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Prescription vs. Over-the-Counter Prenatal Vitamins

Apr28

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Hi Amy!

I am currently in week #12 of Project Incubation. This is my second baby. When I was pregnant 2+ years ago my doctor prescribed my prenatal vitamins. Some fancy schmancy pills that cost me $60/month because my insurance didn’t cover the brand. I figured the baby’s health was worth 2 bucks a day. PLUS, I was sure these pills were far superior because they were expensive which logically equates to better. GO USA!

Advice Smackdown ArchivesThis time my doctor told me the over the counter store brand vitamins I was taking before my first appointment are just fine. What gives? My brain tells me that the basic content of both brands is probably equal, but what about the special fish oil/DHA/Omega3 bells and whistles from last time? Am I dooming baby #2 to live in big brother’s brainy shadow for the rest of his/her life? Can 10 cent vitamins really equal the benefit of the two buckers?

jennifer

Like you, my doctor gave me a prescription for my prenatals during my first pregnancy. They cost $30 a month and made me terribly ill, so for the first three months I could not even keep those pricey pills down on a regular basis. My doctor suggested switching to an over-the-counter (OTC) brand, which I did. (After a little trial-and-error — the first bottle I purchased were foul-smelling tablets the size of quarters that I couldn’t even swallow. I went with a nice coated caplet next.) Neither vitamin option featured the extra Omega-3s or DHA, because I guess FIVE WHOLE YEARS AGO is officially the Pregnancy Dark Ages now. I eventually switched back to the prescription version once the nausea abated because, like you, I just assumed they HAD to be “better.”

For my second pregnancy, he wrote me a prescription again but point-blank told me NOT to feel pressured to use it. He said something along the lines of prescription versions being “fancy” now (since the brand he recommended included two separate pills: a multi and a DHA supplement), but that it was entirely possible to get all those benefits from OTC versions. Since he knew my struggles with morning sickness, he mostly advised me to take whatever I could keep down, provided I included some folic acid. “Take a Flintstones if you have to,” he said.

The prescription version was again $30 a month, and after adding up the cost of a regular OTC prenatal AND the DHA supplement (not to mention the convenience of Target Pharmacy’s auto-fill and reminder service), the difference was negligible. The new brand didn’t make me sick like the first time, so I stuck with the prescription version until I ran out of refills sometime around three months postpartum. At that point I switched to the OTC version for the remainder of my breastfeeding months.
If I’d been paying the full out-of-pocket price for those “fancy” pills month after month, you betcha I would have probably gone with the OTC version, with

my doctor’s blessing, the second time around. But I remember standing in Whole Foods during my first pregnancy, contemplating a good half-dozen prenatal vitamin options, staring blankly at the labels in paranoid terror because what if I chose the wrong one? The ones from the pharmacy seemed…easier, safer. Pregnancy-medical-establishment approved. What if these other ones were made by cheap off-the-grid hippies who think the government is tracking us through iron supplements?

(An important note: I somehow made it through my first pregnancy without an iPhone. There was no Googling in the grocery store! IT WAS MADNESS!)

So what really makes a “good” prenatal vitamin? According to WebMD, it should contain about the following:
400 mcg of folic acid
400 IU of vitamin D
200 to 300 mg of calcium
70 mg of vitamin C
3 mg of thiamine
2 mg of riboflavin
20 mg of niacine
6 mcg of vitamin B12
10 mg of vitamin E
15 mg of zinc
17 mg of iron

So the big difference, usually, between prescription vs. OTC vitamins is the amount of folic acid. 400 to 600mcg is generally what you’ll see in an OTC version, while the prescription pills sometimes contain up to 1000mcg. There’s not really any evidence that 1000mcg of folic acid is really “better” than the recommended minimum, and the truth is that sometimes expensive vitamin supplements simply mean expensive pee, as your body filters out whatever is in excess of your actual need. 1000mcg of folic acid is actually considered to be the absolute upper limit of “tolerable intake,” which might explain why many women complain that prescription prenatals make them feel sick. But this is usually why women chose to stick with prescription versions, if they’re holding up the labels and doing a straight line-by-line comparison.

But if you look at the label on your OTC prenatals and see that they meet or exceed the amounts WebMD recommend, you are very likely *just fine.* Most of us try to up our folic acid intake anyway, through our diet. Leafy greens, orange juice, lentils, beans, whole wheat breads — if you’re eating a lot of healthy foods, chances are you are making up for the folic acid difference between the supplements.

As for the Omega-3s and DHA, those are absolutely available without a prescription as well, and in special formulations for pregnant and nursing moms.
Honestly, the ONLY REALLY IMPORTANT THING about prenatal vitamins is that you TAKE THEM. If they are making you sick or becoming a financial hardship, you might not take them. Which is bad. If switching to another brand, for whatever reason, makes it easier for you to take them every day, then whatever. By taking prenatals everyday, you’re giving your baby a healthy start in life, even if you opted to save a few bucks and a trip to the pharmacy.

About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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35 Responses to “Prescription vs. Over-the-Counter Prenatal Vitamins”

  1. Hi, I'm Natalie. Apr 28 at 12:37 pm Reply Reply

    I liked the “fancy” ones (Sweetmomma brand) because they went down easily and didn’t make me feel sick. (I lived on crackers and lemon-ginger tea for a while there, so keeping them down was important!) I do think that you’re mostly paying for pretty packaging and good advertising… *sigh*
    Also, random thought: Take folic acid or a pre-natal vitamin BEFORE you start trying if possible!

  2. Katie Apr 28 at 12:45 pm Reply Reply

    My OB recommends the prenatals you can buy at Costco, and actually says they’re as good as any prescription. They even include DHA! And, at about $18 for 120 pills, the price is right :)

  3. Mouse Apr 28 at 1:05 pm Reply Reply

    First pregnancy–$20 a month for prescription prenatal vitamins. No omega-3s (prescription or OTC) since that was almost 8 years ago. (Talk about the Dark Ages!)
    Second pregnancy–staff at specialist (due to IUI and history of miscarriages) steered me to OTC prenatals with one vitamin and one omega-3 supplement a day. Target brand is a couple dollars cheaper and contains exactly the same stuff. Insurance deductibles and co-pays higher than before, so I was happy to spend my $11-14 a month, depending on coupons and sales, for the OTC stuff.
    Now that I’m breastfeeding, I’m finishing up a bottle of Whole Foods prenatals I had around and am taking regular fish oil that has been standardized and processed to remove all toxins.

  4. Jamie Apr 28 at 1:22 pm Reply Reply

    I just took two flinstones chewables every day. My doctor said it was just fine. And I still take two of them every morning since I’m nursing. It was a little fun, a little silly, and A LOT less stressful than choosing from those intimidating prenatal options.

  5. Katie Apr 28 at 1:28 pm Reply Reply

    I never even considered taking prescription prenatal vitamins with my first pregnancy. I took Target brand OTC vitamins beginning three months before I got pregnant until I was done nursing. My child is a flipping *genius*, grown on only 400 mcg of folic acid a day (although probably way more than that from my foods).
    So I am sticking with the same program this time around (I’m 12 weeks TOO!!!! Squeeee!!!) and not worrying about it. I can keep them down, they have at least the minimum of everything, and I know they did enough for my first child that he at least had all his limbs and a functioning brain! Score!
    Of all the things to worry about in pregnancy, I’d say WHICH vitamin you’re taking is low on the scale.

  6. Regan Apr 28 at 1:31 pm Reply Reply

    I specifically asked my OB-GYN about OTC verses prescribed prenatal vitamins. She said she was OK with me taking OTC until I became pregnant, but while pregnant she preferred the prescription. I didn’t ask her why mostly because I’m lucky enough to have a good prescription plan where I get a 90-day supply of prescription prenatal vitamins for about $25.
    That being said, a good friend of mine had a horrible time with taking pills during pregnancy (some prenatal vitamins smell nasty), so I agree with Amalah, take what you can stomach, both literally and financially.

  7. Bitts Apr 28 at 1:37 pm Reply Reply

    I do my OB visits at a nationally-recognized teaching hospital and they only ever instructed me to take OTC prenatals + an O3 supplement.
    There are SO MANY BENEFITS to taking O3s, pg or not, that it is really an excellent idea to arrange to do so regularly aside from prescription or OTC vitamins. Some benefits include: helping with PPD (the equivalent of low-dose SSRIs in some studies), preventing blocked milk ducts, fish burps!, mitigating hormonal effects on hair & skin, not to mention the brain benefits to both mother and baby while in utero and while nursing.
    FWIW, the theraputic dose for helping with / preventing PPD is 3000-4000mg a day. Do your research re: purity. Most brands, even the cheapo ones, are ok. “Overdose” is gastrointentinal only since fish oil is a macronutrient.

  8. Brook Apr 28 at 1:40 pm Reply Reply

    I switched to the generic of my prescription prenatals and it went from $60 a month to $10!!! Every dr. I’ve ever asked told me there is nothing “better” about the expensive ones.

  9. Stephanie Apr 28 at 1:46 pm Reply Reply

    My problem with vitamins in general is that the pills are just TOO big. Combine that with being pregnant and gag. I’m a member of Kaiser in California and the doctors just told me to get the OTC prenatal pills they sell in the Kaiser pharmacy. They were easy to swallow, they cost $8 for 100 pills, and voila! No brainer. I say go for whatever is easiest to swallow.

  10. pbblythe Apr 28 at 2:29 pm Reply Reply

    At first I was all about the Gummis. Seriously. Gummi vitamins were the only ones that didn’t make me sick. I took Gummi calcium, gummi multi and a folic acid non-gummi supplement. Once my stomach stopped its revolt, I tried the Target Pre-Natal combo pack (regular pills and DHA/Omega-3 fishfood stuff). It was fine, but then when I ran out of those I got the GMC combo pack. More power!
    It’s the first time I’ve been able to take a multi-vitamin without massive stomach upset, so part of it may be my willingness to stick with it (must! suffer! for! fetus!) through the pain until my stomach got used to it -or- maybe its because I take it right before bed so I miss the owie tummy.
    But yeah, not really needing the prescription, per my doctor, so just finding the pill OTC that works for me.

  11. incognito Apr 28 at 2:52 pm Reply Reply

    Oh hey, I was just doing my own vitamin internet research last night, so this is a long comment to download everything I learned!
    Somewhere online suggested that the prescription ones may have some kind of threshholds for “dissolvability” or “absorbability” or whatever the medical word is that OTC ones haven’t been standardized for (so that straight line comparisons of ingredients aren’t 100% indicative), and prescriptions may also have some extras, like anti-constipation additives.
    From the outset (pre-preg), my OB recommended Nature Made’s prenatal, plus Expecta (DHA) plus any kind of Folic Acid, all OTC. Not knowing how long we’d be trying I bought like a 6 months’ supply. When I reported the positive test, she gave me quite a lot of free samples of, and a prescription for, Citra-Natal (I actually saw the rep leaving as I arrived), plus (prescription) Folgard, which has a generic. Googling Citra-Natal I discovered that, in addition to the vitaminery, it contains that anti-constipation element. And all this time I was congratulating myself on my fiber intake.
    When I ran out of the samples, I said that I already had a stockpile of the Nature Made and she said, “Oh, those are perfectly fine, as long as you keep taking the Expecta and the folic.”
    More recently, though, I noticed that 50% my throwing up occurred within 30 minutes of taking my vitamins, so I started looking into alternatives – I guess because different brands may have different formulations (e.g. more or less iron, which may trigger nausea). Weirdly, just the thought of the *Expecta* (DHA) makes me want to heave – mostly because it is bright pink (carmine) so I wonder how much of this is mental.
    Without asking my dr (yet), I’ve tried some kind of hippie brand, which is a double-boxed set of a huge vitamin horse pill and a DHA. It claims to have ginger for nausea and be all vegan and whatnot. I noticed that the DHA is fish sourced, where most other brands are plant (flaxseed) sourced, though it claims to be thoroughly filtered. It’s also orange oil scented, because of the fish. Both pills together have 1000 mg of folic acid.
    I don’t know if Amalah has covered this, but Dr. Google also said that if you rolf them, you shouldn’t take them again, because it’s hard to tell how much you’ve absorbed.
    Lastly, for the queasy, I’ve come across many, many last resort recommendations for Flintstones (contain aspartame), some chewable available at Trader Joe’s, and even just a big daily bowl of Total cereal.

  12. Jamie @ PB&N Apr 28 at 3:26 pm Reply Reply

    Wow. I will try to be brief :) The only other thing I would add is that the OTC vitamin industry is pretty much unregulated so there could be things in your prenatal vitamins that you would rather not ingest. For me that would be chemicals/preservatives like propylene glycol. Just check the labels. I take like the Rainbow Light One with an extra B complex and a fish oil/Omega supplement.

  13. Heidi Apr 28 at 3:48 pm Reply Reply

    I could not keep any prenatal vitamin down at all. The nurse finally told me, “Just pop two Flinstones, they’re the same damn thing.” Every morning, I did. I am thankful I did, because A) dashing out of a very important meeting to hurt doesn’t = professionalism and B) flinstones tasted better.

  14. Gaby Apr 28 at 3:53 pm Reply Reply

    The only anecdote I have to share is that I asked my midwife for a prescription for prenatals, and she told me that OTC were just fine. I told her, “Yeah, but Meijer (local grocery store chain) fills the prenatal prescriptions for FREE!” So, she wrote me a ‘scrip. Just throwing that out there in defense of the OTC, and to also let women know that more and more store pharmacies are starting to supply vitamins for free, as they should.

  15. Becky Apr 28 at 4:30 pm Reply Reply

    I confess that when my husband and I started TTC, I stood in the aisle of CVS and read the back of the pre-natal vitamin box, and the back of the women’s one-a-day box. Except for DHA, two women’s one-a-day pills each day pretty much matched one prenatal. I just took the two one-a-day pills, and tried to eat healthy, as I have my doubts as to how much you can absorb from a multi-vitamin.

  16. miriam Apr 28 at 5:40 pm Reply Reply

    Flintstones.
    If you want omega3s try to find grassfed meat/milk products– the milk is particularly good since it covers the calcium aspect and lord knows a little yogurt/ cottage cheese etc makes a good snack.

  17. Chaya Apr 28 at 5:42 pm Reply Reply

    Thanks everyone for the info–I’ve always wondered but never quite did the research. Probably b\c yuck, every prenatal I ever tried tasted so so gross!
    @Gaby-I am a little confused about the store pharmacies providing vitamins for free. I never heard of this…it is across the board?? If so, why is it that they shouldn’t charge, aren’t they a business? What am I missing here?

  18. Chaya Apr 28 at 5:42 pm Reply Reply

    Thanks everyone for the info–I’ve always wondered but never quite did the research. Probably b\c yuck, every prenatal I ever tried tasted so so gross!
    @Gaby-I am a little confused about the store pharmacies providing vitamins for free. I never heard of this…it is across the board?? If so, why is it that they shouldn’t charge, aren’t they a business? What am I missing here?

  19. Lori Apr 28 at 6:04 pm Reply Reply

    I couldn’t keep anything down either so took Disney chewable princess vitamins! Like Jamie above, my ob suggested Flintstones as well. I’m still taking them now that I’m breastfeeding, and will eventually finish off the bottle of $90 (!) horsepills my ob had originally prescribed.

  20. lindswing Apr 28 at 7:56 pm Reply Reply

    Just promise me- PROMISE ME- that none of you try to take them on an empty stomach. Right? RIGHT?!
    Even not pregnant, I’ll throw up vitamins I take on an empty stomach. I mostly took (and still take, since I’m still breastfeeding) an organic, whole food prenantal (because the nutrients are more easily absorbed), but on bad days I’d always take the scent-free prescription one. I also take filtered fish oil, but oh dear, those fish burps were not welcome while I was pregnant. Or now either, actually.

  21. Marnie Apr 28 at 8:19 pm Reply Reply

    My OB suggested OTC.
    MOST helpful, was the suggestion to take them at night, just before bed. I did try taking them in the morning, with food, and I didn’t feel great. So, I took her advice and took them at night, literally right before hopping into bed, and had no problems after that. If my stomach was upset, evidently I was too asleep to notice.

  22. Erin Apr 28 at 9:04 pm Reply Reply

    Aside from the contents, the only thing that makes one vitamin better than another is how much of the nutrients get taken into your body. I have no idea how it works, but when I go to GNC they always sucker me into their vitamins because they say that most brands have the same amount of goodness, but because however they’re put together your body only absorbs part of it. Also: the thing that bothers women with the prenatals are the MINERALS, not the actual vitamins. So you could go to GNC or some pharmacy and put together a billion (smaller) pills to take to equal the same thing you’d get in one pill, but it’d be more absorb-able for your body and more easily swallowed. Just make sure you run the combo of pills by your doctor to make sure it’s ok.
    Or just take a couple of Flintstone’s. I really do believe that something is better than nothing. And something about chewing them up makes me think you get that much coveted absorbability.
    And don’t knock eating well, either. Find out which foods are rich in the nutrients you need and stock up. I ate TONS of spinach when I was pregnant. Mostly in pasta and on pizza, but hey! I ate it!

  23. Susan Apr 28 at 10:42 pm Reply Reply

    Here’s my confession: I took maybe 20 prenatal vitamin pills the entire time I was pregnant with Snackbox. They made me nauseous no matter what time of day I took them, so I was more likely to “forget” to take them. Baby Boy was a whopping 8lbs 13 oz at birth and has reached every brainy baby milestone early or on time. I was fortunate because I actually craved salad, salmon, and fresh fruit for my entire pregnancy. I also walked the dog twice a day, took prenatal yoga, and hiked on the weekends.
    This time around (I’m 19 weeks) my midwife told me the American Academy of Baby Doctors is actually considering dropping the recommendation that EVERY pregnant woman MUST take prenatal vitamins, but that they probably won’t since the Standard American Diet generally lacks fresh fruits and veg. She then loaded me up with free Expecta samples, of which I’ve taken five or six.
    I’m trying to be a little more conscientious of taking my Nature Made OTC vitamins this time because I am too busy keeping track of what the toddler puts in his mouth to think about what to put in mine… so thanks for reminding me to take a pill!

  24. Gaby Apr 29 at 9:38 am Reply Reply

    @Chaya: It’s not across the board yet. I think it’s a device to get new customers to use grocery store pharmacies as opposed to stand alone pharmacies. As far as I know, Meijer may be the only places (in my area) that provide free prenatals.
    Hmm…just did a quick Google search, and it looks like Schnucks, Associated Foods, and Basha’s also offer free vitamins. I’m not familiar with the last two in this list, so I can’t speak to what areas they serve.
    As for the “as they should” comment, that my was my editorializing! They are a business, and they do deserve to make earnings off of their transactions, but I feel that ALL pregnant women, regardless of financial situation, should have access to prenatal treatment, including vitamins. Good prenatal care is one of the most important elements of a healthy pregnancy and child (notice: I’m not saying it’ll lead to a 100% healthy pregnancy, delivery, or child; I’m aware of the risks. I’m just saying it serves as a good preventative measure). I think that vitamins of all kinds should also be available for free, but I’ll take what I can get. Sorry if my soapbox moment was confusing :)

  25. Ms. K Apr 29 at 10:38 am Reply Reply

    I didn’t know prenatal vitamins were…required. They seem to be yet another way for companies to make money off of pregnant women. They’re great – potentially life savers – if you have real deficiencies, but it’s totally possible to grow a healthy genius child without them. For real. You have to be honest with yourself about your diet and the amount you’re throwing up. If you’re eating well with lots of vegetables and beans and whole grains and fish AND keeping it down, you’re fine. (Both midwives and doctors have told me this.)
    On the other hand, if you’re having trouble eating well for whatever reason, or hurling so frequently that you can’t be sure you’re gaining any nutrition from your food, then supplement with vitamins.
    But if you’re eating well and only blow chunks WHEN YOU TAKE VITAMINS, then maybe skip the vitamins, kwim?

  26. Kati Apr 29 at 1:50 pm Reply Reply

    I did the two flintstones a day thing. My OB, Cardiologist and Oncologist (I like to see multiple specialists when pregnant, keeps things lively) all agreed that if it stayed down it was a winner. I tried taking the regular prenatals at night and still got super sick. It’s like Amalah said, just take them. That’s what is key.

  27. Caitlyn Apr 29 at 2:55 pm Reply Reply

    I took the prenatals from Trader Joe’s through pregnancy – though after reading this: http://www.quackwatch.org/03HealthPromotion/supplements.html I cut back to one every other day in the final trimester. (I had very little nausea, so I could eat a healthy diet. If I was having to avoid some foods I wouldn’t have cut back.)
    I also take fish oil supplements normally, to fight depression, so I just doubled my fish oil dose during pregnancy. My baby is 13 weeks old today, and so far I’ve been taking a dose and a half each day, but I’ll probably cut down to one dose a day soon.

  28. Heather Apr 29 at 10:30 pm Reply Reply

    I have used Target brand prenatal vitamins for my two pregnancies. Neither my OB or my specialist had a problem with my taking them. I do take an omega supplement, too (unbeknownst to them).
    I was in Whole Foods last week, and I asked the Supplements person about prenatals, and she suggested taking one that is “whole foods” based, since you get more out of it. ??? I ended up buying a bottle of them…but only because I was out of my Target vitamins and didn’t see myself running over to Target that day.
    Good luck!

  29. Stephanie P. Apr 30 at 12:33 pm Reply Reply

    I can also confirm the Meijer comment. I had my scrips filled at Meijer for free – my ob’s nurse filled me in on that one. Took them for the 5 months we tried to get pregnant and all the way through to today (month 6 of breastfeeding). I have switched in the last two months to CVS perscription generics as Meijer is not very convenient for me. They’re costing me about $5 a month now.

  30. Mel May 02 at 10:16 pm Reply Reply

    Just to clarify, the biggest reason that prenatals are “required” is for folic acid, which is needed especially in the first trimester to prevent birth defects like spina bifida. So yes, it is important to get 400mcg of folic acid into your body each day. Many vitamins can accomplish that task, particularly and form of prenatal.

  31. Janay Oct 03 at 1:43 pm Reply Reply

    Another thing to consider is that multivitamin contents are not regulated by the FDA. A lot of OTC brands do not contain the levels of vitamins that are reported on the label.

  32. Jegillen Dec 08 at 1:18 pm Reply Reply

    No. I sell prenatals, what makes a prenatal a prescription is 1mg of folic acid. This is the recommended amt to help prevent neuro tube defect, which cause death for your baby. In addition, the recommendations for vitamin d is 800 IUS, and if you are deferent, and you’re not supplementing enough , your baby is deficient, and then your feeding him breast milk that’s deficient as well. There are many differences, but it’s mainly the recommended dosages are not met with over the counter.

  33. sarah Dec 19 at 4:50 am Reply Reply

    You had me listening intently until you put out some unfounded, lame hippie joke. I also think its important to acknowledge the fact that at least some of your “healthy” food suggestions are not healthy at all, since the majority bought and sold is ultra processed or pasteurized. I know this article is about vitamins, and some people will justify drinking pasteurized milk or orange juice because it is fortified with synthetic vitamins.I won’t even go into the GMO issue. Just see thingsI think are important.

  34. Concerned Jan 27 at 6:08 pm Reply Reply

    I am in the process of trying to get pregnant are prenatal vitamins something you HAVE to start while you are trying? I mean they don’t help you to conceive I’m sure…I just want to know if it is ok to wait until I get pregnant to take them or if it is detrimental that I start taking them now.

    • Isabel Kallman
      Isabel Kallman Jan 27 at 6:34 pm Reply Reply

      It is recommended that you start prenatal vitamins when you are trying to conceive. The reason is that prenatal vitamins contain folate and other important vitamins which are important to fetal development, especially in the very early days/weeks. Usually when women discover that they are pregnant, it’s already week 4, 5 or later after they have missed their periods. Fetal development already started by then. Web MD writes it best: “Ideally, you’ll start taking prenatal vitamins before conception. The baby’s neural tube, which becomes the brain and spinal cord, develops during the first month of pregnancy — perhaps before you even know that you’re pregnant.” Here is more information: http://www.mayoclinic.org/prenatal-vitamins/art-20046945?pg=2

      Hope this helps.

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