To supplement or not to supplement?

Should we be taking supplements during pregnancy to support our nutritional status?

Recommendations

To answer this question, we need to look at the wider evidence. The Department for Health and Social Care, recommend supplements for some population groups deemed at risk of deficiency. This includes pregnant women.

The National Institute for Health and Care Excellence (NICE), who develops evidence-based guidelines for clinical practice within the NHS, state that if we are planning a pregnancy, we should start taking a daily 400μg folic acid supplement.  This is to reduce the risk of neural tube defects, such as Spina Bifida. It’s recommended from about 3 months before conception until about 12 weeks after.  Easier said than done when 50% of women have an unplanned pregnancy, and not many know the point of conception.  So there is always a little bit of guesswork. However, we should already be regularly consuming folic acid (folate), as part of a healthy balanced diet. It is found in lots of foods including green leafy vegetables, citrus fruits. It’s even in eggs and seafood.

NICE and governments Scientific Advisory Committee on Nutrition (SACN), also recommend that everyone in the UK should take a 10μg vitamin D supplement between October and March. This is due to the limited exposure to sunlight during these months.  Sunlight is how we generate the majority of our vitamin D. However, pregnant women should take vitamin D throughout the entire pregnancy and continue whilst breast-feeding. These supplements are recommended because food sources of vitamin D are fairly limited.  Fish, eggs, fortified foods such as spreads and cereals and mushrooms being the most notable sources.

But…

The general consensus is that unless we have a diagnosed deficiency of a specific nutrient, then taking supplements will give no additional benefit. However, some of us are at more risk of developing insufficiencies or deficiencies.  Especially if we don’t consume enough fresh and/or natural produce like fruit, vegetables and whole grains  etc.

Those of us in receipt of universal credit, or equivalent welfare benefits, are eligible to receive healthy start vitamins and minerals. Interestingly, they only contain vitamin C in addition to folic acid and vitamin D. For the majority of us, all the micronutrients we need to support pregnancy can be got from a healthy balanced diet.  With lots of that fresh produce like fruits, vegetables, legumes, whole grains, beans, meat, fish, dairy, nuts and seeds.

Alternative ways to top up without supplements

We can also top up our intakes from a number of fortified foods, including bread, breakfast cereals, snack bars, spreads and beverages.  They all contain varying levels of essential micronutrients. Some of these staple foods, are modified at production to enhance vitamin and mineral content for benefit of the whole population. For example, in the UK all flour is fortified with calcium, iron and vitamins B1 and B3.

There is also an increasing availability of voluntarily fortified foods and drinks in addition to over-the-counter dietary supplements.  For example Centrium or Multibionta that can help us increase our intakes. But we do need to exercise some caution as dietary supplements have an ‘overage’ of nutrients. Amounts can deviate by as much as 25-50% from what is stated on the label. Overage ensures that the levels of the nutrient at the end of shelf life, still reflect the amounts indicated on the product label.  Consequently, there may be significantly more than what is stated at the start of its shelf life.

This has resulted in significant differences in micronutrient intakes within populations. Because of this, safe upper limits have been set for a number of micronutrients. The upper limit is defined as the highest level of a nutrient that can be consumed that is likely to pose no risk for adverse effects in the general population.
Intakes of nutrients above the safe upper limits can increase the risks of negative effects, particularly in respect of damage to the developing foetus. This is an unlikely event for most nutrients if we consume them as part of a healthy balanced diet.  However, high intakes of fortified foods and dietary supplements taken at the same time, could lead to excessive intakes.

Caution

So it is advisable to exercise caution when taking supplements during pregnancy.  Whether multivitamin and mineral (with the exception of folic acid and vitamin D) or any other form of nutritional supplements, we should first check with our GP/obstetrician before doing so.
The use of supplements may be able to reduce adverse outcomes in certain at-risk women.  However there is still a question over optimal recommendations for most of us. There is insufficient evidence as to what these are.  And in some cases, it has been shown that over consumption may increase adverse outcomes. I appreciate that many women choose to take a tailored pregnancy multivitamin and mineral complex, like Pregnacare, during pregnancy to help support their nutritional status.  However we shouldn’t be taking them as a substitute for healthy nutrient rich food.

The benefits of fresh food

We can still get the majority of essential nutrients from a variety of fresh, frozen and canned fruit and vegetables, wholegrains, legumes, beans, pulses, lean meats and up to 2 portions of oily fish per week (during pregnancy). Plus, there are additional benefits to consuming fruit and vegetables. Most plant foods have a complex cellular matrix containing biologically active compounds, known as phytochemicals. These infer the plant with a host of benefits, including colour, aroma, flavour, and protection against solar radiation and disease. In some ways we could think of phytochemicals as the plant version of our immune system.

As well as the vitamins, minerals and fibre found in plant-based foods, there is evidence to suggest that there is a very beneficial relationship between phytochemicals and micronutrients, that enables optimum bioavailability, absorption and utilisation.  In essence we can absorb more nutrients and use them better if they come from a natural food source rather than a manufactured or synthetic supplement. Additionally, there is evidence that suggests that many phytochemicals found in fruit, vegetables, and whole grains, have antioxidant, anti-inflammatory, anti-obesity and chemo-preventative properties for us as humans.

Take home message

Another reason why it might be beneficial to discourage the use of nutritional supplements, and to encourage the intakes of a healthy nutrient rich diet, is that it is not only beneficial for pregnancy and breastfeeding, but it may help to encourage us as new mums to introduce a wider variety of different foods to our infants during weaning. Which in turn can also promote lifelong healthy eating habits.

• Eat fresh food where possible, there are added benefits
• Keep processed food to a minimum
• Check with your GP/consultant about supplement use

You may have heard of the Greek philosopher Hippocrates. He is credited as being the ‘father of medicine’.  It is where the Hippocratic oath that doctors and medics used to swear to uphold, came from. He noted the healing power of food and good nutrition and is supposedly quoted as saying ‘Let food be thy medicine and medicine be thy food.’ It says it all, nature really does have it all boxed off!