PH7 Health and Fitness

The Great Vitamin Debate

As a Midwife and Personal Trainer one of the most frequently asked questions is whether woman should take a multivitamin during pregnancy. The answer to this question is not a simple one, but I generally would not advise a woman to buy a branded multivitamin such as Pregnacare. My rationale is in part due to the fact that these supplements are manufactured by large pharmaceutical companies that are taking advantage of a new mothers desire to do the right thing for her unborn baby. The vitamin, mineral and supplement industry is one of the fastest growing in the world. Figures published by Forbes estimate that this industry is worth $32 billion in the US and £13.5 billion in the UK. So these big multivitamin manufacturers advertise to vulnerable women and get them to part with their hard earned cash. These pregnancy multivitamins don’t come cheap costing at least £6.35 a box and women are encouraged to also buy the preconception, conception and breastfeeding supplements.

The other problem is that Midwives, GPs and Obstetricians receive basically no training about nutrition and vitamin supplementation. The pharmaceutical industry have cottoned onto this fact and advertise their supplements at conferences, training days and even give free samples in the bounty packs given to women at their booking appointment. Some would say that taking a multivitamin doesn’t do any harm, other than to your bank balance. On a simplistic level I would agree but I think there is a massive lack of knowledge about vitamin supplements that can lead to anxiety and confusion in pregnancy.

Let’s look at a relatively common scenario. If you go to your midwife and report a persistent headache, pain under your ribs and have protein detected in your urine or elevated blood pressure then the midwife will send you for blood tests to check your liver function amongst other things. This blood test forms part of the diagnosis of pre-eclampsia which if detected would be very serious. The problem is that women who are taking multivitamins often have abnormal liver function results, essentially a false positive. This is because the liver is responsible for the metabolism of vitamins and is having to work much harder than it should be. Abnormal liver function results aren’t the end of the world and usually revert back to normal within two weeks of discontinuing the multivitamin, but is it really worth the anxiety and maybe the liver shouldn’t be working so hard?

During pregnancy there are a couple of vitamin supplements that I recommend women take. These do not need to be branded versions or cost a lot of money. Healthy woman with no pre-existing health conditions, who eats a balanced diet of carbohydrate, protein and fat are likely to require minimal supplementation in pregnancy.

Firstly, folic acid, also known as vitamin B6 is important for foetal development, specifically the prevention of spinal defects. It is found in green leafy vegetables, granary bread, brown rice and fortified cereals. The NHS recommends taking 400 micrograms of folic acid a day pre-conception, continuing until the 12th week of pregnancy. This water soluble vitamin is efficiently absorbed in the bowel but is also easily excreted in urine. Research suggests that women who take folic acid in this manner can reduce the risk of spina bifida in their foetus by 70%. The evidence supporting this claim is substantial, and identified that the mothers of babies born with neural tube defects had a low serum rates for folates and low vitamin levels in their red bloods cells. A rigorous trial carried out in Hungary conclusively proved the power of folic acid supplementation and the prevention of neural tube defects. Simplistically, folic acid provides an essentially building block in the chemical cascade that results in the closure of the neural tube.

When it comes to folic acid I say take the supplement and increase dietary intake. This means more leafy green vegetables particularly spinach and brussel sprouts as well as other vegetables and legumes including beetroot kidney beans, lentils and avocado.

Another vitamin that is more often recommended in pregnancy is vitamin B12. Vitamin B12 deficiency is not routinely checked in pregnancy and is currently only recommended as a supplement for women who are at risk of low level. Vitamin B12 is required for the proper formation of red blood cells. Unsurprisingly a deficiency is associated with pernicious anaemia. If during pregnancy you are informed that you have a low iron level it may be associated with a vitamin B12 deficiency.

Vitamin B12 is also involved in feotal development and the prevention of neural tube defects. Good sources of vitamin B12 are meat, salmon, cod, milk, eggs and marmite! The Department of Health state that pregnant women should be able to get all the vitamin B12 they require from dietary sources. If you are vegan then you may considering supplementation in the first 12 weeks of pregnancy and taking 2mg or less a day is unlikely to cause any harm.

The last vitamin to consider supplementing during pregnancy is vitamin D. Vitamin D deficiency has made the headlines in the last year after a sudden increase in the cases on infant rickets. It was discovered that the children with rickets and their mothers had a vitamin D deficiency. Vitamin D is required for the absorption of dietary calcium in the gut. An insufficient amount of vitamin D therefore results in poor bone mineralisation.

Living in a northern European country means that in the winter all women are three times more likely to be vitamin D deficient in the winter and spring than the summer and autumn as the best source of vitamin D is from the sun and dietary intake is relatively minimal. The women at most risk of vitamin D deficiency are those with pigmented skin, especially Indian Asian, Black and Middle Eastern women. Another risk factor for vitamin D deficiency is obesity. Women who are obese prepregnancy have been identified as almost twice as likely to have a vitamin D deficiency.

Global studies on the association of vitamin D deficiency and complications in pregnancy have identified several very interesting things. Maternal vitamin D levels is important for foetal bone development, lung development and neonatal immune conditions such as asthma. There is also some conflicting research of the association between vitamin D deficiency and pre-eclampia, low birthweight, and diabetes. There is even research suggesting that vitamin D deficiency results in an increased risk of caesarean section for first time mothers. As vitamin D deficiency is so prevalent and the risk of vitamin D toxicity is so low, it seems wise to supplement particularly for women in the high risk groups.


So to summarise, I recommend that all pregnant women supplement their diet with folic acid up until twelve weeks. Vitamin B12 should be supplemented if you are anaemic or are in the high risk group for spinal defects. Vitamin D if it is the winter, you are a woman with pigmented skin or are obese. In addition to the supplementation we should all be ensuring that our diets are balanced and varied to optimise our nutrient intake, as well as spending as much time as we can outside during the summer and autumn.

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I often get asked vitamin supplements are best to take in pregnancy. This week I will be releasing a Blog post on this subject so give it a read and get my definitive answer!