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Pre-natal multivitamins: ‘Pregnancy is no time to gamble’

By Stephen Daniells+

14-Jul-2016
Last updated on 15-Jul-2016 at 00:07 GMT2016-07-15T00:07:41Z

Image: © iStock / FtLaudGirl
Image: © iStock / FtLaudGirl

Recent headlines related to a review calling pre-natal vitamin and mineral supplements an “unnecessary expense” for most expectant mothers could lead to serious repercussions and a stronger response from all stakeholders is needed to challenge such statements.

As reported by our European edition, a review published in the British Medical Journal’s Drug and Therapeutics Bulletin warned that some pregnant women were being manipulated by the marketing of complex multivitamin and mineral preparations, which were “unlikely to be needed” if the women had a healthy balanced diet.

The review also called into question the evidence for all nutrients apart from vitamin D and folic acid – and pressed for greater availability of low-cost tablets containing these two nutrients and vitamin C.

In response to the review, BBC News ran an article with the headline, Pregnancy multivitamins 'are a waste of money', TIME asked the question, Do Pregnant Women Really Need a Multivitamin?, The Guardian ran with, Pregnant women wasting money on vitamin supplements, study says, and the New York Daily News had the headline, Hey pregnant moms — stop taking those prenatal multivitamins.

“It is unfortunate that, in addition to disregarding the immense value a multivitamin and its ingredients can provide pregnant women, the authors fail to acknowledge that conducting randomized controlled trials (RCTs) on a multivitamin in pregnant women would be unethical as you cannot deprive a pregnant woman of essential nutrients,” said Dr Duffy MacKay, Sr VP of scientific and regulatory affairs for the Council for Responsible Nutrition. “When the totality of all available evidence is considered, the value of nutrient supplementation during pregnancy makes a clear case.

“We know from the 2015-2020 Dietary Guidelines that most Americans fall short in key nutrients, and pregnancy is no exception, especially if you consider appetite changes and nausea that can accompany pregnancy,” added Dr MacKay.

“The scientific evidence is clear—requirements for folic acid, calcium, iron, iodine, protein, and other nutrients go up during pregnancy—and the consequences of not getting enough can be significant for both mother and child.”

Response

With the exception of Dr MacKay, the response from key stakeholders has been disappointing. The American College of Obstetrics and Gynecology (ACOG), for example, does not specifically advise women to take multivitamins and it did not issue an official response to the review’s conclusions (although a spokesperson did tell TIME that he didn’t agree that multivitamins were a complete waste of money).

The American Academy of Pediatrics, the Endocrine Society, and the American Thyroid Association do recommend that pregnant women take a multivitamin as a way to assure they are getting adequate nutrients such as folic acid and iodine, but none of these issued a press release in response to the review or the headlines.

This topic is close to my heart as the first time father to a five month old. He’s happy and healthy and his mother took a daily multivitamin and mineral, omega-3s, and choline supplements during pregnancy. I was also pleased to hear our OBGYN ask my wife during the first pregnancy visit if she was is taking a multivitamin and an omega-3 supplement.

(This was in stark contrast to the typical response I hear from members of the mainstream medical community when supplements are mentioned: Their comments range from, “I don’t know” to “They don’t work/They’re a waste of money/They may even be harmful”.)

Image © iStock / Bcarlsness

Health and healthcare cost benefits

All of this is important because the benefits from pre-natal supplements, from multivitamins and minerals to omega-3 fatty acids, include both the health of the baby and mother (which you cannot put a price on) to the associated healthcare costs savings such benefits can provide (which you can put a price on).

Results from the Longitudinal Investigation of Fertility and the Environment (LIFE) Study, published earlier this year in Fertility and Sterility , indicated that a daily prenatal multivitamin during pregnancy may reduce the risk of losing the baby by 55%, compared to not taking a multivitamin. That is huge.

 “This strong protective effect for preconception multivitamin usage is somewhat consistent with findings from a preconception cohort of female Chinese textile workers, where women in the highest versus lowest quartile of vitamin B6 had a lower odds of pregnancy loss,” wrote the researchers, led by Germaine Buck Louis, PhD, from the National Institute of Child Health and Human Development.

Image © iStock / Antonio Gravante

For omega-3s, there is data to support that DHA supplements may significantly reduce early preterm birth, and this would result in significant hospital cost savings.

Data from the Kansas University DHA Outcomes Study (KUDOS) indicated that universal supplementation with DHA during the last two trimesters of pregnancy could result in cost savings of $1,678 per infant. Taking out the $166.48 cost of the DHA supplements for 26 weeks and a $26 increase in maternal care costs, the net saving became $1,484.

For the nearly 4 million live births in the US every year this cost saving would become almost $6 million, reported the researchers in Prostaglandins, Leukotrienes and Essential Fatty Acids (Vol. 111, pp. 8–10).

Results of a cost-benefit analysis published in The Lancet Diabetes and Endocrinology last year concluded that pregnant women in the UK who take iodine supplements compared to those who do not can save the National Health Services about £200 in direct service costs and save the larger society £4,476 per child over their lifetime of earning and in public sector costs.

And all this without considering the elephant in the room: Folic acid. A meta-analysis  published in 2010 showed an overall 46% reduction in neural tube defects such as spina bifida and anencephaly in countries where wheat flour was fortified with this B vitamin.

The US Centers for Disease Control and Prevention (CDC) has listed the prevention of neural tube defects through flour fortification amongst its list of 10 great health achievements  in the US for the last decade.

Not insurance - essential

I spoke recently with Dr Jeff Blumberg and he told me he dislikes the analogy of multivitamins being an “insurance” for good health because that takes away from the essentiality of vitamins and minerals. They’re not a good thing to have. They’re necessary.

CRN’s Dr MacKay sums this up succinctly: “We know that Americans are not getting all the nutrients they need from food alone. So while it’s ideal to strive to get the Recommended Daily Allowance (RDA) of key nutrients from diet only, realistically, there will be shortfalls and dietary supplements fill those gaps. Pregnancy is no time to gamble. The alarming headlines that issued after this report published could lead to serious repercussions.

“We hope that other health organizations and healthcare practitioners will step up and speak out against the irresponsible nature of this report in order to protect the health of our pregnant population.”

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