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You want the healthiest pregnancy possible, but does that mean you should continue to take your nutritional supplements during pregnancy? This guide will help you to know which supplements are fine to continue in pregnancy and which should be discontinued.
If you are like most women, you are probably already taking some nutritional supplements. This could be a multivitamin, extra B vitamins, or perhaps you are on a preconception supplement program. No matter what you are taking, you want to take care of yourself and your developing baby, so questioning supplementation intake comes naturally. The problem is it can be difficult to find the right answers about the safety of taking nutritional supplements in pregnancy.
To be safe, there is a common sense rule of thumb doctors and midwives like to stick to: Don’t take any nutritional supplements or herbal supplements during pregnancy, unless directed to do so by your healthcare practitioner. I agree with this. A pregnancy should be supported first and foremost with good nutrition, including a high-quality whole food prenatal vitamin, plenty of filtered water, adequate rest and regular moderate exercise.
So, let’s get down to the nitty gritty of taking nutritional supplements in pregnancy…
Top nutritional supplements to continue in pregnancy:
Note: Please consult with your doctor or midwife before using any supplements during pregnancy.
Prenatal Multivitamin
Every single pregnant woman should be taking a prenatal multivitamin. We encourage pregnant mamas to take a prenatal vitamin that is 100% whole food. Prenatal multivitamins ensure mother and child are getting all the vital nutrients required for pregnancy. Prenatal multivitamins should not be a replacement for eating a nutrient rich diet, they should be the bridge to complete nutritional wellness. We like Baby and Me Multivitamin by MegaFood.
Cod Liver Oil – Omega-3 Essential Fatty Acids
There is a lot of research showing the benefits of supplementing with omega-3 essential fatty acids. We find the number one way to get high quality omega-3 is to supplement with cod liver oil. According to some research, cod liver oil may help make your baby smarter in the long-run by supporting healthy brain development.
Omega-3 fats contain two acids that are crucial to good health: DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). These two acids have been shown to be extremely healthy for the body. Low levels of DHA and EPA have been linked to depression and other mental health issues. DHA is essential for proper brain development, while EPA supports healthy behavior and mood. These are not only critical for the development of your baby, but to help prevent postpartum depression as well. Cod Liver oil is also naturally rich in vitamin A & D3, which are other key nutrients for proper development of a baby.
Learn all the benefits of continuing cod liver oil supplementation in pregnancy here…
For vegan or vegetarian mothers, supplementing with a DHA supplement instead of cod liver oil is going to be important.
Vitamin D3
Several studies have shown that humans are vitamin D3 deficient due to overuse of sunscreen, lack of sun exposure and lower dietary consumption.
Vitamin D3 helps with calcium and phosphorus absorption, essential to healthy bone formation. It also helps to support the immune system, regulation of cell growth, helps reduce inflammation, increases muscle strength, aids the body in hormone production, and may help prevent depression.
New research is showing that pregnant mothers may benefit from supplementing additional vitamin D3 outside of their prenatal vitamin to help prevent premature labor, preeclampsia, gestational diabetes and infections. Research has also shown that vitamin D3 supplementation in pregnancy promotes optimal bone-mass in the child later in life.
Traditionally 400 IU of vitamin D3 daily is the suggested recommendation for pregnant women, but several experts are now suggesting supplementation should be up to 1000 IU per day in pregnancy. Because prenatal vitamins typically already contain 400 IU and cod liver oil contains around 300-400 IU depending on the product purchased, it is important to be sure not to exceed the suggested daily maximum dosage of 1200 IU per day. Supplementing with too much vitamin D in pregnancy may cause hypercalcemia which can cause placental calcification and fetal arterial stenosis (narrowing of the aorta), both of which limit blood and oxygen supply to the baby. Choose a whole food sourced vitamin D3 supplement.
Calcium
Calcium is necessary for the proper formation of bones and teeth. It enables the blood to clot and muscles to work smoothly. This mineral may also help to prevent high blood pressure and preeclampsia.
It is important to get enough calcium every day because your baby’s body will be calcifying it’s bones. If you do not consume enough calcium your baby’s placenta and body will take it from your bones. Lack of calcium can also cause painful leg cramps in pregnancy.
Even if you are taking a good prenatal vitamin you may need to supplement calcium. It is best to take calcium on an empty stomach with magnesium and vitamin C for proper absorption. Most high quality calcium supplements should include these. Suggested supplementation is 1000mg a day. Do not exceed 1200 IU per day, as this may increase the risk of kidney stones for the mother and hypercalcemia of the placenta. Be sure to avoid dolomite, bone meal and oyster-shell sources of calcium, as these tend to be high in lead. A whole food source of calcium would be best.
Magnesium
This mineral plays an important role, along with vitamin D3 and calcium, in bone and tissue development in the fetus, as well as your own body. Along with calcium it may also help prevent leg cramps and promote restful sleep. Sleep is invaluable during pregnancy and lactation!
500 mg is the maximum dose per day, so be sure if you supplement additionally you do not exceed this amount. Many calcium supplements include magnesium.
Coconut Oil
Coconut oil supplies rich amounts of saturated fat with high amounts of lauric acid. Not only will your body benefit, but your baby will receive the same benefits. The saturated fat content helps you to build-up adequate fat stores in pregnancy and in preparation for breastfeeding. Fat stores are vital to maintaining adequate energy and proper body function for both pregnancy and lactation.
Lauric acid, found in coconut oil and also in breast milk has been found to have antiviral, antibacterial and parasiticidal (kills parasites) properties that support proper immune function. This may help to protect your and your baby’s health in pregnancy.
Coconut is a medium-chain fatty acid, which makes it easily metabolized by the body. It withstands high heat for cooking, making it a superior choice to olive, vegetable and canola oil. Add 2 Tablespoons of raw organic virgin coconut to your diet each day. It is excellent in smoothies or on toast, or even raw! Coconut oil is delicious and nutritious.
Spirulina
If you know anything about the work we do and the diet we support, you know we are huge proponents of green foods. Spirulina can be eaten as a food during pregnancy, added to smoothies, soups and sauces. This cyanobacteria is the most protein dense plant source known to man and is very high in a variety of vitamins and minerals.
Researchers in Mexico found that supplementation with spirulina in pregnancy may help to treat preeclampsia and prevent it from occurring at all, by providing pregnant mothers with nutrient dense nourishment. The maximum consumption of spirulina a day is 3000 mg.
Probiotics
Probiotic supplementation can help to keep your good gut bacteria at optimal levels. This will help to prevent illness, yeast infection and promote healthy digestion. Did you know that babies are born with a sterile gut and their gut flora is established by the time they are 3 years of age? Their first exposure to good bacteria is during birth, as they move through the birth canal. A mother contains good bacteria in the vagina. A baby also receives good bacteria through healthy breast-milk, so supplementation is suggested while nursing as well.
Be sure if you choose to take a probiotic supplement make sure it lists the genus, species and strain(s). Probiotics’ names are in three parts, listed in order. First is the genus name, second is the species and last is the strain. For example the label may say L. acidophilus NAS, which may simply be shortened to just Acidophilus. Be sure to avoid products that don’t list the genus, species and strain. Choose probiotics that are refrigerated, not pasteurized and say “contains live cells.” The supplement should contain at least a billion colony forming units (CFU’s).
Whey Protein Powder
Proteins are required for building and repair of the body’s tissues. The amino acids that make up protein are the building blocks of the body’s cells, including those of your baby. Protein is also an excellent source of energy. During pregnancy, a mother requires 70-90 grams of protein per day. Whey protein powder added to smoothies, soups, stews, etc., can help a woman to meet those requirements.
Our FertiliWhey contains 15 grams of protein per serving. It is derived from the milk of grass-fed cows that graze year round on natural pastures, is hormone-treatment-free, pesticide-free, chemical-free and does not contain GMOs.
If you are allergic to dairy, lactose intolerant or vegan, consider hemp protein powder instead.
Click here to see a kit with nutrient dense nutritional supplements for pregnancy…
Nutritional supplements that may be safe in pregnancy to continue individually, along with a prenatal vitamin:
The best way to get vital nutrients is through consuming whole foods rather than through supplementation. You can avoid having to take a variety of nutritional supplements, in most cases, if you eat a nutrient rich whole food diet and take a whole food prenatal vitamin.
In some cases nutritional deficiencies may occur during pregnancy, even while taking a prenatal vitamin. In the case of nutritional deficiency, a healthcare provider may suggest additional supplementation of a specific vitamin or mineral to help keep you and your baby healthy during pregnancy. Remember, always follow the product label guidelines for suggested daily use. Never exceed dose.
Folic Acid in the form of Folate
It is important that you begin taking folic acid before pregnancy occurs, this is because in the first few weeks of formation your baby’s spinal cord is forming. Folic acid has been found to help proper formation of the spinal cord, proper formation includes the closing up of the back around the cord. A good whole food prenatal vitamin should contain 800 mcg of folate, so you should not need to supplement additionally with folic acid, unless directed to do so by your healthcare practitioner. Up to 1200 mcg of folate is safe for pregnancy.
Iron
Your doctor or midwife will be checking to see if your iron levels are adequate, if they are not, they will encourage you to supplement iron. Iron helps with increased blood volume because it is vital for formation of blood cells, as well as transportation of oxygen to blood cells. Iron deficiency can lead to anemia.
Most iron supplements are constipating, which is extremely uncomfortable when you are pregnant. Choose a whole food iron supplement such as Blood Builder by Megafood or Iron and Herbs by Floradix. They are non-constipating and are easily absorbed. Suggested supplementation is 30mg a day. Consuming vitamin C rich food sources will help the body to absorb and utilize iron properly.
Vitamin E
Vitamin E in amounts up to 600 IU per day in the first trimester of pregnancy (use only 50 IU if you have high blood pressure, heart disease, or diabetes) has been shown to help prevent miscarriage in women with a history of recurrent miscarriage.
Vitamin E supplementation has been shown to help prevent premature rupture of the membranes (amniotic sac) in pregnancy. It appears that vitamin E may increase the quality of the amniotic sac.
Vitamin E may inhibit proper coagulation of the blood, therefore it should not be taken in high amounts close to delivery. Pregnant mothers should avoid taking more than 800 IU per day during the 3rd trimester on, this will decrease the risk of hemorrhage during and after delivery.
Vitamin C
Vitamin C supplementation, in addition to a healthy, vitamin C rich diet has been shown to reduce the likelihood of preeclampsia and premature rupture of the membranes in pregnancy. Large quantities of ascorbic acid is utilized by the female during conception and is necessary to formation and integrity of the fetal membranes. Research suggests vitamin C supplementation may also help prevent birth defects.
Suggested daily supplementation is 500 mg a day in addition to a healthy whole foods diet rich in vitamin C. Avoid taking more than 1000 mg per day.
Zinc
Zinc helps you to keep a strong immune system, heal wounds, metabolize fats and helps to regulate gene expression. Vegetarians and vegans are more likely to have a zinc deficiency. Deficiency in zinc may cause preterm labor and/or poor fetal development. The suggested amount of zinc supplementation intake in pregnancy is 15 mg per day. Since vegetarians and vegans tend to absorb less zinc from foods, a health care practitioner may suggest additional supplementation.
Systemic Enzymes
Systemic enzymes have been shown to be helpful throughout pregnancy to help prevent recurrent miscarriage due to immunological imbalances (see one study here) with the agreement/approval of your doctor. Your doctor will be able to suggest the correct dosage for your needs.
Nutritional supplements that should not be continued into pregnancy:
DIM (diindolylmethane)
DIM supports the body in metabolizing estrogen. It is not recommended for use during pregnancy or lactation.
If estrogen dominance was an issue for you prior to pregnancy, a great alternative during pregnancy, for continued estrogen metabolism support would be to consume 1-2 tablespoons of fresh ground flaxseed daily.
L-Arginine
This amino acid is not suggested for pregnancy because it may increase bleeding risk. It is also not suggested for use during lactation. L-Arginine is best taken in preparation for pregnancy.
There is some research that has shown its safety for use in combination with antioxidants in preventing preeclampsia for women with a history of preeclampsia due to nutritional deficiencies. In this case it should only be used while under the supervision of a doctor.
Green food powder mixes
Only consume green food supplements in pregnancy that do not contain any herbs or nutritional supplements that are not recommended for pregnancy such as royal jelly. Our FertiliGreens is not suggested for pregnancy because it contains some herbs not meant to be continued in pregnancy. A pure powdered spirulina or nutritious herbal pregnancy infusion is a better option for pregnancy.
Antioxidants blends
Antioxidant supplements shouldn’t be necessary to take during pregnancy. Not all nutrients considered to be antioxidants have been studied for safety in pregnancy or during lactation, so it is best to avoid them. Some antioxidant blends like Network Antioxidants contain medicinal herbs. Most all medicinal herbs should be avoided during pregnancy and lactation. Antioxidant blends are best taken in preparation for pregnancy.
Important antioxidants like vitamin A, E, & C should all be included in your prenatal vitamin and are an important part of preventing preeclampsia.
In very rare cases severe nutritional deficiencies have been found in pregnant women. In those cases, a doctor may require the pregnant mother to take an antioxidant blend.
Bee Products: Bee Pollen, Royal Jelly, Bee Propolis
Do not use bee products during pregnancy if either side of your family or the father’s family has a history of bee, pollen or honey allergy. Royal jelly has an action on hormones, which is considered by some, unsafe for use in pregnancy. If you choose to continue bee products in pregnancy, notify your healthcare practitioner.
CoQ10 Ubiquinol
There is limited research done to prove that CoQ10 ubiquinol supplementation is safe for pregnancy or lactation in the general population of pregnant women. One study of 235 women at increased risk of preeclampsia, showed that 200 mg supplementation daily of CoQ10, lowered the risk of developing preeclampsia. Women with a history of preeclampsia may wish to speak to their doctor about CoQ10 supplementation during their pregnancy. In general, it is best to take this supplement prior to pregnancy.
Vitamin B Complex
B complex supplements include thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), biotin, folic acid and the cobalamins (vitamin B12). Vitamin B complex is not suggested in pregnancy because a good quality prenatal multivitamin contains or exceeds a pregnant woman’s daily needs of all these important B vitamins.
Omega Essential Fatty Acid Blends
Due to the omega-6 content in these blends, they are not recommended for use during pregnancy. Borage oil is often the source of the omega-6 in these blends, which may cause uterine contractions.
Thyroid Supplements
Thyroid supplements usually contain key vitamins and minerals for proper thyroid function. They may also include herbs for thyroid and endocrine system support. Thyroid supplements are not suggested for use during pregnancy or lactation, unless directed to do so by your healthcare practitioner. Thyroid health is best monitored by a doctor.
Adrenal Health Supplements
Adrenal health supplements usually contain key vitamins and minerals for proper adrenal gland function. They may also include herbs for adrenal gland and endocrine system support. Adrenal health supplements are not suggested for use during pregnancy or lactation, unless directed to do so by your healthcare practitioner.
Herbal Supplements
Most all medicinal herbal supplements should be avoided during pregnancy. There are some that are safe to consume in pregnancy, but for the most part they should be avoided. If you are interested in taking herbs during pregnancy, it is imperative you work with a midwife trained in herbal medicine or with an herbalist in your area.
Learn which fertility herbs are safe for pregnancy here…
Learn which fertility herbs are safe for breastfeeding here…
Learn the safe way to discontinue herbs in pregnancy here…
- Watson, L. (n.d.). Too Much of a Good Thing. Retrieved from http://drlisawatson.com/too-much-of-a-good-thing
- Mama, K. -. (n.d.). Supplements for Pregnancy & Nursing | Wellness Mama. Retrieved from https://wellnessmama.com/4403/pregnancy-nursing-supplements/
- Barton-Schuster,, D., CH, Doula. (n.d.). Vitamin E Essential to Improve Fertility. Retrieved from http://natural-fertility-info.com/vitamin-e-essential-to-improve-fertility.html
- Barton-Schuster,, D., CH, Doula. (n.d.). Improve Your Fertility With Vitamin C. Retrieved from http://natural-fertility-info.com/vitamin-c-to-improve-fertility.html
- Rumiris D, Purwosunu Y, Wibowo N, Farina A, Sekizawa A. Lower rate of preeclampsia after
antioxidant supplementation in pregnant women with low antioxidant status. Hypertens
Pregnancy. 2006;25(3):241-53. http://www.ncbi.nlm.nih.gov/pubmed/17065044 - VadilloOrtega F, PerichartPerera O, Espino S, AvilaVergara MA, Ibarra I, Ahued R, Godines
M, Parry S, Macones G, Strauss JF. Effect of supplementation during pregnancy with Larginine
and antioxidant vitamins in medical food on preeclampsia in high risk population: randomised
controlled trial. . BMJ. 2011 May 19;342:d2901.
doi:10.1136/bmj.d2901. http://www.ncbi.nlm.nih.gov/pubmed/21596735 - Rodriguez, H., C.H., C.M.T. (n.d.). How to Use Systemic Enzyme Therapy to Increase Your Fertility…. Retrieved from http://natural-fertility-info.com/fertility-enzyme-therapy
- LargemanRoth, Frances, R.D. Feed the Belly, Sourcebooks, Inc. 2009
- Murray, Michael T., N.D. Encyclopedia of Nutritional Supplements, Three Rivers Press,1996
- Barton-Schuster,, D., CH, Doula. (n.d.). Royal Jelly, Bee Pollen & Bee Propolis for Fertility. Retrieved from http://natural-fertility-info.com/bee-pollen-fertility.html
- Teran E, Hernandez I, Nieto B, Tavara R, Ocampo JE, Calle A. Coenzyme Q10
supplementation during pregnancy reduces the risk of preeclampsia. Int J Gynaecol Obstet.
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Practicing natural health and herbalism since 2000, Dalene received her training and certification under the guidance of Lynn Albers at Yarmony Mt. Herbal College in Colorado. She went on to become a Certified Birth Doula at Birthingway College of Midwifery in Portland, Oregon in 2007.
I have a question about vitamin e supplementation. I’ve seen 400 IUs recommended for women with a thalassemia trait, which I have (but my husband does not). And this webpage suggested that up to 600 IUs is okay. However, a general google search suggests that vitamin E supplementation is harmful. Please help me understand why you are saying that supplementation is safe. I’ve had two previous miscarriages.
Thank you,
Michele
Dear Michele,
It is always best to follow the advice of the practitioner guiding you. I venture a guess that the search done perhaps didn’t differentiate between synthetic vitamin E and food sourced vitamin E. The latter not toxic to the body. Vitamin E should be consumed by eating a diet rich in a variety of different whole foods. Foods that are rich in vitamin E are: Raw vegetable oils, nuts, nut butters, rice bran oil, barley, seaweed, green leafy vegetables, asparagus, avocado, berries, and tomatoes. It is not harmful from food! If you need to supplement, choose one made from a natural source.
Hi there, I was wondering if taking Maca was ok during pregnancy, I have been using it pre- pregnancy.
Many thanks
Abbey
Dear Abbey,
Since there have been no studies on the use of Maca during pregnancy, we can’t state that it is proven safe to use during pregnancy. We don’t suggest it’s use in general due to this. Please do your own research and make a personal decision on the use of Maca during your pregnancy.
Congratulations!
Thanks for your previous response Elizabeth 🙂
Also wondering… if I haven’t taken any spirulina or green supplements during pregnancy, if I were to start now at 28 weeks along, would that be too detoxifying/chelating? I’ve bought some spirulina capsules, although I’m just a little concerned that it might be too much for the baby?
Thanks 🙂
Dear Trisha,
You are welcome! 😉
To my knowledge pure Spirulina is perfectly fine in pregnancy. Our guide, Spirulina: Nutritional Fertility and Pregnancy Support will share more information.
I can not speak to the “green supplements” mentioned.
Hi,
I am very interested in taking spirulina as a supplement during pregnancy (I’m now almost 28 weeks along). I see that taking 3,000 mg per day (recommended here and elsewhere as the max) would provide around 7500 to 8000 IU of Vitamin A (beta carotene) … if I am also taking a whole food prenatal multivitamin which provides 5000 IU of beta carotene (total of 3 capsules), wouldn’t that be too much beta carotene/vitamin A then?
I am very interested in taking spirulina, and many sites recommend taking a prenatal multivitamin along with a spirulina supplement, although it seems confusing as it’d be too much beta carotene/vitamin A… right? Please let me know what you think
Dear Trisha,
Congratulations on your pregnancy! I hope you are feeling well!
This is a controversial topic indeed. What I have learned is that tolerable upper intake levels (ULs) of preformed vitamin A in pregnancy and lactation (from foods and whole food supplements) for women ages 19+ is 3,000 mcg RAE or 10,000 IU per day. I share more information about vitamin A consumption in pregnancy that you may be interested in in my guide Is Vitamin A Dangerous for My Pregnancy and Baby?
All my best!
Hi! I have the same concern as Trisha. Mine prenatal has 1500 IU vitamin A (retinyl palmitate) and 4000 IU Vitamin A (mixed Caratenoids). Could I take just one 1000mg capsule of the spirulina to keep below the 10,000 IU and still get the benefits of the spirulina?? Hoping I dont also eat vitamin A rich foods over 1900 IU in addition to my prenatal and 1 spirulina because then I would be over the 10,000 safety limit. Would love to know your thoughts. Thank you
Hi Amanada!
I first would like to share my guide Is Vitamin A Dangerous for My Pregnancy and Baby?
Yes, one 1000mg capsules of Spirulina will still offer you benefit. Know that vitamin A from whole foods should not be a concern!
I wanted to make a comment on the vitamin D and placental calcification. I am not a physician (former L&D nurse and now a holistic nutritionist) but I am knowledgeable about D3, which necessary for the gut absorb calcium; and calcification. An important and often overlooked vitamin, K2, is necessary to then deliver that calcium to the bones and teeth (rather than kidneys, arteries, and I suppose the placenta). I recommend reading Vitamin K2 and the Calcium Paradox by Kate Rheume-Bleue if you want to delve deep into the topic. A D3 level of 80 is great, but I would personally take K2 to balance that. There is no specific recommendation, it is likely a ratio that may differ per individual.
Hi-
I had IUGR with my first pregnancy and all that came up was that I had calcifications on my placenta. I am not a smoker so I’m wondering if it was too much D supplementation? My first pregnancy, my D-levels were at 30, this time I was checked and I’m at 80. I do raw egg yolks daily and I’m wondrering if perhaps I should skip the Vitamin D3/K2 drops I’ve been taking? I’d love to avoid getting induced early bc of a failing placenta this time around. I’d love your thoughts / advice / opinion.
Hi Merle,
Thank you for contacting us with your concerns and questions. There are many things that can cause calcification on the the placenta besides cigarette smoking. I have never heard of a correlation between vitamin D supplementation, the calcification of the placenta and IUGR. I think your questions would be better suited to your doctor or midwife. Definitely go with your gut, if you are concerned, call your healthcare provider, they will know more than I will and they have your health history on file.
May you have a healthy pregnancy and baby!
I don’t understand how you can say you never heard of it when the reason I commented on THIS SPECIFIC ARTICLE, on this page is because it says: ‘Supplementing with too much vitamin D in pregnancy may cause hypercalcemia which can cause placental calcification and fetal arterial stenosis (narrowing of the aorta), both of which limit blood and oxygen supply to the baby. Choose a whole food sourced vitamin D3 supplement.”
Hi Merle,
You are correct about the statement in the article and I apologize if my response was confusing. I meant that I have never heard of a correlation between IUGR and too much vitamin D supplementation. I guess we could assume that they could be connected due the possibility of hypercalcemia, but without further research, there is no way to know. That is why I said what I said before. Without knowing for sure, it is all speculation. If you are concerned this may be an issue for you, you can certainly bring it up to your doctor, letting them know what you learned about the development of hypercalcemia in pregnancy due to too much vitamin D3 supplementation.
Because I am not a medical doctor, I cannot comment on your vitamin D test results. I think you should talk to your doctor about your concerns.
I hope that helps clear things up.
I see that your recommendation on vitamin D3 is no more than 1200 IU per day while pregnant, however I have been reading in numerous other publications that the recommendation is closer to 4000 IU per day for optimal prenatal health. Can I ask why your recommendation is so low?
Dear Jennifer,
The suggestion to not exceed 1,200IU of vitamin D3 per day is because as shared, “Supplementing with too much vitamin D in pregnancy may cause hypercalcemia, which can cause placental calcification and fetal arterial stenosis (narrowing of the aorta), both of which limit blood and oxygen supply to the baby.” Neither of these issues we want even of course.
Ultimately it is best to talk to your doctor about your specific need for vitamin D3 supplementation and follow his/her guidance.
Thanks for asking!
is it safe to take alivher tablets and gro 9 sachets during pregnancy?
Dear Tajma,
My apologies, I am not familiar with Alivher tablets or Gro 9 sachets. Please reach out to the manufacturers of these products or your healthcare provider to ask them your question.
Best wishes!