Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients

Abstract

The blood levels of most vitamins decrease during pregnancy if un-supplemented, including vitamins A, C, D, K, B1, B3, B5, B6, folate, biotin, and B12. Sub-optimal intake of vitamins from preconception through pregnancy increases the risk of many pregnancy complications and infant health problems. In the U.S., dietary intake of vitamins is often below recommended intakes, especially for vitamin D, choline and DHA. Many studies suggest that insufficient vitamin intake is associated with a wide range of pregnancy complications (anemia, Cesarean section, depression, gestational diabetes, hypertension, infertility, preeclampsia, and premature rupture of membranes) and infant health problems (asthma/wheeze, autism, low birth weight, congenital heart defects, intellectual development, intrauterine growth restriction, miscarriage, neural tube defects, orofacial defects, and preterm birth). The primary goal of this paper is to review the research literature and propose evidence-based recommendations for the optimal level of prenatal supplementation for each vitamin for most women in the United States. A secondary goal was to compare these new recommendations with the levels of vitamins in over 180 commercial prenatal supplements. The analysis found that prenatal supplements vary widely in content, often contained only a subset of essential vitamins, and the levels were often below our recommendations. This suggests that increasing prenatal vitamin supplementation to the levels recommended here may reduce the incidence of many pregnancy complications and infant health problems which currently occur.

Preparatory work for the update of the tolerable upper intake levels for vitamin B6

“…This review suggested a daily intake of 10 mg vitamin B6 to compensate for the decreasing plasma vitamin B6 concentration, especially during the third trimester, and to maintain a plasma concentration of vitamin B6 similar to the pre-pregnancy state. The recommended intake level was also suggested to minimize risk of various maternal and neonatal adverse effects (Adams et al, 2022). Thus, alterations in the requirement and metabolism of vitamin B6 are indicated during pregnancy.…”

Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO program

“…( 15,16 ) For those who cannot or choose not to eat fish, omega-3 PUFAs supplements are recommended. ( 17 ) The extent to which pregnant women take omega-3 PUFA supplements is not well described. In addition, it is unclear whether supplement use is more common in those with low fish intake.…”

Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO programme

“…Most experts believe that fish consumption is the optimal way to meet recommendations for adequate n -3 PUFA intake ( 14 ) , in part because experimental evidence has not supported offspring developmental benefits of supplementation ( 15 , 16 ) . For those who cannot or choose not to eat fish, n -3 PUFA supplements are recommended ( 17 ) . The extent to which pregnant women take n -3 PUFA supplements is not well described.…”