The best way for a doctor or other health professional to use fluoride in early pregnancy is to encourage women of childbearing potential to visit before pregnancy. In addition to other known methods to prevent birth defects, fluoride, at a dose of .5 mg F, should be prescribed, to be taken orally once per day, until the end of the second month of pregnancy.

The best way for a mother-to-be to use fluoride in early pregnancy is to see her doctor before pregnancy. If her doctor is not already well-versed in the importance of fluoride nutrition, she should ask the doctor to prescribe fluoride as above.

Fluoride is a safe and simple nutrient at this dosage. Almost all modern women seem to be deficient in fluoride and are therefore in need of such treatment. This includes women in areas with fluoridated water.

It is already known that prenatal vitamins with folic acid will prevent birth defects if started early in pregnancy. It is highly recommended to take both fluoride and prenatal vitamins.

A small packet of convincing evidence. I think a person could make a good and easy case for the use of fluoride in early pregnancy with just 3 papers already cited. (Almost any librarian can get you a copy of these for about $1 each.)

1.      The New  England Journal of Medicine  December 24, 1992, page 1832, by Dr. Andrew Czeizel. (Use of prenatal vitamins, folic acid, etc. in early pregnancy to prevent neural tube defects.)

2.      American Journal of Obstetrics and Gynecology 143:560-64. Glenn FB, 1982 Fluorideduring pregnancy(Safety and efficacy of fluoride prescriptions in pregnancy.)

3.      Archives of Environmental Health 48(2):105-13. Aschengrau A, 1993. drinking water andadverse pregnancy outcomes. (Fluoride, specifically in early pregnancy, reduced adverse outcomes, including birth defects.)

Choice of doctor. A woman interested in preventing birth defects should see her doctor well before pregnancy. Generally this doctor would be an OB (obstetrician). A tremendous advantage of an OB is a very current knowledge of all of the other factors (chemicals, drugs, genetics, etc.) that are known to cause birth defects. Roughly 10% of OBs are already prescribing prenatal fluoride (for the childs teeth, a little later in pregnancy) on a routine basis. About 70% will prescribe prenatal fluoride, if asked by the woman. (An excellent and entertaining book on prenatal fluoride just came out: How to have children with perfect teeth, Glenn FB 2000.)

Another choice as a source of fluoride is a womans dentist. About 50% of dentists will say that the best time to start fluoride is during pregnancy, and most will prescribe it if asked.

A pediatrician is another choice. About 90% of pediatricians prescribe fluoride for infants on a routine basis. Pediatricians are usually far more familiar with nutrition and how it affects children as they grow up.

Prescription products to use. There are many safe and effective forms of the mineral fluorine, which are generally known as fluoride. There are at least three types of prescription products that will be convenient to administer.

(Other nutrients. Very early in this paper I mentioned that there were other nutrients that may prevent birth defects. Although I have only covered fluoride, ideally a person taking fluoride to prevent birth defects would also include a reasonable dose of all of these other nutrients. In the first 2 prescription recommendations below I will give a few sources that do that. When I recommend a product below, if I say it also has all the common nutrients, I mean all of this list: folic acid, vitamin A (the first two of the sources below are a combination of beta carotene, which is equivalent and safer in early pregnancy, and vitamin A), vitamin B12, vitamin D, copper, and zinc. If I say it has the trace nutrients, I mean this list: chromium, manganese, and selenium. The final list is the 2 amino acids lysine and methionine. As far as I know you have to get them separately at a store like GNC, so I wont mention them again.)

1.  Plain sodium fluoride tablets, 2.2 mg NaF, provide 1 mg F. A half tablet  will provide .5 mg F. This form of fluoride would go well with a prenatal vitamin.

There are at least two brands of prenatal vitamins that contain all of the common nutrients and all the trace nutrients. Materna® by Lederle is available by prescription from your doctor. VITA-MIN® can be ordered (by you or your doctor) from BioTech Pharmacal 1 800 345-1199.

Another brand available in some countries, Elevit Pronatal®, from Hoffmann-LaRoche 1 800 526-0189, has all but chromium and selenium (available separately at health food stores), and has been shown to prevent about 50% of birth defects in well-accepted clinical trials (Czeizel, above).

(I last checked the other top 10 prenatals listed in the PDR 2002, and most were missing the trace nutrients and some were missing a few of the common nutrients. The best, which were missing only chromium, selenium, and manganese, were Nestabs, Obegyn, and StuartNatal. Below is a little table you might find handy if you're looking at products.)

2.  At least 1 adult vitamin-mineral product contains .5 mg F. It is o-cal f.a.® from Pharmics 1 800 456-4138. It also supplies the common nutrients, but to get the trace nutrients, you would also need a trace element mix such as Essential Minerals® from VRP 1 800 877-2447. One tablet of this (not the 3 shown on the label) will give a reasonable dose. (Another trace element mix is Right Choice® from Body Wise®, Carlsbad CA. 1 caplet. The big chain GNC® 1 877 716 6862 was one of the first businesses to promote folic acid supplements in early pregnancy, and they have at least one trace nutrient product, I think called Trace Element Mix. )

3.  Pediatric products will give the dose of fluoride (.5 mg F) and other vitamins and minerals that pediatricians use for small children.

4.  A fourth choice is to ask your doctor to ask your pharmacist to custom make a product for you. This one is expressly designed for periconceptual (the period near conception) use. This is an ideal product that would contain both fluoride (.5 mg F) and the state of the art in other nutrients for early pregnancy. Here is the recipe:

Fluoride .5 mg F (1.1 mg NaF), Beta Carotene 8000 USP units, Vit D3 400 USP units, Vit E (d-Alpha Tocopherol) 30 USP units, Vit C (Ascorbic Acid, Mn, Zn Ascorbate) 120 mg, Folic Acid 1 mg, Vit B1 1.7 mg, Vit B2 2 mg, Vit B3 20 mg, Vit B6 10 mg, Vit B12 (Resin Adsorbate) 8 mcg, Biotin 150 mcg, Pantothenic Acid 10 mg, Ca (Citrate) 500 mg, Fe (Gluconate) 50 mg, Mg (Cl) 150 mg, Cu (Cupric Oxide) 2 mg, Zn (Ascorbate) 25 mg, Mo (Na) 25 mcg, Mn (Ascorbate) 5 mg, Cr (Cl) 25 mcg, and Se (Chelate) 25 mcg.

Non-prescription products to use. Fluoride may also be purchased without a prescription. Here are 5 examples.

1.  Probably the "mellowest" fluoride you can take in a pill is in a product called Bone Nourisher from L&H Vitamins, Inc. (1 800 221-1152 or http://foodform.com/). Three of their tablets combined contain 1 mg F, so each one is about .3 mg F. (I didn't figure in the calcium effect on this one, but it would probably further reduce the dose to .1 mg.) A very gentle start program could be taking one tablet, one meal per day, for a week or so, then two meals a day, then three.

2.  Monocal® from Mericon has 3 mg F actual, but it has enough calcium to make only about 1 mg of that available. There are a few ways you can get this down to .5 mg F: taking a half pill, or taking a whole one every other day, or taking a whole one with the biggest meal of the day. There is a similar product, Florical®. These are very high-quality calcium supplements, and sell for about $13 per 100 pills. These products are sold behind the counter, meaning you dont need a prescription, but you have to ask the pharmacist for it. (Ive tried all the F products, for me, just as an adult, and Monocal is my overall favorite.)

3.  A good source is ocean fish, in a can and including the bones. A large serving (about 170 g, or 6 ounces) of canned salmon a day is a delicious choice, which also provides calcium and many other important nutrients for pregnancy.

4.  Bone meal tablets, about 8 tablets a day, are another choice.

(Either of these last two choices above will provide the bioequivalent of a 1.1 mg NaF (.5 mg F) dose.)

5.  Some baby waters have .5 mg F per liter. (Both Wal-Mart and K-Mart have one that comes in a gallon jug.) Roughly 4 glasses per day would be fine. Trinity Springs Mineral Water® has 3.7 mg F per liter bottle. One half cup per day would be fine.

Doses to use. It is my opinion that .5 mg F is a fine dose to use for all modern women. This will not be too much for any woman who is living in normal circumstances. A dose of .5 mg F should be enough even for someone who was getting no other sources of fluoride. However, it is not too much trouble to get a daily dose that is a little more exact:

Fluoride doses (mg F, NaF equivalent) for early pregnancy

(* High risk is defined here as parents who already have 1 child with both birth defect and some sign of fluoride deficiency [enamel defects, pits and fissures, caries, or malocclusion], or parents who had birth defects as children and are now having children of their own, or HIV infected mothers-to-be [= over 10 times the risk of heart defects, 12%  vs  .8%], or parents going through infertility treatment, which appear to have roughly 2X the risk for birth defects.)

(** There are no known risks with any of the doses in this table, and the following cautions may be ignored. However, doses of higher than .5 mg are probably more than a natural meals intake. For extra care, particularly between day 17 and 57 of pregnancy, intakes of over .5 mg could be taken in separate doses. Care could also be taken to not cause a sudden increase in fluoride intake during early pregnancy. I suggest increasing the dose by .5 mg a day, or starting before pregnancy.)

The lowest dose I would use under any circumstances is .01 mg F per day, and the highest would be 10 mg F per day in sodium fluoride (NaF) equivalents. Some formulations of fluoride (for example, with lots of calcium) have a high mg F, but actually deliver to the bloodstream about a third as much fluoride as an equivalent amount of sodium fluoride.

Timing of preventing birth defects. In order to prevent a birth defect that is caused by a nutrient deficiency, it is necessary to begin taking the nutrient before the defect occurs. For neural tube defects and heart defects this is about the 21st day after conception, and for cleft lip about the 42nd day. The precise timing of all birth defects is not known, but the vast majority occurs in the period that begins near conception and ends about 2 months later. It would be best to start this prevention program before conception if possible.