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Collagen is a protein that is found in many parts of the body, including the cartilage between bones. Since collagen is made up of amino acids, the building blocks of protein, it has been hypothesized that the body can use the amino acids in collagen supplements to protect and rebuild joint cartilage that has been damaged by osteoarthritis (OA) and rheumatoid arthritis (RA). The research on the effectiveness of collagen in these conditions is mixed but shows promise. What Is Collagen? Collagen is known as the most abundant protein in the body. It is the main component of the body’s connective tissues and can be found in skin, bones, cartilage, tendons, and teeth. Tough bundles of collagen, called collagen fibers, support most of the body’s tissues and can be found inside and outside cells. The word "collagen" comes from the Greek word for glue because it acts as a glue between cells and provides structure to the body's organs. For this reason, a drop in collagen levels in the body will cause the skin to lose its shape. Many people therefore take collagen supplements to preserve their skin health. Similarly, low collagen levels can loosen cartilage and tendons, making them more vulnerable to injuries. Types of Collagen Natural Collagen There are 16 types of collagen, with the most common types in the body being:3 Type I: Found in skin, tendons, internal organs, and the non-mineral parts of the bone Type II: Found in cartilage, allowing cartilage to be springy and cushioning the stress on joints Type III: Found in the liver, bone marrow, and lymphoid These three types of collagen make up 80% to 90% of the collagen in the body. Collagen Supplements Collagen supplements also come in three types: Gelatin Hydrolyzed Undenatured Gelatin and hydrolyzed collagen have been broken down from large proteins to smaller bits.3 When collagen is boiled for a long time, it turns into gelatin. Collagen can be further predigested into its basic amino acids and is called collagen hydrolysate, hydrolyzed gelatin, collagen peptides, or hydrolyzed collagen. Undenatured collagen is not broken down into smaller proteins or amino acids. Undenatured type II collagen (UC-II) is not intended to be used by the body as a collagen rebuilder. Health Benefits of Collagen for Arthritis Collagen type II is most often used to treat pain in osteoarthritis and rheumatoid arthritis. It is usually taken from chickens. It is said to work by causing the body to produce substances that fight inflammation, but this has not been proven. Chicken collagen contains the chemicals chondroitin and glucosamine, which may help rebuild cartilage. However, studies on supplementing with chondroitin and glucosamine have been mixed, and there is no convincing information on the efficacy of these two chemicals on OA.5   Uses in Osteoarthritis Osteoarthritis (OA), also known as degenerative joint disease, is one of the most common forms of arthritis, affecting more than 32.5 million adults.6 It occurs when the cartilage that protects the joints wears down over time. It is said that collagen supplements may help in rebuilding joints and reduce inflammation in osteoarthritis, but clinical evidence is mixed. One study showed that when patients with knee osteoarthritis were given acetaminophen and collagen, significant improvements in their joint pain, function, and quality of life were reported.7 This was, however, a small study and included only 39 subjects. A systematic review focusing on osteoarthritis and cartilage repair found that collagen hydrolysate and undenatured collagen showed some potential as an option for managing osteoarthritis, but further investigation is needed before any definite conclusion on their effectiveness can be made.8 Uses in Rheumatoid Arthritis Rheumatoid arthritis (RA) happens when the body’s immune system attacks healthy cells by mistake, causing painful swelling mainly in the hand, wrist, and knee joints. In RA, the lining of the joint becomes inflamed, damaging the joint tissue. Research studying the use of collagen supplements in RA has yielded mixed results as well. A study that looked at both OA and RA noted that reports of positive results with oral collagen in RA remain controversial, particularly when compared with conventional therapies such as methotrexate, a drug designed to slow down the progression of RA.9 Research into oral collagen for OA in the form of UC-II and partially denatured collagen has shown promise as a pain reliever for those suffering from OA. However, there are still not enough large and long-term studies to verify the effectiveness of collagen in these conditions. Overall, oral collagen supplementation has achieved some positive results against RA in preclinical and clinical studies. Possible Side Effects Side effects vary depending on which type of collagen supplement you take, but they are generally minor overall. Possible side effects include: Upset stomach Diarrhea Rashes, or skin reactions Nausea Constipation Heartburn Headache People with allergies to fish, shellfish, chicken, or egg should avoid taking collagen supplements since many of them contain these ingredients. Collagen supplements haven't been tested for safety, so people who are pregnant or breastfeeding should avoid using these products when possible. Doses and Preparation The best dosage for collagen supplements has not yet been established, but studies have used daily doses of between 1 g and 10 g of collagen hydrolysate and 0.1 mg to 1 mg of chicken or bovine type II collagen.10 UC-II should be taken in very small doses, usually 20 mg to 40 mg per day, while gelatin and hydrolyzed collagen should be taken in higher doses, 10 gm per day.3 Collagen supplements come in powder, capsules, drink mixes, concentrated elixirs, gummies, and chewable tablets. What to Look For Unlike prescription and over-the-counter medications, the Food and Drug Administration (FDA) does not approve dietary supplements like collagen for safety and ability to produce results. Organizations do exist that oversee nutritional supplements like collagen, however. Look for seals of approval from U.S. Pharmacopeia (USP), ConsumerLab, or NSF International to be sure the products are manufactured properly.3 The USP Dietary Supplement Verification Program gives a USP verified mark to products that met the program's strict testing and evaluation criteria.11 If you are looking for collagen that is easy to take, look for hydrolyzed collagen powder. It usually has no flavor or color, unless it is added, and dissolves easily in beverages, smoothies, soups, and sauces. Powdered collagen can be added to drinks or food. It mixes best with cold liquids but can be added to warm or hot liquids as well, although it will need more mixing if added to hot liquids. A Word From Verywell Even though collagen is considered a natural supplement, always tell your healthcare provider if you are taking collagen or any other dietary supplements. Collagen has been shown to be helpful for some people in reducing the symptoms of OA and RA. However, more research is needed for collagen to verify its effectiveness and ensure its safety in different people. That said, collagen supplements usually cause very mild effects. It's still important to watch out for side effects and let your healthcare provider know if you experience any changes to your health while on collagen supplements.

Both mother and fetus need sufficient nutrition. The first 1000 days of life is a crucial period in pregnancy and nutrition plays a significant influence on the growth and development of a child in this period. Good nutrition can be obtained from sufficient macronutrients and micronutrients in the body. Micronutrients can be obtained from minerals and vitamins contained in food and supplements. Micronutrient deficiency still becomes a serious issue for women of reproductive age, especially pregnant women. This issue is quite common in developing countries. One of the micronutrient deficiencies is vitamin D. 1,2 Vitamin D is a fat-soluble vitamin that can be obtained from some food sources including milk, fish, and eggs, but only in small amounts.1 Vitamin D is also produced and activated in the body through exposure to sunlight.1,2 Generally, vitamin D mostly can be obtained from vitamin D3 supplements. Vitamin D is divided into vitamin D2 (Ergocalciferol) which is found in many foods, vitamin D3 (Cholecalciferol) which is a measurable form to increase body vitamin D levels obtained from supplements, Calcidiol or serum 25-hydroxyvitamin-D ( 25-OH-D) which is a measured parameter of vitamin D levels in the body, and calcitriol which is the active form found in blood plasma.1,2  The main mechanism of action of vitamin D is the metabolism of calcium and phosphorus which are beneficial for bone mineralization. However, vitamin D has receptors spread almost throughout the body. Therefore, besides calcium and phosphorus metabolism, vitamin D also has an important role in the immune system. A deficiency of vitamin D can cause various health problems such as allergies, autoimmune, and cancer. 1,2,3 The measurement of Vitamin D levels can be through serum concentrations of 25-OH-D as an indicator of vitamin D status in the body. A minimum vitamin D level of 20 ng/ml is needed to avoid bone disorders, but with various metabolic interactions in the body, it is considered to be deficient in vitamin D if the serum 25-OH-D level is lower than 32 ng/ml. Currently, vitamin D deficiency still becomes a global issue and is mostly experienced by pregnant women.1,3 Vitamin D deficiency in pregnancy mostly occurs in a population with high risk such as vegetarians, women who rarely sunbathe or have limited access to sunlight, and are black race. 4 Pregnant women need vitamin D as Vitamin D levels in newborns depend on vitamin D levels during pregnancy. Thus, if pregnant women have a low Vitamin D level, it can also affect the fetus or baby 3,4 Vitamin D deficiency is associated with various disorders and health problems considering that vitamin D receptors are found in almost all parts of the body such as the reproductive tract, ovaries, endometrium, and placenta.5 Serum levels of vitamin D in pregnant women have decreased during pregnancy due to the increased physiological needs of the fetus. Vitamin D levels will be needed more along with the age of the gestation period. In the 2nd and 3rd trimesters of pregnancy, the need for vitamin D will increase.3,4,5 In pregnancy, vitamin D deficiency is associated with various problems in both the mother and fetus. For mothers, this can increase the risk of hypertension in pregnancy, premature birth, and diabetes in pregnancy, while for the fetus, it can increase the risk of low birth weight, and bone mass abnormalities which can lead to several diseases such as rickets and fractures in newborns, attention deficit hyperactive disorder behavior (ADHD) and autism. 3,4 The recommended dose of vitamin D is different for each person. However, adults in general can regularly consume 1000-4000 IU per day. 2,4,6 Pregnant women are recommended to get vitamin D supplements of 400 -600 IU per day. The administration of vitamin D at a dose of 1000-4000 IU per day is considered safe and has an effect.2-7 Research conducted states that consumption of vitamin D at a dose of 4000 IU per day for 6 months in pregnant women is considered safe and provides good benefits. Indeed, consuming vitamin D should be done by checking the initial serum vitamin D level in the body and checking it periodically within 3 months to see changes in the body's vitamin D levels for adjustment.1-7 Routine vitamin D administration is safe since early pregnancy. Clinical studies reveal that no toxicity occurs with the use of 30,000 IU of vitamin D3 per day as long as the serum vitamin D level is below 200 ng/ml.1,3   Conclusion Vitamin D supplementation at a dose of 1000-4000 IU per day for pregnant women is considered safe and can provide good benefits to both the pregnant woman and the fetus or child. [1] The provision of vitamin D supplements in pregnancy has been proven to improve fetal growth and reduce the risk of low birth weight, hypertension in pregnancy, premature birth, and gestational diabetes. Besides, pregnant women with sufficient levels of vitamin D contribute to the reduced incidence of enamel defects in their babies as well as a reduced risk of attention deficit hyperactive disorder (ADHD) and autism.1-7   References 1. Bi WG, Nuyt AM, Weiler H, Leduc L, Santamaria C, Wei SQ. Association between vitamin D supplementation during pregnancy and offspring growth, morbidity, and mortality: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018 2. Mousa A, Naqash A, Lim S. Macronutrient and Micronutrient Intake during Pregnancy: An Overview of Recent Evidence. Nutrient. 2019; 11(2). 3. Lopez P, Faustino R, Stefan P, Peter C. Vitamin D supplementation during pregnancy: an overview. Current Opinion in Obstetrics and Gynecology. 2020; 32(5):316-321 4. ACOG Committee. Vitamin D: Screening and supplementation during pregnancy. Obstet Gynecol. 2011; 118(1): 197-198. 5. Franasiak JM, Lara E, Pellicer A. Vitamin D in human reproduction. Current Opinion in Obstetrics and Gynecology. 2017; 29(4):189-194. 6. Mithal A, Kalra S. Vitamin D supplementation in pregnancy. Indian J Endocrinol Metab. 2014; 18(5): 593-596. 7. Sass L, Vinding RK, Stokholm J. Pregnancy and Neurodevelopment in Childhood. JAMA Netw Open. 2020; 3(12)