Summary and conclusion

In summary, although most pregnant women take one or more dietary supplement, there is strong evidence to support the efficacy of only three of these products during this period of the lifespan, especially for otherwise healthy women. These include folic acid, iodine, and iron, and published recommendations concerning these nutrients are provided in Table 14.2. Additional supplements may be useful in specific circumstances. For example supplemental zinc may be necessary for vegans; and women who smoke, have poor quality diets, or are carrying more than one fetus should consider taking a MVMM supplement. Other nutrient supplements such as vitamin A may be warranted for poorly nourished women, especially those with comorbidities. There is very little high quality research on the efficacy and safety of botanical supplements during pregnancy, and extreme care should be taken when recommending their use during this time.

It is important to recognize that as scientists learn more about the mechanisms by which nutrients interact with genetic or epigenetic predisposition, future studies will undoubtedly identify subpopulations of individuals who might benefit from additional supplementation during pregnancy. Clinicians are strongly urged to stay abreast of the current research concerning the use of all types of dietary supplements during pregnancy, and a list of reputable resources of such information can be found in Table 14.3.

Table 14.2

Recommendations for Dietary Supplement Use in Pregnancy

Nutrienti s)

Guidelines

Multivitamin-multimineral (MVMM)

Folic acid

Vitamin D

Iron

Zinc

Iodine Botanicals

  • The American Dietetic Association and the Institute of Medicine recommend that all pregnant women who consume poor-quality or vegan diets, have iron deficiency anemia, smoke, abuse alcohol or drugs, or are carrying more than 1 fetus take MVMM supplements
  • US Centers for Disease Control and Prevention, American Academy of Pediatrics, and the National Healthy Mothers, Healthy Babies Coalition recommend that all women of childbearing age who are capable of becoming pregnant should consume 0.4mg/day folic acid, keeping total folate consumption to less than 1 mg/day
  • The Institute of Medicine recommends that women able to become pregnant should take 0.4 mg/day folic acid daily from fortified foods, supplements, or both, in addition to consuming food folate from a varied diet
  • The Institute of Medicine recommends that women—whether pregnant or not—who receive regular exposure to sunlight do not need vitamin D supplementation. However, they also state that an intake of 10 mcg/day (400IU/day) supplied by prenatal vitamin supplements would not be excessive
  • The World Health Organization recommends daily iron supplementation of 60 mg/day for all pregnant women for 6 months or, if 6 months of treatment cannot be achieved, either continuation of supplementation during the postpartum period or increased dosage of 120 mg/day iron during pregnancy
  • The US Centers for Disease Control and Prevention recommend that oral, low-dose (30 mg/day) supplements of iron be provided to all pregnant women beginning at the first prenatal visit
  • The Institute of Medicine recommends that, because iron may interfere with the absorption and utilization of zinc, individuals should be supplemented with 15 mg/day zinc when therapeutic levels of iron (>30 mg/day) are given to treat anemia
  • The American Thyroid Association recommends that all pregnant women living in the United States or Canada consume 150 mcg/day of supplemental iodine.
  • See McGuffin M, Hobbs C, Upton R, Goldberg A (eds) (1997) Botanical safety handbook: guidelines for the safe use and labeling for herbs in commerce. CRC Press, Boca Raton, Fla.

Missions and Contact Information for Selected Reputable Organizations Providing Information Concerning the Efficacy and Safety of Dietary Supplements

Organization

Mission

Website

National Academy of Science's Institute of Medicine (IOM)

National Institutes of Health's Office of Dietary Supplements (ODS)

National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM)

US Department of Health and Human Services' Centers for Disease Control and Prevention (CDC)

US Food and Drug Administration's Center for Food Safety and Applied Nutrition (CFSAN)

World Health Organization (WHO)

To serve as adviser to the nation to improve health by providing unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large To strengthen knowledge and understanding of dietary supplements by evaluating scientific information, stimulating and supporting research, disseminating research results, and educating the public to foster an enhanced quality of life and health for the U.S. population To explore complementary and alternative healing practices in the context of rigorous science; train complementary and alternative medicine researchers; and disseminate authoritative information to the public and professionals To promote health and quality of life by preventing and controlling disease, injury, and disability To promote and protect the public's health by ensuring that the nation's food supply is safe, sanitary, wholesome, and honestly labeled, and that cosmetic products are safe and properly labeled To facilitate the attainment by all peoples of the highest possible level of health

  • a href="http://www.iom.edu/">http://www.iom.edu/
  • a href="http://ods.od.nih.gov/">http://ods.od.nih.gov/
  • a href="http://nccam.nih.gov/">http://nccam.nih.gov/
  • a href="http://www.cdc.gov/">http://www.cdc.gov/
  • a href="http://www.cfsan.fda.gov/list.html">http://www.cfsan.fda.gov/list.html
  • a href="http://www.who.int/en/">http://www.who.int/en/
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