Nutritional supplements for pregnancy

Most people in the UK can achieve an adequate nutritional intake via a healthy balanced diet that includes all four food groups (see nutrition module), without needing to take nutritional supplements.

In pregnancy however, daily nutritional supplementation is recommended for folate (folic acid) and vitamin D, even for women who eat a healthy balanced diet.

Additional supplements may also need to be considered for women who are vegan or women who do not gain sufficient nutrient intake from their diet.

Recommended supplements for all pregnant women

The two recommended supplements for all pregnant women are folate (or folic acid) and vitamin D.

Folate
All pregnant women in the UK are recommended to take supplements of folic acid (400 µg per day), prior to conception and up to 12 weeks’ gestation. This is to reduce the risk of having a baby with a neural tube defect, such as spina bifida. There is also recent evidence to suggest that supplementation during the 2nd and 3rd trimesters may positively affect child IQ.

Women with a previous history of neural tube defects, diabetes or living with obesity (Body Mass Index >30 kg/m2) may be at increased risk, and should be prescribed a higher dose of folic acid (5 mg per day).

Vitamin D
All pregnant women and lactating women are recommended to take 10µg per day of vitamin D (regardless of whether they eat a healthy diet). This is to prevent maternal deficiency and risk of rickets (a severe bone deformity) in the new born. Women living with obesity (Body Mass Index >30kg/m2), darker pigmented skin or limited exposure to sunlight may be at increased risk and may benefit from a higher dose of 25µg per day.

Healthy start vitamins
Most women in the UK are entitled to ‘Healthy Start’ vitamins during pregnancy and lactation (although in some areas they are restricted to those in receipt of certain benefits). The daily supplement provides 70mg vitamin C, 10µg vitamin D and 400µg folic acid and is suitable for vegetarians, but not vegans. Pregnant women and/or those with children under 4 years of age in receipt of certain financial benefits, or under 18 years of age, can also access Healthy Start vouchers every 4 weeks; to buy cow’s milk, formula milk or fruit and vegetables.

Visit NHS Healthy Start for more information.

Additional considerations for women at nutritional risk

Pregnant women who are at increased nutritional risk (e.g., women who are vegan or who eat a nutritionally poor diet) may need to consider additional supplements, such as vitamin B12, iron, iodine and/or omega 3 fatty acids. A supplement suitable for vegans can be obtained via The UK Vegan Society’s website called VEG1. This contains folic acid, vitamin B2, B6, B12, vitamin D3, iodine and selenium in suitable doses for pregnancy.

Over-the-counter multi-vitamins

Despite only folic acid and vitamin D supplements being recommended routinely, multi-vitamin supplement use during pregnancy is popular in the UK. Health professionals often recommend ‘Pregnacare’ as it contains 19 vitamins and minerals (such as iron, zinc, vitamin B12, vitamin D and folic acid), plus omega 3 fatty acids. This and several other preparations, including healthy start vitamins, are suitable for vegetarians but not vegans.

Important note: For supplements purchased over the counter, it is important to check these are suitable for pregnancy, as preparations that contain vitamin A (> 700 µg/day) can be harmful to the foetus and should be avoided.

Key messages:

• Folic acid and vitamin D supplements are recommended for all pregnant women (400 µg/day of folic acid prior to conception and up to 12 weeks of pregnancy; 10 µg/day of vitamin D whilst pregnant and lactating)
• Women with increased risk may need higher doses of both folic acid and vitamin D
• Eligible women can access Healthy Start vitamins which include the recommended dose of folic acid and vitamin D
• Some pregnant women (e.g., vegans) may need to consider additional supplementation to make up for nutritional deficits
• Over the counter vitamin supplements need to be used with caution, and checked for their suitability for pregnancy