You are pregnant. You have questions. We have answers. You will read about vitamin A for a pregnant woman here.
We know you’re probably worried about a lot of things right now: how to get your partner to stop hogging the remote control, whether or not you can still eat sushi, and if now is really the time to go platinum blonde. But one thing you needn’t worry about is vitamin A. Vitamin A is essential for healthy pregnancy, but it’s also important for healthy eyesight and skin for both you and your baby—and it’s totally safe for use during pregnancy.
But what does this mean? It means that you can get all the vitamin A you need from foods like carrots, broccoli, sweet potatoes and leafy greens—and you’ll be doing both yourself and your baby a big favor!
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Vitamin A For Pregnant Woman
For women who are pregnant and their unborn children, vitamin A is a critical micronutrient. Vitamin A has a systemic impact on a number of embryonic organs, as well as the skeleton and morphological and functional development of those organs, as well as the integrity of the eyes. Therefore, during pregnancy, vitamin A requirements are higher.
In the world, vitamin A deficiency (VAD) continues to be the predominant factor in avoidable blindness. In the majority of developing nations, VAD in pregnant women is a public health concern. However, in some industrialized nations, consuming too much vitamin A during pregnancy might be dangerous since it can have teratogenic consequences in the first 60 days after conception.
However, in areas where VAD is a public health concern, vitamin A supplementation is advised to avoid night blindness. Routine prenatal vitamin A supplementation is not advised to prevent mother and infant morbidity and mortality. Given the significance of this subject and the lack of a comprehensive, current study on vitamin A and pregnancy, a thorough evaluation of the literature was carried out to spot any inconsistencies or gaps in the information already available.
The World Health Organization (WHO) has designated vitamin A as a public health priority for more than 60 years. Vitamin A was first discovered 106 years ago. However, there is still much to learn about vitamin A deficiency (VAD), including its epidemiology, categorization, metabolism, and pathogenesis. The goal of this review article is to contribute to the clarification of these issues and the identification of potential new alternatives regarding practical actions, including future research requirements. It focuses on the pregnant woman and her fetus as representing the most vulnerable group in terms of this problem.
Due to its involvement in cell differentiation, the maintenance of eye integrity, and the avoidance of xerophthalmia, vitamin A is crucial for proper ocular function. The primary factor in worldwide preventable blindness is its lack. Vitamin A is also related to the growth and maintenance of epithelial tissue, bone development, the protection of the skin and mucosa, the ability of reproductive organs to function normally, immune system support, the formation of healthy teeth and hair, and many other processes. Vitamin A plays a critical role in many bodily tissues and is crucial for the embryo’s healthy growth.
In order to preserve the health of both the mother and the fetus throughout pregnancy, there are specific nutritional requirements. Due to the faster fetal development during this time, there is a rise in the demand for vitamin A, especially in the third quarter. The WHO states that VAD, which affects over 19 million pregnant women globally, is still regarded as a public health issue at the population level, particularly in some developing nations.
In contrast, excessive vitamin A intake is a worry, especially in developed nations, due to the potential teratogenic effects associated with high dosages of this vitamin. Spontaneous abortion and congenital heart and nervous system defects are the two main side effects of consuming too much vitamin A, especially early in the first trimester of pregnancy.
Therefore, for the health of both the mother and the fetus, optimal vitamin A levels throughout pregnancy are crucial. There hasn’t been a comprehensive assessment of recent research on vitamin A and pregnancy published. In order to summarize the information that is now available on vitamin A metabolism, epidemiological data on the nutritional status of vitamin A in pregnant women, and the significance of supplementation, including current guidelines, the current study proposes to analyze accessible data.
Between March and December of last year, this narrative literature evaluation was completed, and it was revised in January 2019. The following Medical Subject Headings (MeSH) were used in the search of the PubMed, ScIELO, and LILACS databases: “Vitamin A” or “Vitamin A Deficiency,” and “Pregnancy.” The search was restricted to human research over the previous ten years.
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Vitamin A: Summary Review of Metabolism
The complicated metabolism of vitamin A includes many various forms, sources, and methods, including storage, storage proteins, enzymes, and physiological and pathological issues. Retinal, retinol, and retinoic acid are the three active forms of vitamin A in humans. The liver also stores vitamin A in another form (retinyl ester). The body cannot produce this liposoluble vitamin, hence it must be consumed through diet. Preformed vitamin A (retinol and retinyl ester) and provitamin A are the two main sources (caratenoids). Beta-carotene, alpha-carotene, and beta-cryptoxanthin are the main provitamin A carotenoids found in foods out of the many naturally occurring carotenoids.
Foods of animal origin include dairy products (such milk, yoghurt, and cheese), liver, fish oils, and human milk contain preformed vitamin A. Fruits, leaves, and tubers like carrots, pumpkin, kale, spinach, sweet potato, papaya, mango, and red palm oil contain provitamin A, which comes from vegetable sources. Brazil’s richest sources of provitamin A are buriti (Mauritia vinifera) and palm oil (Elaeis guineensis). Foods of animal origin could be required in order to attain adequate levels of vitamin A in the body because vegetarian sources of the vitamin are thought to absorb it poorly.
Lipids are absorbed in conjunction with the digestion and absorption of vitamin A. Therefore, extremely low dietary fat intake (less than 5–10 g/day) or ailments like pancreatic, hepatic, or repeated gastroenteritis that impair lipid digestion or absorption and cause steatorrhea can hinder vitamin A absorption.
Mammals produce retinoids from provitamin A carotenoids using the carotenoid oxygenases -carotene-15,15′-oxygenase (BCO1) and -carotene-9′,10′-oxygenase (BCO2). Apocaretenoids are created by cleavage by BCO2, and BCO1 transforms them into retinoids. Additionally, -cryptoxanthin is crucial for the formation of vitamin A because it reduces competition between -carotene metabolites due to BCO2’s preference for carotenoids with 3-OH-ionone ring sites as a substrate.
This is also supported by the fact that mice lacking BCO2 accumulate -cryptoxanthin. To meet the body’s needs, the absorbed retinol can either be released directly into the extrahepatic tissues or collected by the liver and either stored there or released back into the bloodstream. The liver reserve might be able to meet the demands for a very long time (up to months).
Vitamin A is converted to retinoic acid in any tissue, including the liver, and this active metabolite is necessary for healthy morphogenesis. Retinoic acid, which is found in serum at extremely low levels but is not a stable metabolite like retinol, is not. High levels of trans-retinoic acid and 13-cis-retinoic acid, two retinoic acid metabolites, can alter gene activity during crucial stages of organogenesis and embryogenesis, resulting in teratogenicity.
Retinol-binding protein and circulating vitamin A are carried in the plasma as a 1:1 combination (RBP). RBP and vitamin A have unique binding sites in the retina and other tissues that depend on the vitamin. Since RBP is the only carrier, illnesses including proteinuria, kwashiorkor (protein malnutrition), and zinc deficiency may lower RBP levels and cause VAD. For instance, a decline in serum retinol levels may be brought on by pre-eclampsia, which progresses with proteinuria.
Vitamin A is transferred from the mother to the child via the placenta during pregnancy, at delivery, and during lactation via the mammary gland (breastfeeding). The newborn hepatic reserves of vitamin A are low at birth to prevent potential teratogenic consequences because of the reduction in serum retinol levels in pregnant women (especially in the third quarter) and the selective placental barrier during pregnancy.
Following birth, RBP transports a significant portion of serum retinol to the breast, where it becomes breast milk. From that point on, compared to the placental pathway during the whole pregnancy, the delivery of vitamin A to breast milk during the first six months of life offers 60 times more vitamin A. Additionally, active provitamin A carotenoids are transported in breast milk and provide the newborn with extra nutrients.
Despite the significance of carotenoids in protecting the health of nursing mothers and their infants, excessive vitamin A intake has been linked to obesity in recent research with rats throughout early life (during breastfeeding).
Vitamin A Deficiency during Pregnancy: Epidemiological Aspects
Even though the pathophysiology of VAD is well understood and its signs and symptoms are widely recognized by medical experts and a segment of the general public, VAD continues to rank among the top global public health priority, along with iodine shortage and iron deficiency anemia.
Epidemiological control of VAD remains a challenge in Brazil and several other developing nations despite national and international agreements involving policymakers, program managers in health and education, and multisector programs of action (e.g., agricultural policies, food supply, and enrichment of industrialized foods with specific nutrients).
Sadly, this makes it impossible to plan, execute, evaluate, and monitor public or private policies and initiatives with the consistency needed to address the issue at the population level.
For instance, and primarily as a study subject, the significant problem of VAD in pregnant women is unquestionably the least well-known link in the chain of epidemiological events connected to this particular nutritional deficit at the national and worldwide levels.
The problem theoretically might affect the entire populace at any point in the biological cycle, from embryonic/fetal life through old age. However, the risk of this insufficiency increases throughout the brief pregnancy/lactation phase. Fundamental biological triggers for this process include:
Due to the dual demands of the mother and her unborn child, nutritional vitamin A requirements rise significantly throughout pregnancy. During lactation, breastfeeding solely should serve as the infant’s exclusive and independent supply of fluids, energy, and nutrients.
However, it is also important to consider the impact of these nutritional needs on the health/illness process that may continue into adulthood, including preventing and delaying the onset of chronic noncommunicable diseases, as well as the physiological nutritional needs of children in their first few months and years of life.
The gestational process can diminish or exacerbate existing nutritional deficits, while excesses and insufficiencies of certain nutrients in the diet might result in certain nutritional problems, making pregnancy a vital time for nutrition. Therefore, throughout pregnancy, childbirth, and the postpartum period, nutrients such as vitamin A can prevent the occurrence or aggravation of prior or concurrent diseases.
Due to the physiologically increased maternal blood volume and rapid fetal development in the final third of pregnancy, VAD is more common during this time. When vitamin A-rich foods are scarce or when there are infections, diabetes mellitus, or gestational diabetes present, pregnant women may be more susceptible to developing VAD.
According to the WHO, VAD in pregnancy is defined as serum retinol levels below 0.70 mol/L. The condition is deemed a serious public health concern when it affects 20% or more of pregnant women, moderate when it affects 10% to 20% of pregnant women, and mild when it affects 2% to 10% of pregnant women (Table 1). It should be noted that high performance liquid chromatography should ideally be used to determine serum retinol levels (HPLC).
Serum retinol has been used as a marker of vitamin A status during pregnancy (particularly in the last trimester) and inflammation, although its usefulness has been questioned. The physiological changes that occur during pregnancy affect the relationship between hepatic reserves and circulating retinol. Additionally, RBP, the serum’s retinol transporter protein, is an acute phase protein, and inflammation may change its concentration.
Given the immunological modifications required to support the viability of the conceptus, gestation itself physically resembles an inflammatory process. The status of vitamin A near the end of pregnancy and in populations with a high prevalence of infections may thus be underestimated by serum retinol and its standard cut-off point.
As a result, studies that evaluated the nutritional status of vitamin A during pregnancy found a link between serum retinol and C-reactive protein that was unfavorable (CRP). Thurnham et al. came to the conclusion in a meta-analysis that a rise in CRP is connected to a 25% drop in serum retinol levels.
An increase in CRP, an acute phase protein that is primarily involved in the innate immune response, can happen during infections as well as in many other circumstances, such as a healthy pregnancy. The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project has proposed methods for correcting for inflammation using both retinol and RBP when estimating VAD in children and women in light of the evidence that the infectious process is associated with a transient reduction in the biomarkers of vitamin A status.
The International Vitamin A Consultative Group (IVACG) determined that a night blindness prevalence of 5% during pregnancy, as observed in population research, is adequate to designate VAD as a public health issue because night blindness is the primary clinical consequence of VAD. There are still no definitive statistics on the dietary status of vitamin A in pregnant women in a number of nations, including Brazil. In actuality, VAD is still frequently perceived as ubiquitous in locations where night blindness is widespread.
VAD is viewed as a public health concern at the population level in many developing nations, despite the fact that there is insufficient data to allow for the development of WHO recommendations. Between 1995 and 2005, over 19 million pregnant women were affected by VAD, with an estimated 9.8 million of those suffering from night blindness globally, the bulk of whom were from South-East Asia and Africa.
Since socioeconomic factors are more common in underserved areas, families, and poorer nations that experience disparities in income, education, housing, access to healthcare, and other relevant areas, they have a significant impact on VAD as well as most epidemiologically interesting defects. The WHO’s requirement to collect and organize data on the status of vitamin A in nations with a gross domestic product (GDP) of less than $15,000 is therefore justified by the important role that these elements play.
Over the past 10 years, few studies assessing the nutritional status of vitamin A in pregnant women have been published, and even fewer have used a representative sample. One of these, which analyzed 1209 pregnant Chinese women and can be regarded as standard, found that VAD represents a minor public health concern in China.
It has been proposed that improvements in socioeconomic conditions may account for the low frequency of VAD seen in pregnant Chinese women. The report also noted the following risk factors for the development of VAD in pregnant women: living in impoverished rural areas; having low levels of education; not having access to adequate healthcare; having low incomes; having advanced gestational ages; and having unhealthy lifestyle habits like smoking and drinking.
Another study conducted in the Republic of the Congo on 319 expectant and nursing mothers revealed that VAD is a significant public health issue in that nation. Similar to this, a review found that due to socioeconomic constraints and poverty, a significant number of pregnant women in South Asian developing regions had VAD.
Pregnant women in other developing nations were also found to have a high prevalence of VAD: 24.6% of a sample of 3270 pregnant women in Iran, 20% of 80 pregnant adolescents in Egypt, 18.5% of 200 pregnant women in Bangladesh, 15.8% of 101 pregnant women in Nigeria, 13.8% of 738 pregnant women in Guinea-Bissau, and 10.6% of 160 pregnant adolescents in Venezuela. As can be shown, only population samples from China, Iran, and Guinea-Bissau were statistically reliable.
A recent analysis of research from Ethiopia, Kenya, Nigeria, and South Africa revealed a prevalence of VAD among pregnant women that ranged from 21% to 48%.
The majority of the women in Brazilian research to evaluate the nutritional status of vitamin A throughout pregnancy and postpartum were postpartum, which may have constituted a conceptual bias in terms of sampling. Without concentrating on pregnant women especially, VAD is generally seen as a public health issue in Brazil. In a group of women and their young children in the state of Pernambuco in northern Brazil, the frequency of VAD was 6.9% in 664 mothers and 16.1% in 790 children under the age of five.
Additionally, 8.7% of the 92 pregnant women who participated in the Brazilian study in the upper Jequitinhonha valley of Minas Gerais reported having night blindness. In another study, 606 pregnant and postpartum women in Rio de Janeiro had a prevalence of night blindness of 9.9%. Another study in northern Brazil’s state of Piau discovered 89 pregnant adolescents had a VAD prevalence of 34.8%, raising the possibility of a serious public health problem. Low pre-gestational body mass index and insufficient hygienic conditions were the risk factors in that case (BMI). Additionally, it was discovered that the serum retinol level decreased with pregnant trimester, encouraging the development of VAD.
According to a recent study, 6.2% of 676 pregnant women getting prenatal care at a reputable maternity hospital in northeastern Brazil had VAD, which was considered to be a modest public health concern. In that study, maternal anemia and vitamin A insufficiency were linked to the third trimester of pregnancy.
Since serum retinol had no statistically significant impact on the infectious process as measured by CRP, inflammation could not be controlled. Further research should be done to assess inflammatory markers in compliance with the WHO and BRINDA recommendations in light of these findings.
Further research is needed because the data currently available in Brazil are still insufficient to determine the prevalence and severity of VAD during pregnancy at the national, regional, and microregional levels.
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Vitamin A and Pregnancy: Importance and Effects of Deficiency and Excess
The more frequent occurrence of VAD is when there is an abrupt decrease in vitamin A intake, a lengthy time of dietary scarcity, or a simultaneous combination of these two situations, i.e., both severe and prolonged, with the potential involvement of an underlying disease. VAD can cause clinical illnesses such increased viral morbidity, growth retardation, anemia, and xerophthalmia as well as subclinical disorders like poor iron mobilization, altered cellular differentiation, and diminished immunological response.
The eye-related symptoms of VAD are referred to as xerophthalmia. These ocular manifestations include include keratomalacia and corneal ulceration-induced night blindness. One of the initial symptoms of this particular micronutrient deficit is night blindness, albeit this is not a pathognomonic sign because it can also occur in retinitis pigmentosa.
In addition to being crucial for the development of other organs, the fetal skeleton, and the maintenance of the fetal immune system, vitamin A is necessary for the pregnant woman and the fetus. It also helps to maintain maternal night vision and fetal ocular health. Vitamin A molecule concentrations in the mother and the baby have been linked to neonatal outcomes. This section discusses the impact of maternal vitamin A levels on fetal and perinatal health, with an emphasis on studies from the past ten years as well as the traditional sources on the subject.
Animal studies have provided compelling evidence that VAD is linked to negative effects on offspring during the embryonic and post-natal periods. There is a requirement for vitamin A even before the development of the basic circulatory and cardiovascular systems and the definition of the rhombencephalon. VAD causes serious problems, including early embryonic death, at this crucial period.
Experimenting on rodents also demonstrates the need for vitamin A at later stages of development. The heart, the central nervous system and its related structures, the circulatory, urogenital, and respiratory systems, as well as the skull, skeleton, and limb, are among the primary target tissues of VAD. A recent rat study revealed that dietary vitamin A deficiency two weeks before and during pregnancy might cause anorectal malformations, and that the pathological alterations associated with these malformations may have an impact on how the enteric nervous system develops.
Studies on humans indicate that inadequate or excessive vitamin A intake during pregnancy may have negative consequences on the fetus. As a result, 48 neonates were found to have congenital abnormalities in a recent study that examined 1180 pregnant mothers in the first trimester. Mothers of newborns with congenital deformities had considerably lower serum concentrations of selenium, zinc, magnesium, and the vitamins A, E, B12, and folic acid than did mothers of newborns without malformations.
revealing a potential connection between VAD and congenital abnormalities. In light of these findings and the microcephaly outbreak that peaked in January/February 2016, researchers at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) in the Brazilian state of Pernambuco began to track a cohort of pregnant women over a year ago.
Fetal growth restriction and the subsequent risk of insulin resistance and glucose intolerance in adulthood are both likely caused in large part by maternal VAD. According to studies, gestational diabetes and diabetes mellitus are linked to VAD. In rats, VAD during pregnancy can disrupt the endocrine pancreas’ development, pointing to a potential role for VAD in the pathophysiology of diabetes. The development of the endocrine pancreas can be hampered by VAD during pregnancy, according to a recent mouse study.
Studies on animals revealed that maternal vitamin A insufficiency during pregnancy led to poor fetal inner ear development. Therefore, it is thought that consuming enough vitamin A during pregnancy can encourage healthy inner ear development and lower the chance of sensorineural hearing loss in people. These assumptions are supported by research demonstrating that vitamin A supplementation in preschool can lower the risk of hearing loss brought on by otitis media, which has been linked to an increased risk of otitis media associated with VAD.
In a large cohort research involving 19,044 live births, it was discovered that VAD in the second trimester of pregnancy was linked to a three-fold increased risk of schizophrenia and other schizophrenia spectrum disorders in children.
In a different recent cohort study, mother-child pairs’ bone size and birth weight were assessed. Serum retinol levels of 520 mothers were found to be negatively associated with these measurements, while serum beta-carotene levels of 446 mothers were found to be positively associated with these measurements.
There is also evidence that dietary intake of vitamin A during pregnancy below the recommended daily intake is significantly associated with an increased risk of fetuses having congenital diaphragmatic hernia (CDH), according to a case-control study that included 46 control pregnancies and 31 pregnancies diagnosed with congenital diaphragmatic hernia (CDH). Nevertheless, a meal frequency questionnaire was used to evaluate the maternal vitamin A intake.
In an animal research, severe VAD during pregnancy was linked to fetal renal agenesis, whereas mild VAD resulted in a reduction in the newborn’s kidney weight and number of nephrons. Based on these findings, a research comparing 16 women with VAD and 64 moms who had adequate vitamin A levels was carried out. Infants born to moms with VAD showed considerably lower mean retinol levels and smaller kidney size than infants born to mothers with adequate vitamin A levels. According to a recent comprehensive study, a child’s kidney structure and function are negatively impacted by a vitamin A shortage during pregnancy.
As was already mentioned, maternal VAD is linked to a number of detrimental effects in the kids. Contrarily, excessive vitamin A has been proven to have teratogenic consequences in a variety of animal species. The type of malformation depends on the dosage of vitamin A and the stage of pregnancy at which it is given. Vitamin A (not beta-carotene) has been thought to be teratogenic due to the teratogenicity of both isotretinoin and vitamin A in people and animals, especially during the first 60 days after conception in humans. Isotretinoin is a medication that includes 13-cis-retinoic acid, one of numerous vitamin A derivatives that are frequently used to treat dermatological problems, including cystic acne and nodular acne. It is prohibited during pregnancy since it is thought to be teratogenic.
The influence of high concentrations of specific retinoic acid metabolites (such as trans-retinoic acid and 13-cis-retinoic acid) on the activity of genes at crucial stages of organogenesis and embryogenesis is thought to be the mechanism of action by which vitamin A exerts its teratogenicity.
The study by Rothman et al., which found that pregnant women who consume more than 10,000 IU (3000 g RE) in the form of supplements or more than 15,000 IU (4500 g RE) per day in total vitamin A intake are at an increased risk of abnormalities in the development of neural crest tissues, is what first raised concerns about vitamin A’s teratogenicity in humans (on which 13-cis-retinoic acid has a teratogenic effect). The inhabitants of high-income nations frequently use vitamin supplements and/or foods high in preformed vitamin A, such as liver, which have intakes of this order that are higher than those that are recommended.
The amounts of vitamin A that can harm pregnant women or women of childbearing age have not been extensively studied in the literature. There may be a chance of teratogenicity when the daily dose of preformed vitamin A exceeds 10,000 IU. When mothers take high amounts of preformed vitamin A (>25,000 IU/day) when pregnant, there have been instances of abnormalities in the fetuses of those children. These papers emphasize the urinary tract’s peculiarities.
A miscarriage and congenital heart and central nervous system defects are linked to an increase in preformed vitamin A (retinoic acid) in maternal blood during the first trimester of pregnancy. Retinol consumption above 10,000 IU per day during pregnancy is therefore thought to be a risk factor for fetal cardiopathy (absolute risk between 1% and 2%), suggesting a need for fetal echocardiography throughout the prenatal period given the possibility of cardiac deformity.
Vitamin A Supplementation during Pregnancy: Recent Evidence and Current Recommendations
According to the WHO, there are three methods for preventing and controlling VAD: fortification of foods (redistribution of nutrients) in the medium term; dietary diversity as a permanent remedy in the long run; and supplementing with enormous doses as an emergency intervention.
Massive dosage distribution programs typically provide positive benefits, but because they rely on community engagement and governmental support, they lose their effectiveness over time. Since changing habits and increasing the consumption of certain foods necessitates dietary variety, it is a challenging and time-consuming strategy.
Therefore, the only remaining strategy is food fortification, which entails increasing the nutrient content in specific foods and requires a number of crucial components, including a food vector, nutrient aggregation in a way that ensures its stability until reaching the consumer, the integrity of the organoleptic characteristics of the vector, and a straightforward and affordable fortification technology.
The most recent research on vitamin A supplementation during pregnancy. Children’s pulmonary function improved in a sizable cohort of 9 to 13-year-old children in rural Nepal whose mothers had taken part in a placebo-controlled, double-blind, cluster-randomized trial of vitamin A or beta-carotene supplementation when this tactical alternative was applied to women before, during, and after pregnancy in a population with chronic VAD.
Children whose mothers received preformed vitamin A only benefited from maternal supplementation with vitamin A; children whose mothers received beta-carotene did not. This may be because beta-carotene is a less effective source of vitamin A than the preformed ester.
An analysis of two previous trials’ cohorts of rural Bangladeshi children revealed that while general intelligence, memory, and motor functions are unaffected by prenatal or postnatal vitamin A supplementation, these periods are associated with an improvement in school performance and some executive function measures in children tested at age eight.
Regarding food fortification, a recent Danish study found a link between fetal exposure to a 25% increase in the quantity of vitamin A consumed by the mother during pregnancy and a lower risk (OR = 0.88) of type 2 diabetes in the offspring as adults.
Due to vitamin A’s crucial role in the immune system and improvement of host defenses, several studies indicate a decrease in the incidence of infections following vitamin A intake. Intestinal barrier function is aided by secretory IgA, and research indicates that these antibodies play a role in maintaining immunological homeostasis.
IgA antibody-secreting plasma cells and their immediate precursors (plasmablasts), which amass in the mucosa, are necessary for its production. An important part of the immune responses of the intestinal mucosa is played by the vitamin A metabolite all-trans retinoic acid, which also functions as a feedback mechanism for the production of the enzymes necessary for its own synthesis. This increases mucosal IgA responses and improves the efficacy of oral vaccines.
Clinical investigations that examined vitamin A supplementation during pregnancy did not find a reduction in the risk of placental malaria and negative pregnancy outcomes, nevertheless. Another clinical research that examined the prevalence of malaria among Tanzanian women who were HIV-positive came to the same conclusion that taking vitamin A supplements did not change the prevalence of malaria during the study.
Low levels of vitamin A in pregnant HIV-positive women may be linked to a much higher likelihood of vertical transmission and newborn mortality, according to observational studies carried out in sub-Saharan Africa. Vitamin A supplementation during the prenatal or postnatal period, however, probably has little to no impact on HIV transmission from mother to child, according to a systematic review.
According to a recent study, vitamin A supplementation during pregnancy raised hemoglobin levels and decreased the likelihood of anemia. Since anemia is the most prevalent perinatal deficit, the rise in serum retinol levels and the decline in anemia define a significant link. Therefore, VAD is one of the primary causes of anemia. The pathophysiology of this connection, however, is still unclear. Vitamin A has been shown to influence hematopoiesis, boost immunity to illnesses (therefore preventing anemia from infection), and modulate iron metabolism.
A recent retrospective cross-sectional study in Brazil found that, regardless of the source used, taking multivitamin supplements containing vitamin A while pregnant protects VAD. Only postpartum women were included in the other Brazilian trial on the effects of vitamin A supplementation that was made available.
A cohort study in Rio de Janeiro to evaluate the impact of nutritional prenatal care found that pregnant women who consumed a medium-sized piece of ox liver (110 g) per week experienced a significant decrease in the prevalence of night blindness during follow-up. This finding is relevant to the diversification of diet as a means of preventing and controlling VAD.
A 2015 systematic study found that vitamin A supplementation during prenatal care had no impact on maternal or perinatal death. The majority of the studies examined throughout the analysis, however, only looked at the basal level of vitamin A and provided no data on vitamin deficiency.
Additionally, it was challenging to follow up with these women. According to the review, supplementing in HIV-positive pregnant women and people who live in locations with low levels of vitamin A may lessen anemia and night blindness, but this is unrelated to the decline in vertical HIV transmission.
It has also been claimed that the rate of maternal infection may be declining, however it is vital to keep in mind that these data are not of high quality.
The 2013 WHO recommendation states that systematic prenatal vitamin A supplementation is not advised to reduce maternal or perinatal morbidity and mortality. However, vitamin A supplementation during pregnancy is advised to stop night blindness in areas where VAD is a public health concern.
The recommended intake of vitamin A during pregnancy is 800 g/day due to an increase in demand of about 10% to 20%. It could be challenging to get this amount only by diet, especially in populations with VAD.
There are numerous forms of vitamin A that can be used for prenatal treatment. The two most often utilized ingredients when taken alone are retinyl palmitate and retinyl acetate, which come in the form of tablets or oil-based solutions. Other options include oil, fish liver oil, beta-carotene, and a supplement that contains both beta-carotene and vitamin A.
Table 2 lists the programs recommended for pregnant women to take vitamin A supplements to avoid night blindness in regions where vitamin A deficiency is a serious public health issue. To increase vitamin A intake, food fortification and variety are also advised in addition to supplements.
The WHO recommends a maximum dose as safe during pregnancy of up to 10,000 IU daily or 25,000 IU weekly after the first 60 days of gestation due to the teratogenic consequences linked to excessive vitamin A intake.
Headache, hazy vision, vertigo, nausea, vomiting, and impaired motor coordination as a result of intracranial pressure are signs of acute vitamin A toxicity. Skin peeling, weight loss, and exhaustion have all been listed as additional symptoms. The majority of the time, consuming too much dietary vitamin A supplements causes these harmful effects. However, regular liver consumption can lead to toxicity because of its high vitamin A content, even if it is typically not an issue in places with retinol insufficiency.
The UK National Institute for Health and Clinical Excellence (NICE) guidelines for the prenatal period advise against vitamin supplements containing more than 5000 IU (1500 g) of vitamin A because of the potential negative effects, particularly teratogenic effects, associated with high doses. This recommendation applies to developed countries and places where there is no VAD. However, most dietary supplements substitute beta-carotene for retinol, and there is no evidence linking a high intake of beta-carotene to birth abnormalities.
In addition to these suggestions, the National Health Service and the Finnish Food Safety Authority advise against eating liver while pregnant because it is high in vitamin A.
Additionally, pregnant women who frequently consume liver are advised to consult their region’s food composition databases because vitamin A levels in liver can vary significantly. For instance, according to the national nutrient database of the United States Department of Agriculture, the amount of vitamin A in liver and liver products ranges from 4900 international units (IU) in one raw chicken liver to 59,500 IU in three ounces of cooked New Zealand ox liver.
There are no established policies or initiatives in Brazil for vitamin A supplementation during pregnancy. The Brazilian Ministry of Health previously decided to advise the administration of high doses of vitamin A (200,000 IU) to postpartum women leaving the hospital as a method of replenishing the tissue reserves of this nutrient depleted during pregnancy and needed to meet the increased demands during breastfeeding. This recommendation was implemented in the 1980s but was discontinued in 2016 due to a technical addendum.
Vitamin A supplementation has been used in a number of nations despite the paucity of research that have been done to assess the nutritional status of vitamin A in pregnant women and even in the general population globally.
To enable new guidelines and management strategies to be implemented for pregnant women, children, other biologically or socially vulnerable groups, and even for the general population, scientific evidence on the prevalence of vitamin A deficiency and on the supplementation and fortification of this micronutrient is required.
According to the most recent research, pregnant women’s and their fetuses’ health depends critically on maintaining optimal amounts of vitamin A during pregnancy. Unfortunately, VAD in pregnancy is still seen as a public health problem. Few studies have examined the nutritional status of vitamin A in pregnant Brazilian women over the previous ten years. More research with fresh perspectives and novel methodologies is needed to determine the true scope of this issue, especially in developing nations.
Previous studies showing a prevalence of 5.2% and 6.2% for serum retinol levels < 0.70 mol/L may indicate that epidemiological control of VAD in pregnant women is finally in reach. Although this is a welcome development, it should be reevaluated in fresh assessments carried out in compliance with WHO and BRINDA recommendations given its significance in decision-making with regard to the readjustment of policies and administration of programs on the subject.
The current guideline is that vitamin A supplementation be saved for populations with severe deficiencies of this micronutrient during the prenatal period in order to prevent night blindness. The frequency and duration of vitamin A administration during pregnancy require more study. Contrarily, in areas where VAD is uncommon, it is advised to use caution when it comes to overdosing and to avoid consuming vitamin A supplements or even foods high in the vitamin, such liver.
Most Important Vitamins for Pregnancy
During pregnancy you need folic acid, iron, calcium, vitamin D, choline, omega-3 fatty acids, B vitamins, and vitamin C.
Vitamins, Supplements and Nutrition in Pregnancy
You can receive the majority of the vitamins and minerals you need during pregnant by eating a healthy, diversified diet.
But it’s crucial to also take a folic acid supplement if you’re pregnant or have a probability of becoming pregnant.
It is advised that you take:
From before becoming pregnant until you are 12 weeks along, take 400 micrograms of folic acid daily.
This lowers the possibility of developmental issues during the first few weeks of pregnancy.
You should also consider taking a daily vitamin D supplement.
When you are pregnant, avoid using cod liver oil or any supplements that include vitamin A (retinol). You shouldn’t give your infant too much vitamin A. Check the label every time.
You should also be aware of the foods to avoid while pregnant.
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Where to Get Pregnancy Supplements
Supplements are available at pharmacies and grocery stores, or your doctor may be able to prescribe them.
Make sure the multivitamin pill doesn’t contain vitamin A if you want to receive your folic acid from one (or retinol).
If you are eligible for the Healthy Start program, you could be able to receive free vitamins.
Learn more about the Healthy Start initiative.
Folic acid before and during pregnancy
It’s crucial to take a 400 microgram folic acid tablet every day up until you are 12 weeks pregnant.
Spina bifida and other neural tube problems, such as birth defects, can be prevented with folic acid.
If you didn’t start taking folic acid before being pregnant, you should do so as soon as you find out.
Attempt to consume green leafy vegetables, which are rich in folate (folic acid’s natural form), as well as folic acid-fortified morning cereals and fat spreads.
Because it’s challenging to obtain the recommended quantity of folate for a healthy pregnancy from diet alone, it’s crucial to take a folic acid supplement.
Higher-dose folic acid
If you have a higher chance of your pregnancy being affected by neural tube defects, you will be advised to take a higher dose of folic acid (5 milligrams). You will be advised to take this each day until you’re 12 weeks pregnant.
You may have a higher chance if:
- you or the baby’s biological father have a neural tube defect
- you or the baby’s biological father have a family history of neural tube defects
- you have had a previous pregnancy affected by a neural tube defect
- you have diabetes
- you take anti-epilepsy medicine
- you take anti-retroviral medicine for HIV
If any of this applies to you, talk to a GP. They can prescribe a higher dose of folic acid.
A GP or midwife may also recommend additional screening tests during your pregnancy.
Find out about epilepsy and pregnancy.
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Vitamin D in Pregnancy
You need 10 micrograms of vitamin D each day and should consider taking a supplement containing this amount between September and March.
Vitamin D regulates the amount of calcium and phosphate in the body, which are needed to keep bones, teeth and muscles healthy. Our bodies make vitamin D when our skin is exposed to summer sunlight (from late March/early April to the end of September).
It’s not known exactly how much time is needed in the sun to make enough vitamin D to meet the body’s needs, but if you’re in the sun take care to cover up or protect your skin with sunscreen before you start to turn red or burn.
Vitamin D is also in some foods, including:
- oily fish (such as salmon, mackerel, herring and sardines)
- red meat
Vitamin D is added to some breakfast cereals, fat spreads and non-dairy milk alternatives. The amounts added to these products can vary and might only be small.
Because vitamin D is only found in a small number of foods, whether naturally or added, it is difficult to get enough from foods alone.
Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful.
You can get vitamin supplements containing vitamin D free of charge if you’re pregnant or breastfeeding and qualify for the Healthy Start scheme.
There have been some reports about vitamin D reducing the risk of coronavirus (COVID-19). But there is currently not enough evidence to support taking vitamin D solely to prevent or treat COVID-19.
If you have dark skin or cover your skin a lot
You may be at particular risk of not having enough vitamin D if:
- you have dark skin (for example, if you’re of African, African Caribbean or south Asian origin)
- you cover your skin when outside or spend lots of time indoors
You may need to consider taking a daily supplement of vitamin D all year. Talk to a midwife or doctor for advice.
Iron in Pregnancy
If you do not have enough iron, you’ll probably get very tired and may suffer from anaemia.
Lean meat, green leafy vegetables, dried fruit, and nuts contain iron.
If you’d like to eat peanuts or foods that contain peanuts (such as peanut butter) during pregnancy, you can do so as part of a healthy, balanced diet unless you’re allergic to them or your health professional advises you not to.
Many breakfast cereals have iron added to them. If the iron level in your blood becomes low, a GP or midwife will advise you to take iron supplements.
Vitamin C in Pregnancy
Vitamin C protects cells and helps keep them healthy.
It’s found in a wide variety of fruit and vegetables, and a balanced diet can provide all the vitamin C you need.
Good sources include:
- oranges and orange juice
- red and green peppers
- brussels sprouts
Calcium in Pregnancy
Calcium is vital for making your baby’s bones and teeth.
Sources of calcium include:
- milk, cheese and yoghurt
- green leafy vegetables, such as rocket, watercress or curly kale
- soya drinks with added calcium
- bread and any foods made with fortified flour
- fish where you eat the bones, such as sardines and pilchards
Vegetarian, Vegan and Special diets in Pregnancy
A varied and balanced vegetarian diet should provide enough nutrients for you and your baby during pregnancy.
But you might find it more difficult to get enough iron and vitamin B12.
Talk to a midwife or doctor about how to make sure you’re getting enough of these important nutrients.
If you’re vegan or you follow a restricted diet because of a food intolerance (for example, a gluten-free diet for coeliac disease) or for religious reasons, talk to a midwife or GP.
Ask to be referred to a dietitian for advice on how to make sure you’re getting all the nutrients you need for you and your baby.
Find out more about healthy eating if you’re pregnant and vegetarian or vegan.
Healthy Start Vitamins
You may be eligible for the Healthy Start scheme, which provides vouchers to buy milk and plain fresh and frozen fruit and vegetables at local shops.
You can also get coupons that can be exchanged for free vitamins.
If you’re not eligible for the Healthy Start scheme, some NHS organisations still offer the vitamins for free, or sell them. Ask a midwife about what’s available in your area.