Prenatal Vitamins

[anu]

Hello Dr Fett,


Can you please advise if there is anything specific I should be looking in prenatal vitamins? I am STILL on Coreg. I have not had an appointment with local cardiologist and so, have not had a chance to revise my meds.

I was worried if there will be any side effects with Coreg and prenatal vitamins.

Please advise,
Anu

[JAMESFETT]

Did you see my earlier post to someone else regarding subsequent pregnancy supplements? This is it:

Yes, avoid anemia if at all possible (iron supplement). [A general prenatal vit is fine. Specifics in addition include]: Take folic acid supplement prior to and with pregnancy (to avoid risk of neural tube defect in fetus). Taking selenium, [does your prenatal vit have selenium?] 50 mcg once or twice per week is not a bad idea, since one certainly does not want to be selenium deficient, which may increase the potential to develop dilated cardiomyopathy (Keshan disease in China, adolescent dilated cardiomyopathy related to selenium deficiency, preventable with selenium supplements). Be sure pre-pregnant echo is normal, and monitor echo each trimester, looking for any signs of dip. Establish normal baseline blood B-type natriuretic peptide (BNP) to compare levels drawn each trimester of pregnancy (elevation above cut-off may precede symptoms of heart failure) and establish baseline level of blood high sensitivity C Reactive Protein, to compare to each trimester level, level above 10 to 20 mg/Liter may prewarn about inflammatory process in the heart. It is good to review with your cardiologist and your obstetrician the safety of Coreg in early pregnancy. In my practice in Haiti I never used it because we could not afford it. During pregnancy we used metoprolol and hydralazine, both safe during pregnancy. Now, in the USA, I am not actively treating PPCM patients, but I am doing a lot of work on it, and collaborating with a number of researchers and clinicians in USA and elsewhere. Best wishes.

James