Pregnancy Multivitamins Are An Unnecessary Expense, Review Says
Multivitamins and mineral supplements for pregnant women are unlikely to be needed by most and are an unnecessary expense, according to an evidence review published in the journal Drug and Therapeutics Bulletin (DTB).
However, the review does recommend that women continue to take folic acid and vitamin D supplements and that they should focus on improving their overall diet while pregnant.
To critically examine the current UK guidance for vitamin supplements recommended for pregnant women, and the evidence behind it, the DTB reviewed the published research on folic acid, vitamin D, iron, vitamins C, E, and A, and multivitamin supplements.
It found that folic acid had the strongest evidence to support national UK guidance, which recommends that women take 400ug of folic acid daily from before, until 12 weeks of, pregnancy.
A daily dose of 5mg is recommended for those women at higher risk of having a child with neural tube defects – those who have neural tube defects themselves, a family history of the condition, or who have diabetes.
The evidence for vitamin D supplementation was less clear-cut, with little of the trial data showing any impact on reducing the risk of complications of pregnancy or birth, the review found.
Nevertheless, a daily dose of 10ug is recommended throughout pregnancy and breastfeeding.
As to the other supplements, there was no evidence of any obvious clinical benefit for most women who are well nourished, and high doses of vitamin A may harm the developing fetus.
‘We found no evidence to recommend that all pregnant women should take prenatal multinutrient supplements beyond the nationally advised folic acid and vitamin D supplements, generic versions of which can be purchased relatively inexpensively,’ DTB said.
The review added that much of the evidence on which the marketing claims for multivitamin supplements are based, comes from studies carried out in low income countries, where women are more likely to be undernourished or malnourished than women in the UK.
RCM professional policy advisor Janet Fyle said: ‘This is an interesting study and adds to a growing body of evidence that the benefits of eating a well-balanced, nutritious diet during pregnancy cannot be underestimated in improving outcomes for both mother and baby.
‘We would encourage women who are pregnant or are thinking of becoming pregnant to have a healthy, varied diet including fresh fruit and vegetables, alongside taking folic acid supplements. We would also stress that there is no need for pregnant women to “eat for two”. This is a myth and all that is required is a normal, balanced amount of food.
‘In terms of vitamin D supplementation, the benefits have been know for some time and currently UK health departments recommend that all pregnant and breastfeeding women should take a daily supplement containing 10µg of vitamin D, to ensure the mother’s requirements for vitamin D are met and to build adequate fetal stores for early infancy.
‘Many pregnancies in the UK are unplanned and the benefits or effects of taking folic acid are linked to taking supplementation at the right time. There remains the issue of the large group of childbearing women who do not have access to supplements, particularly vulnerable groups of pregnant women, younger women, ethnic minorities and some women from low socio-economic groups.
‘We need a rethink of policy priorities to ensure that all childbearing women can access folic acid supplementation at the right time. This is particularly important for women before conception where we need to ensure that women get better care, advice and support.
‘The RCM would advise women to talk to their midwife or GP for advice on vitamin D and folic acid supplementation if they are unsure, especially if they fall into the ‘at risk’ group.’
