Investigation reveals worrying truth about pregnancy supplements

When you’re pregnant, it feels like there’s very little you’re allowed to have: No cured meats! No soft cheese! And definitely no alcohol!

But the one thing all expecting mothers are urged to consume are prenatal supplements.

And yet, despite the crucial role they play in the health of both mum and baby, these vitamins are unregulated, meaning manufacturers can basically put what they like in them.

There are no rules surrounding which nutrients they should contain, nor the appropriate doses.

As a result, research has found that none of the most popular over-the-counter pregnancy supplements provide adequate levels of five key nutrients: folic acid, iron, vitamin D, calcium and docosahexaenoic acid – an omega-3 fatty acid.

This is despite the fact that getting enough of these nutrients is associated with improved health outcomes for both pregnant patients and their children.

In light of this, family medicine and nutrition expert Dr Mary Scourboutakos, of Eastern Virginia Medical School, set about investigating these products.

She found that many of the vital vitamins required during pregnancy were either entirely missing from these pills, capsules and gummies, or contained insufficient or excessive amounts of them.

In other words, as Dr Scourboutakos puts it in a piece for The Conversation: “Finding the best supplement with just the right amount of each nutrient – not too much and not too little – is difficult, if not impossible.”

Most women assume they'll get all the nutrients they need from over-the-counter supplements(iStock)

She cited the example of three nutrients: folate, omega-3 fatty acids and choline, all of which are considered key to reducing birth defects in babies and ensuring healthy development.

Indeed, folate, which lowers the rate of birth defects by 50 per cent, is “the central reason why prenatal supplements were developed”, she said.

However, what many aspiring mums don’t know is that folate only prevents birth defects when it's taken before the 28th day of pregnancy.

Put simply, a woman needs to take prenatal supplements before she even knows she’s pregnant in order to ensure the prevention of certain birth defects.

For this reason, the American College of Obstetrics and Gynecology recommends that women start taking prenatal supplements at least three months before conception.

And yet, only around a third of women do – with the figure dropping to just 10 per cent of African American women, Dr Scourboutakos says.

Still, even women who do take supplements early in pregnancy might not get the 400 micrograms of folic acid – a synthetic version of folate – that they need, since as many as 27 per cent of prenatal supplements contain less than that amount.

On the other side of the spectrum, some supplements contain more than 1 milligram of folic acid – “a potentially dangerous amount associated with impaired cognitive development, most notably decreased verbal skills,” according to Dr Scourboutakos.

Taking excessive amounts of folic acid can be dangerous for your unborn child(iStock)

Turning to omega-3 fatty acids, the US-based nutritionist pointed out that these serve as “building blocks for the construction of the foetal brain,” with some 40 per cent of the human brain composed of omega-3s.

Whilst studies into insufficient intakes of omega-3s during pregnancy have yielded mixed results, Dr Scourboutakos says there does seem to be a link between omega-3s and preterm birth, with increased intakes leading to a decreased risk.

New US guidelines recommend that pregnant women who don't routinely eat enough omega-3 fatty acids should take 600-1,000 milligrams of omega-3s daily, and yet, this amount is nearly impossible to find in prenatal supplements

Understandably, the need for supplements is less urgent in patients who eat fatty fish – including salmon, mackerel and sardines – twice a week, but most Americans don't consume this much.

This means that 95 per cent of pregnant and lactating women in the country aren't getting enough omega-3s.

Finally, choline – an essential compound that is also critical for foetal brain development – is worryingly absent from women’s diets and supplements.

Few foods – with the exception of organ meats like beef liver – contain enough of the nutrient to meet pregnant women’s requirements, and more than half of prenatal supplements contain no choline at all.

Those that do typically provide far too little of it – less than 100 milligrams, according to Dr Scourboutakos. For reference, pregnant and lactating women typically need between 450 and 550 milligrams per day.

Furthermore, some research suggests that consuming even more choline than guidelines suggest could offer additional benefits.

One study found that doubling the recommended level in the third trimester of pregnancy may improve a child's attention span, while another concluded that quadrupling the recommended level could mitigate some of the effects of foetal alcohol syndrome.

Lactating women require even more choline than during pregnancy(iStock)

So what can be done?

The issue, Dr Scourboutakos stresses, is down to a “lack of education: and a lack of incentive.

“Doctors are taught very little in medical school about nutrition, and I've observed that most patients just assume they're getting what they need from their prenatal supplements,” she points out.

Plus, because there are no regulatory standards for these products, there's no incentive to improve them.

“No one is mandating that these companies change their formulation, so it's not a priority for them,” she added.

Therefore, given the inadequacy of most supplements, she urges anyone who is pregnant, or planning to become pregnant, to do the following three things:

1. Choose a prenatal supplement with no more and no less than the recommended 400 micrograms of folic acid daily, and take it for three months prior to conception.
2. Eat two weekly servings of fatty fish and consider taking a daily omega-3 fatty acid supplement of 100-200 milligrams. Or if you don't routinely eat fatty fish, take a supplement containing 600-1,000 milligrams.
3. Gauge your current intake of choline-rich foods (including eggs, beef, soybeans and chicken) consider taking a choline supplement.

But the fact of the matter is maternity care is woefully inadequate, and more needs to be done to support expecting mothers through every stage of the process.

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