prescribe. We found no Singapore hospital or HealthHub advice either way on raspberry leaf tea or evening primrose oil. Ask your doctor before you start either.

Food first: getting nutrients from your plate

Supplements fill gaps; food does most of the work. Singapore food makes this easier than it sounds.

• Folate: kai lan, spinach and other dark leafy greens, citrus fruit, beans and lentils.
• DHA: two servings a week of lower-mercury fish such as salmon, sardines or canned light tuna.
• Iron: red meat, chicken and fish are absorbed best; tofu, greens and beans work better with vitamin C from fruit at the same meal.
• Calcium: milk, yoghurt, calcium-set tofu (tau kwa) and leafy greens.
• Iodine: iodised salt, seafood, eggs and dairy.

If you are still building healthy habits, our guide to eating well in pregnancy in Singapore goes deeper on balanced local meals.

How to choose a prenatal

A prenatal multivitamin saves you swallowing five separate pills, but more isn't better. Health supplements in Singapore don't need approval and are not evaluated by the Health Sciences Authority (HSA) before they go on sale, HealthHub explains; the seller is responsible for safety and for honest claims.

• Ask your doctor or pharmacist before you buy. KKH's doctors say some over-the-counter products contain herbs or too much of one nutrient.
• Check the folic acid: at least 400 micrograms.
• Look at what's already inside. If your multivitamin has fish oil, iron or iodine, you may not need them separately.
• If big tablets make you gag, ask about smaller ones, or take them at night.
• If you're vegetarian, ask about B12, zinc, iron and algae-based DHA; our vegetarian pregnancy diet guide covers each.
• Skip products with vague ingredient lists, added herbs, or promises of quick results.

How to read a supplement label in Singapore

HSA doesn't approve or test health supplements before they go on sale; the seller is responsible for safety and for honest labels. That makes the label your main check:

• Ignore "HSA approved". HSA says it doesn't assess or approve health supplements, so that claim is false, and a Lion Head symbol on the pack is not a government endorsement either.
• Look for a full ingredient list with amounts per tablet. HSA's rules say every active substance must be stated on the label.
• Check vitamin A. HSA caps retinol at 1.5mg (5,000 IU) a day for general adult supplements, and the CGH pharmacists' recommended amount is 2,500 IU, so a pregnancy product should sit well below the cap.
• Check iron. HSA's limits let multivitamins made for pregnant women carry up to 30mg a day, a little above KKH's 27mg daily amount.
• Be wary of words HSA calls misleading, such as "100% safe", "no side effects", "clinically proven", "detox" and quick-fix promises.
• Chinese proprietary medicines (TCM capsules and tablets) are different: HSA requires a product listing approval and a dealer's licence before they can be sold here. Buy them from a TCM shop or pharmacy, not an overseas website.

If a supplement makes you unwell, HSA's advice is to see your doctor or pharmacist straight away; you can also report it to HSA.

Managing side effects

HealthHub lists the common ones, and none usually means you should stop. Check with your doctor before changing anything.

• Constipation from iron or calcium: drink more water and eat more fruit and vegetables, and ask about a gentler iron if it lasts.
• Dark stools from iron: harmless.
• Feeling alert at bedtime: the B vitamins in a multivitamin can do this, so take it earlier in the day.
• Fish oil can cause nausea, a fishy aftertaste or burping. Take it with or after a meal.
• Morning sickness: SingHealth suggests taking supplements at night before bed, or switching to another kind, and seeing your doctor if you can't keep them down.

If nausea is making supplements hard to keep down generally, our guide to common pregnancy discomforts by trimester has more ways to cope.

Bring your bottles to your check-ups

SingHealth suggests bringing your supplement packaging to your first prenatal visit, so your doctor can check for overlap and adjust iron and vitamin D to your blood results. What suits a friend may not suit you. Our guide to prenatal check-ups and scans in Singapore shows when those blood tests happen, and our pregnancy week-by-week guide follows the rest. Browse the Fussy Mama pregnancy blog for more. Related reading: our guides to trying to conceive in Singapore and ovulation and your fertile window.

Frequently asked questions

When should I start taking prenatal vitamins?

Start folic acid at least three months before you try to conceive, KKH advises, or as soon as you know you're pregnant. HealthHub says prenatal multivitamins, fish oil and calcium usually start from week 12.

What supplements do I need in pregnancy in Singapore?

Folic acid, a prenatal multivitamin with iron and calcium, and fish oil if you eat little fish cover most healthy pregnancies. Iron and vitamin D are added if your blood tests show you need them.

Is magnesium safe in pregnancy?

Ask your doctor first. HealthHub tells pregnant women to check before taking magnesium, and KKH says it isn't clear that it prevents leg cramps.

How much vitamin A is too much in pregnancy?

Stay within your multivitamin and avoid separate vitamin A products. Changi General Hospital's pharmacists put the adult recommended amount at 2,500 IU (750 micrograms) a day, and say many supplements carry up to 10,000 IU.

Do I need collagen or probiotics in pregnancy?

No Singapore guidance recommends them for every pregnancy. HPB says eaten collagen is broken down into ordinary amino acids, and HealthHub says to tell your doctor before taking probiotics in pregnancy.

Why do I have to take iron and calcium separately?

They compete for absorption. HealthHub says to keep most iron tablets 2 hours apart from calcium, dairy, tea and coffee.

I am vegetarian. What should I watch for?

SingHealth lists vitamin B12, zinc, iron and DHA. Algae-based DHA is a plant option, and your doctor can check the rest.

Are herbal supplements safe in pregnancy?

Some are and some aren't. KKH suggests ginger for nausea, but SingHealth's TCM guide says not to use Chinese ginseng while pregnant and to see a TCM physician before using dang gui. Check any herbal product with your doctor first.

Does "HSA approved" on a supplement mean it's safe?

No. HSA says it doesn't assess or approve health supplements, so an "HSA approved" claim is misleading. The seller is responsible for the product's safety and its label.