Pregnancy Nutrition Isn’t Either Food or Supplements. You Need Both

I had been through pregnancy once before.

And because my first pregnancy had come soon after a miscarriage and had not been easy, I was careful the second time around. Perhaps more careful than I needed to be.

This was my second pregnancy, almost four and a half years after my first. I was older-in my early thirties. I had also had my share of recurring health problems in those intervening years, and my stomach had become particularly sensitive.

But when I became pregnant again, I knew one thing: I would be doing everything by the book. My Health reporting years had taught me a lot- but during my pregnancies it made me more cautious than careful. One can say the hormones made me just about paranoid.

So I had my tests and scans done on time. I took the supplements prescribed to me. No chances. I wanted the second child very badly, and I wanted a daughter.

Pregnancy, after all, is one of those periods when you are constantly reminded that you are eating and taking medicines not just for yourself but for another human being growing inside of you.

Iron and folic acid are routinely recommended during pregnancy because the body's requirements increase. WHO recommends daily iron and folic acid supplementation during pregnancy to help prevent maternal anaemia and reduce the risk of low birth weight and preterm birth.

Calcium is important too, particularly in populations with low dietary calcium intake, although supplementation should be considered in the context of an individual's diet and medical circumstances.

So I wasn't questioning why my doctors wanted me to take these supplements.

My problem was that my body wasn't cooperating.

I couldn't eat much. Heavy meals made me uncomfortable, and my stomach simply didn't seem capable of handling everything being prescribed.

Calcium and iron supplements became particularly difficult.

At one point, I was given calcium in an injectable form because I was struggling with the oral supplement. I was also advised to have iron administered intravenously.

The IV iron was being given under medical supervision. I took it once, and I was fine.

I remember thinking that at least this was being done in a hospital, with doctors around. If anything went wrong, I was in the right place.

And then something did go wrong.

While the infusion was underway, my tongue suddenly felt heavy, soon I felt as though I had lost sensation in my mouth. Followed by a strange tingle in my body.

The doctor was called immediately. They stopped the infusion and treated me for the reaction. I was kept under observation and eventually had to stay in hospital for a day.

I was discharged after being monitored, but with a very different set of instructions.

I was advised against continuing the supplements that had caused the problem.

Suddenly, something I had thought of as a routine part of pregnancy had become complicated.

Iron deficiency is common in pregnancy, affecting approximately 15% to 20% of women, and it becomes more widespread as pregnancy advances. According to a recent Yale study, 84% of pregnant women experience iron deficiency during their third trimester. Iron deficiency can lead to anemia, a more serious condition that can cause heart issues and complications during pregnancy and postpartum.

So I had to go back to food

I wasn't told to simply stop thinking about nutrition.

Instead, I had to make up as much as possible through what I ate.

I was not particularly fond of meat or non-vegetarian food during that pregnancy. Occasionally I would have something grilled, but it wasn't going to form the bulk of my diet.

My dietitian helped me work out how to make my food count.

I started eating a lot of spinach.

Beetroot became a regular part of my diet. So did red grapes and pomegranate, dried fruits, seeds, nuts.

And one food needed no introduction in a Kashmiri household: haak saag, or collard greens.

I ate a lot of it. My mother struggled to find recipes that could help me keep some meat and poultry down. I also ate a lot of fish.

I was conscious that I could not simply assume that eating spinach or pomegranate was equivalent to taking an iron tablet. It isn't.

Food contains nutrients in different amounts and forms, and whether a person can meet a particular nutrient requirement through food alone depends on their diet, nutritional status, deficiency and individual circumstances.

But in my case, when supplements were no longer an option, food became much more important.

And, somewhat to everyone's surprise, my hemoglobin went up.

I was doing fine. Maybe I was lucky.

Maybe my diet, combined with what my body could absorb and whatever nutritional reserves I had, worked well for me. I really don't know.

And I would never turn my experience into advice that pregnant women should abandon supplements and simply eat spinach or beetroot.

That would be the wrong lesson.

Supplements matter. But so does the plate.

Pregnancy is not the time to dismiss supplements.

In a country like India, where anaemia and micronutrient deficiencies remain significant public-health concerns, supplements can be extremely important. WHO recommends iron and folic acid supplementation during pregnancy precisely because nutritional requirements increase and deficiencies can affect both mother and baby.

But there is another message that sometimes gets lost in the conversation about pregnancy supplements.

Nutrition is not a tablet but it is important.

A pregnant woman still needs food.

And not just calories.

She needs a varied diet that provides protein, energy, vitamins, minerals, fibre and other nutrients. WHO recommends a variety of foods during pregnancy, including vegetables, fruit, legumes, whole grains, and appropriate animal-source foods, and advises women to take supplements such as iron and folic acid as recommended by their healthcare provider.

That distinction matters.

A supplement can correct or prevent a deficiency. It cannot replace the nutritional value and variety of a good diet.

And the reverse is also true: a healthy diet cannot always correct a significant deficiency quickly enough or provide a therapeutic dose of a nutrient when one is medically required.

We need both ideas to coexist.

What a mother eats matters to the child she is growing

There is another reason I have become increasingly interested in this conversation.

We tend to think of pregnancy nutrition as something that affects the mother and the baby's birth weight.

But nutrition during pregnancy is also part of the environment in which the fetus develops.

Maternal undernutrition can affect fetal growth and development. WHO's evidence review notes associations between severe nutritional deprivation during pregnancy and later risks such as insulin resistance, glucose intolerance, hypertension, and obesity in offspring.

This does not mean that a child born to an undernourished mother is destined to become obese or develop diabetes.

It means that the foundations of metabolic health begin much earlier than we often think.

And that makes maternal nutrition important not only because of what happens on the day the baby is born, but because of what may happen years later.

This is particularly relevant in India, where we face a strange nutritional paradox: undernutrition and micronutrient deficiencies coexist with rising overweight, obesity and diet-related diseases. WHO describes this as a double burden of malnutrition.

A woman can be eating enough calories and still be deficient in important nutrients.

She can also be overweight and anaemic.

She can have access to food and still have a poor-quality diet.

Pregnancy brings all of these contradictions into sharp focus.

My lesson was not “don't take supplements”; it was to take supplements but also eat well

If there is one thing I would want anyone to take away from my story, it is that supplements are not unnecessary during pregnancy, they can be essential.

My own experience actually taught me the opposite: don't take them casually, but don't dismiss them either.

Understand why they have been prescribed.

Know what deficiency or risk they are addressing.

Tell your doctor if you cannot tolerate them.

If a supplement causes significant side effects, don't stop everything on your own. Talk to your doctor about what can be changed, what needs to be monitored, and whether there are other ways of meeting the requirement.

For me, that alternative became food, maybe because I did take injectables for some time I had reserves.

And perhaps that was one of the unexpected gifts of that difficult pregnancy.

I became much more conscious of what was on my plate.

I learned that spinach, beetroot, grapes, pomegranate, and my beloved Kashmiri haak were not simply food. They were part of the nutritional support I was giving my body while it was doing one of the hardest jobs it would ever do.

I also learned something more important.

Pregnancy nutrition should never be reduced to a strip of tablets.

And it should never be reduced to a plate of vegetables either.

Sometimes the answer is a supplement. Sometimes it is food. Often, it is both — guided by the woman, her diet, her blood tests, her medical history, and the doctor caring for her.

That, to me, is a much more useful conversation than simply asking whether supplements are “good” or “bad”.