Questions about Pregnancy: Vitamins, Hair Dye, Ovulation

Question 1:
Q. I recently got married and we are ready to start a family. I went to my gynecologist and my exam was normal. He then told me to take a multivitamin without giving me a prescription. I thought you needed to take a special prenatal vitamin to prevent birth defects. Is an ordinary multivitamin enough?

Dr. Mitchell answers:
A. All women planning a pregnancy need to be sure to get enough folic acid to prevent spina bifida and other defects of the developing spine and brain. Indeed, the US Public Health Service recommends that all women of child-bearing age get enough folic acid, because you need the folic acid right from the moment of conception, before you even know if you are pregnant, and about half of all pregnancies are unplanned.

There is some controversy about just how much folic acid is enough. The Public Health Service recommends 0.4 mg daily of folic acid, which is the usual amount in a standard multivitamin, and often the amount in a bowl of fortified cereal. Be sure the "nutrition facts" label reads 100% daily value of folic acid.

Others say women who are planning pregnancy need 0.8 mg of folic acid and that women at particularly high risk for having a child with spina bifida (those who already have a child with spina bifida or women taking seizure medications) need full 4 mg of folic acid. The US Food and Drug Administration has mandated that breads and cereals be supplemented with folic acid, but often this isn't enough, since a slice of bread may have only 0.008 mg of folic acid.

Question 2:
Q. I just found out that I am pregnant, but I don't have a doctor's appointment for another month. Next week, I have a couple of appointments to have my hair colored and my acrylic nails redone. Is it bad to color hair or have acrylic nails put on while pregnant?

Dr. Mitchell answers:
A. It is extremely difficult to be sure whether anything is totally safe during pregnancy. No one wants to conduct an experiment about a potential toxin on a pregnant woman, so many times we have to rely on animal studies or incomplete information.

That said, coloring your hair is probably safe. If coloring at home, I would place myself in a well-ventilated room and use gloves. Even safer options would be to avoid hair dyeing in the first trimester or to highlight instead of full color.

I would be more cautious about acrylic nails, considering they would need to be redone more often, and the fumes in nail salons are often pungent. I would take advantage of the stronger nails you have while pregnant and forgo the acrylic nails, or wear a mask at the salon.

Question 3:
Q. I have a granddaughter who would like to get pregnant but she doesn’t ovulate. Is this a common problem? What can be done?

Dr. Mitchell answers:
A. Of course, a woman needs to ovulate (release an egg from her ovary) in order to get pregnant. According to Gloria Halverson, MD, an infertility specialist and Associate Professor of Obstetrics and Gynecology at the Medical College of Wisconsin, anovulation (lack of ovulating) is a common cause of infertility.

The reason for anovulation varies and it’s not possible to know the reason in this particular granddaughter without knowing more of her health history. Either weighing too much or too little can prevent ovulation because our hormones are stored in our body fat. Excess of exercise, various medications and chronic illness also can cause lack of ovulation.

For many women, anovulation is caused by a hormonal imbalance involving the pituitary gland, the thyroid, the ovary or the adrenal gland or a combination of some of these. Rarely, premature menopause causes a loss of eggs.

There are many levels of treatment to jump-start ovulation. Halverson often starts with something as simple as taking five pills a month to stimulate the ovary. Or, later, she may recommend stronger fertility drugs that require monitoring with ultrasounds and blood tests. The good news is that more than 90% of women with anovulation are able to release an egg with appropriate treatment.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic – East. Her column also appears in the Milwaukee Journal-Sentinel.