Multivitamin supplements ‘Is a waste of money’ for most women during pregnancy.

Multivitamins Courtesy Pixabay 

The drug market is flooded with myriad combinations of prenatal multivitamins and nearly all women are routinely prescribed these at prenatal visit to healthcare provider. It has long been claimed that taking a daily multi translate into better health for women and her unborn child.

Maternal deficiency of certain nutrients is linked with congenital malformations and poor pregnancy outcomes like preeclampsia, IUGR, skeletal deformities and neural tube defects.

This has given rise to billion-dollar pharma industry manufacturing and marketing products targeted at antenatal women and her baby. Globally the retail value sales of Prenatal Vitamin grew by 34% between 2008 and 2013 to reach its current market value of US$ 4.7 billion worldwide and is expected to rise continuously.[1]

According to the researchers, a typical prenatal Multi(MV) contains at least 20 different vitamins and minerals and sometimes the dose exceeds 100% RDS value. The average cost of daily prenatal MV is $20 per month.

A recent review[2]  published in British Medical Journal's Drug and Therapeutics Bulletin have refuted the need of Multivitamin supplements in pregnancy, the authors say “For most women who are planning to become pregnant or who are pregnant, complex multivitamin and mineral preparations promoted for use during pregnancy are unlikely to be needed and are an unnecessary expense.”

“The marketing of such products does not appear to be supported by evidence of improvement in child or maternal outcomes. Pregnant women may be vulnerable to messages about giving their baby the best start in life, regardless of cost,” the review further adds.

We found no evidence to recommend that all pregnant women should take prenatal multi-nutrient supplements beyond the nationally advised folic acid and vitamin D supplements, generic versions of which can be purchased relatively inexpensively," they say.

"Pregnancy multivitamins are a waste of money because most mothers-to-be do not need them, according to researchers," BBC News reports[3]

The researchers also looked at individual vitamins and supplements taken during pregnancy like Vitamin A, C, D and E, iron and folic acid. Strong evidence was only found in favor of supplementing Vitamin D and folic acid.

They have also cautioned against the excessive intake of Vitamin A which may be teratogenic to the fetus.

The researchers in this review have further confirmed the NICE guidelines:

• Folic acid (400 micrograms) should be taken when trying to conceive and for the first 12 weeks of pregnancy to protect against neural tube defects (NTD), such as spina bifida, in babies. 
• Folic acid dose is increased to 5 milligrams of folic acid a day where there is a family history of neural tube defects or where they have diabetes or have had a previous baby with a neural tube defect.
• 10 micrograms of vitamin D which equals 400 I.U each day throughout pregnancy that has to be continued while breastfeeding.

ACOG currently advises a pregnant woman to eat a well-balanced diet that includes foods from five groups: grains, fruits, vegetables, protein foods and dairy. Women who are pregnant requires extra folic acid and iron, which can be sourced from taking a prenatal Multivitamin but "a well-rounded diet should supply all of the other vitamins and minerals."[4]

Janet Fyle, from the Royal College of Midwives also dispelled the myth for eating for ‘two’ in pregnancy.

"We would also stress that there is no need for pregnant women to 'eat for two'."This is a myth, and all that is required is a normal balanced amount of food."

This news has angered the pharmaceutical industry, who are arguing that the prenatal vitamins are prescribed to fill in the gaps in the diet and not to cure any specific disease.

Two earlier studies and an expert editorial published in Annals of Internal Medicine have dispelled that myth too.  "The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided," says the editorial, signed by two researchers from Johns Hopkins University in Baltimore, one British researcher and one of the journal's senior editors.[5]

The review may not be systematic, but it provides data supporting the current recommendation of NHS. The researchers also argue that most studies favoring Multivitamin supplementation in pregnancy are from developing countries, where women are deficient in many key nutrients. Hence, the same recommendation does not hold true for developed countries.

However, according to current evidence, eating a good balanced diet, along with folic acid and Vitamin D supplementation ensures the best possible outcome for pregnant woman and her unborn child.

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[1] http://blog.euromonitor.com/2014/05/optimizing-development-the-growing-paediatric-and-prenatal-supplements-market.html

[2] http://dtb.bmj.com/content/early/2016/07/11/dtb.2016.7.0414

[3] http://www.bbc.com/news/health-36765161

[4] http://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy#extra

[5] http://annals.org/article.aspx?articleid=1789253