Prenatal Vitamins – Prescription vs. OTC

Welcome to the program Thank you so much for tuning in

I'm your host Neal Howard here on Health Professional Radio Prenatal vitamins come in many different forms and doses and our guest today is Dr Bradley Price, he's going to talk about prenatal vitamins and hopefully, clear up some misconceptions about them and also talk about an upcoming policy decision from a private company to make all prenatal vitamins over-the-counter vitamins as opposed to prescription Welcome to the program Dr Bradley price

0:00:29760,0:00:34290 Thank you Thank you Glad to be here

Give our listeners a bit of background about yourself Well, I've taken care of pregnant women for a little over 40 years So I know a lot about what kind of vitamins they're willing to take and what problems they will have over time with a different kind of vitamin ingredients Okay So the types of vitamins that they're willing to take and some of the benefits, what are the benefits? Sure the key components of any prenatal vitamin are iron and folate and those those two components are very important for preventing anemia for the mom

Particularly, iron deficiency is very common in childbearing age group and it's hard to get almost impossible to get enough iron in the diet So iron stuff and some sort of it is absolutely necessary Folate is also key not only for the mother to help prevent a certain type of anemia but also for the baby, it's a key for what's called a 'Neural Tube' the formation of the spinal cord So some women with low folate for metabolic reasons will tend to have a much higher chance for a baby with spina bifida or variations on that And being that important, why is it that you know, you mentioned that you knowing what some women will choose to take or are willing to take, why would a woman choose not to take prenatal vitamins? Well a lot of it has to do with just compliance, creature comfort

For instance, if she gets a vitamin that is big, I've heard patients call him a 'Horse Pill' and they basically just refused to take them or have great deal of difficulty swallow So one one thing is just the size of the tablet So with a with a prescription vitamin, I have a real good idea with a particular brand what the size is, where as generic, they're all over the map in terms of that Well size, it seems that these days size would if that was an issue then it would be addressed and easy fixes, why is that not an easy fix? I think that some vitamin makers want the kitchen sink and their vitamin and they want one so complete that it ends up being thick particularly, I think calcium is one of the ones that takes up a lot of space So that's the problem, that tension between lots of ingredients versus versus size

But a well-engineered prenatal vitamin can have plenty of adequate ingredients particularly iron and folate and still have minimal size Well, prenatal vitamins always necessary during pregnancy? I mean is that they have to be taken or can she do okay as far as pregnancy is concerned without having to deal with the size or the pill at all? Really it's impossible to get enough iron in a diet, given the eaters And the other thing that the folate is too particularly early in pregnancy The iron is the absolute key and so some women if they don't take their prenatal on a regular basis or sometimes they're embarrassed to say that we're like they're not even taking it and it will show up in labor per family anemic Then those women if they have any bleeding more than average during delivery are or likely to have to get a blood transfusion

So it's not just a simple cut and dry sort of issue when dealing with prenatal vitamins How do you I guess determine what type of prenatal vitamins are right for your patient? Well I think that's something that ideally every doc should talk with every patient because every patient is different, there's not a one-size-fits-all Besides size, what I look for is the type of folate, folic acid and that's one of the key ingredients of prenatal thousands of micrograms of folate or gram And so one of the best folate is 'Methylfolate' which is it's body ready It doesn't require an enzyme that it turns out of a large number of majority of Hispanics in the U

S lack appropriate amount of an enzyme to convert standard folate to the active form of folate Methylfolate on the other hand is available in some prenatals and it's already body ready so that woman that doesn't have adequate supplies of that particular enzyme and do fine and has built up her folate level without problem That's one of the keys The other absolute key that relates to compliant that has helped how people feel on their vitamin is iron

And so a lot of iron and most say an over-the-counter is so-called 'Iron Salts' like Ferrous Fumarate or Ferrous Sulfate Those are the ones that are poorly absorbed and they ended up aggravating the woman's acid reflux and constipation

So many times the patient will take those and get those kind of symptoms and quit taking it So there are some variations away from the iron salts, there's a chelated iron called as part of glycinate assimilate which has amino acid, aspartic acid and glycine on each side of the iron molecule that ends up in absorb like an amino acid, so much more efficient

So that reduces a lot of the iron side effects Dr Price, you mentioned that being a physician and writing these prescriptions when it comes to I guess tailoring a woman's prenatal vitamin regimen, you've got a little bit of control there, you can consult and as you said knowing specific brands and what not and what the characteristics of those brands are you can better prescribe different types of vitamins But there's a recent decision, a policy decision from from a private company that's going to remove that little bit of control that you have as a physician, am I correct in that? Yes And I'm very worried about that pending change and it's called 'First Data Bank', a policy disclusion

And so that's I think a world of trouble If women are already having trouble with the size and knowing which vitamin is best for them based on their situation, I guess part of your fear lies in the compounding of that that confusion Right It gives the the dark much less control over what the woman is actually taking And so like I say, I think compliance is what I'm worried

If the compliance means help, how well that a patient will actually take a medicine? But the other thing that bothers me about the compliance issue is that a majority of deliveries in US are paid for on Medicaid and currently, medicaid pays for prescription vitamins but not over-the-counter So if prenatals went over the counter, women on Medicaid would probably have to buy on a cash basis through the over-the-counter prenatals and a lot of women on Medicaid just can't afford it So there goes another huge stumbling block towards good compliance

I know this is an opinion called 'Type of Question' maybe some possible collaboration between Medicaid and some of these providers to change policy on the part of Medicaid to begin to pay for these over-the-counter drugs specifically not across the board over-the-counter drugs I think that would be an appropriate step For instance in the state of Texas where I practice, there is a Medicaid Formulary Committee So that would be the group that would decide but basically what prenatal vitamin is covered So that would be a discussion to take to that particular committee, I'd be happy to securing

And so yes, that would be compromised so it's not just totally chaos Well I appreciate you coming in today Dr price and I'm hoping that you'll come back and talk with us in the future to give us some updates as maybe some of these policies will change on the part of Medicaid to allow some of the women who are already enjoying those benefits to continue to enjoy those benefits regardless of this decision by First Data Bank Learn more at wwwrxprenatalvitaminaction

com That's right Dr Bradley Price, talking about prenatal vitamins Transcripts and audio of the program are available at healthprofessionalradio

comau and also at hprfm You can subscribe to the podcast on iTunes, listen in and download at SoundCloud and be sure and visit our affiliates page at healthprofessionalradiocom

au and at hprfm


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