Cognia Health Patient Resource
A Smart Start
Your Guide to Supplements & Medications in Pregnancy
- Folic acid: 1+ month before conception
- Low-dose aspirin: from week 12
- Tdap vaccine: weeks 27-36
1 Take with Food for Best Results
These work better or cause less stomach upset when taken with a meal containing healthy fats (avocado, nuts, olive oil, peanut butter).
| What | When | Why |
|---|---|---|
| Prenatal Vitamins | With dinner or fatty snack | Fat helps absorb vitamins A, D, E, K; reduces nausea |
| Fat-Soluble Vitamins A, D, E, K |
With fat-containing foods | These vitamins need fat to be absorbed properly |
| Zuranolone Postpartum depression |
Evening meal with fatty foods | Fat is essential for absorption; evening timing helps with drowsiness |
| Iron If stomach-sensitive |
With food + vitamin C | Food reduces stomach pain; vitamin C boosts absorption 2-3x |
| Omega-3 Fatty Acids | With meals (200-300 mg daily) | Supports baby's brain and eye development |
2 Best Time of Day
Some medications work better at certain times based on how they affect your energy and sleep.
| What | When | Why |
|---|---|---|
| Activating antidepressants Fluoxetine, sertraline, bupropion |
Morning | Can be energizing; prevents sleep problems |
| Sedating antidepressants Mirtazapine, fluvoxamine |
Bedtime | These cause drowsiness; helps with sleep |
| Sedating antipsychotics Quetiapine, olanzapine |
Evening or bedtime | Helps with sleep; avoids daytime drowsiness |
| Prenatal vitamins If queasy |
Before bedtime | Sleep through any nausea; great for morning sickness |
| Vitamin B6 For nausea |
As directed | Slow-release formula helps reduce morning sickness |
| Magnesium | Before bedtime | Natural muscle relaxant; prevents leg cramps |
| Lithium* | Once daily, usually evening | Simpler schedule; may be easier on kidneys. Provider will guide timing. |
| Low-dose aspirin | Once daily, starting weeks 12-16 | Consistent daily dosing is critical for prevention |
| Progestin-only pills | Same time daily (within 1 hr) | Precise timing required for effectiveness |
*Lithium dosing recommendations are evolving. Some formulations may still use divided dosing. Always follow your prescriber's instructions and attend scheduled blood level monitoring.
3 Specific Timing During Pregnancy
Some medications and supplements need to be started at specific points in your pregnancy.
| What | When to Start | Why |
|---|---|---|
| Folic Acid | At least 1 month BEFORE conception | Prevents neural tube defects; critical in early weeks |
| Vitamin D | 600-4,000 IU daily throughout pregnancy | Supports baby's bone growth; reduces preeclampsia risk |
| Low-dose Aspirin | Weeks 12-16; some providers stop at 36 weeks | Reduces preeclampsia risk in high-risk pregnancies |
| Antiviral (for herpes) | Starting at week 36 | Lowers risk of active lesion during labor |
| Tdap Vaccine | Weeks 27-36 each pregnancy | Passes immunity to your baby before birth |
4 Take on an Empty Stomach
Some medications require avoiding food for proper absorption or accurate test results.
| What | When | Why |
|---|---|---|
| Iron Best absorption |
30-60 min before eating with water or orange juice | Absorbed most efficiently without food competition |
| Glucose Tolerance Test | Fasting overnight (3-hour test) | Required for accurate gestational diabetes screening |
| Brexanolone infusion | 60-hour hospital stay | Breastfeeding can continue; separate caregiver required during infusion due to sedation risk |
5 Spacing Between Supplements
Some supplements block each other's absorption when taken together. Space them out for best results.
Space by at least 2 hours. They compete for absorption.
Antacids block iron absorption. Take separately.
Fiber can block iron absorption. Don't take together.
Take 500 mg twice daily (not all at once) for better absorption.
Wait 14 days when switching (5 weeks for fluoxetine).
6 Pairings to Avoid
Coffee/Tea + Iron
Can reduce non-heme iron absorption
Green Tea + Folic Acid
Decreases folic acid effectiveness
Soda + Calcium
Phosphoric acid lowers calcium absorption
Alcohol + Breastfeeding
Passes into breast milk
7 Important Safety Cautions
These warnings can prevent serious problems during pregnancy.
Vitamins A & D: Do NOT take extra beyond your prenatal
Excessive doses can be toxic to your baby.
Protein Supplements: Prefer whole foods; check ingredients
Powders may contain herbs or sweeteners unsafe in pregnancy.
Herbal Labor Remedies: AVOID castor oil, black cohosh, etc.
Unpredictable effects; never use without medical supervision.
Unpasteurized Foods: Avoid raw dairy and deli meats
High Listeria risk; can cross placenta and cause fetal loss.
High-Mercury Fish: Avoid shark, swordfish, king mackerel, tilefish (Gulf), bigeye tuna, marlin, orange roughy
Mercury causes neurologic problems in developing babies.
Methadone/Buprenorphine: Continue during labor; may split doses
Prevents withdrawal; provider will guide dosing.
*FDA/EPA fish advisory list. For complete guidance including serving recommendations for lower-mercury options, see FDA.gov/fishadvice