Antenatal Supplements

Description

General measures

Medicine treatment

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Z36.9 + (Z29.9)

DESCRIPTION

Supplements before and during pregnancy and lactation can help to prevent, or lessen the effect of, a number of conditions or complications associated with pregnancy. Specifically:

• Folic acid, given for at least one month before conception and during pregnancy (particularly the first 12 weeks) can help to prevent neural tube defects (abnormal development of spinal cord/brain).
• Iron can help to prevent anaemia.
• Calcium can help to prevent pre-eclampsia.
• Low dose aspirin can reduce the risk for early onset pre-eclampsia in women at risk.

GENERAL MEASURES

• Eat a balanced diet to prevent nutritional deficiency.
• Avoid unpasteurised milk, soft cheeses, raw or undercooked meat or poultry, raw eggs, and shellfish. 
• Cut down on caffeine. Reduce intake of tea. Do not drink tea within 2 hours of taking iron tablets.

MEDICINE TREATMENT

Prevention of Neural Tube Defects (NTD)

• Folic acid, oral, 5 mg daily:
  • All women intending to become pregnant or pregnant women (first trimester of pregnancy).
  • If high risk, throughout pregnancy, i.e.:
    • on anticonvulsants - especially valproic acid and carbamazepine
  • previous child with NTD; or 
    • family history of NTD.

LoE:Ia¹⁴

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Caution:
Children born to women taking valproic acid are at significant risk of birth defects (10%) and persistent developmental disorders (40%).
Valproic acid is contra-indicated and should be avoided in pregnancy and women of child-bearing potential.
LoE:IIb¹⁵

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Prevention of anaemia:

During pregnancy, after delivery and during lactation:

• Ferrous sulfate compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) 12 hourly with meals.

OR

• Ferrous fumarate, oral, 200 mg once daily (± 65 mg elemental iron).
  • Taking iron tablets with meals decreases iron absorption, but improves tolerability. (Note: Do not take iron tablets with milk)

If daily iron is poorly tolerated (e.g. epigastric pain, nausea, vomiting and constipation), intermittent iron supplementation may be administered:

• Ferrous sulfate compound BPC (dried), oral, 340 mg per week, (± 110 mg elemental iron), with meals.

OR

• Ferrous fumarate, oral, 400 mg per week (± 130 mg elemental iron).

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Note:
Established anaemia i.e. Hb < 10 g/dL, see: Anaemia and Anaemia in pregnancy.
LoE:IVb¹⁶

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Prevention of pre-eclampsia:

From confirmation of pregnancy (all women):

• Calcium, elemental, oral, 1 g daily.
  • Although the benefit is greatest in high-risk women, consider use of this agent in all pregnant women.
  • Calcium reduces iron absorption from the gastro-intestinal tract. Take supplements 4 hours apart from each other.

LoE:IIIb¹⁷  

From confirmation of pregnancy (all women with risk factors. including: pre-eclampsia in a previous pregnancy, chronic hypertension, diabetes, antiphospholipid syndrome, or systemic lupus erythematosus (SLE)):

• Aspirin, oral, 150 mg, taken at bedtime, preferably not on an empty stomach, until 36 weeks.
  • Start at 6 weeks of gestation but preferably before 16 weeks.
  • Stop at 36 weeks to reduce risk of bleeding during labour.
  • Administration at bedtime reduces the risk of gastric irritation.

LoE:IVb¹⁸

Refer to the next level of care as appropriate for the condition (see Hypertensive disorders in pregnancy). Women with a prior history of pre-eclampsia, but otherwise well, can be referred for the next available appointment, preferably around 20 weeks.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026

Chapter 6: Obstetrics and Gynaecology_6.4.1 Antenatal Supplements