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Should we take special pregnancy food supplements?
Vitamins, minerals, plant extracts… The food supplements market is exploding! Each month, nearly 600 new products land on the market. It must be said that the French are crazy about it. One in five adults uses it and women are twice as likely to take it as men.As for future mothers, they are not the last. According to the NutriNet-Santé * study, nearly 75% of them absorb it during the 3rd trimester of pregnancy, which is not without danger. Already in 2014, the experts of The National Agency for Food, Environmental and Occupational Health Safety (ANSES) called for the greatest caution.
Since the implementation of its Nutrivigilance system in 2010, the Agency received nearly 1 reports of adverse reactions directly linked to food supplements. If slimming products are involved in 15% of cases, followed by hair supplements, anti-cholesterol, vitality / tone, “special pregnancy” cocktails are not spared. They represent 5% of reports, including nine serious cases and two medical terminations of pregnancy. Faced with the severity of certain side effects in pregnant women, ANSES has decided to take a decision in order to assess the risks of an additional intake of vitamins and minerals during pregnancy.
In a notice published in June 2017, the Agency warns against the multiplication of sources of vitamins and minerals, in the absence of established needs.
ANSES makes the following recommendations:
The Agency reminds pregnant women to do not consume food supplements without the advice of a health professional and recommends that they report to their doctor, pharmacist or midwife the taking of any product (drug or food supplement), whether it is prescribed or taken as self-medication.
For the attention of healthcare professionals
- The consequences of a hypercalcemia on the health of the newborn, in the event of hypersensitivity to vitamin D, require the implementation of appropriate preventive measures. In the event of confirmed hypercalcemia, it will be advisable to seek the origin of it by the appropriate examinations and to reconsider the relevance of a supplementation of the pregnant woman in vitamin D.
- In newborns, unexplained hypercalcaemia may be linked to genetic hypersensitivity to vitamin D. It will therefore be necessary, in the event of unexplained hypercalcemia, to look for a possible mutation of the gene predisposing to hypercalcaemia in the child and to take the appropriate measures.
- Simultaneous exposure to multiple sources ofiodine (from drugs or dietary supplements) increases the risk of thyroid disorders in the newborn and should therefore be avoided during pregnancy.
- The Agency stresses the importance of do not combine sources of vitamins and minerals without regular biological monitoring.
Finally, the Agency reminds healthcare professionals of the importance of reporting to the nutrivigilance system any adverse effects brought to their attention, which may be linked to the consumption of food supplements.
Food supplements & pregnancy: overdose and cocktail effect?
Too high doses can indeed be problematic because many of these substances cross the placental barrier. Thereby, maternal overconsumption of vitamin A exposes the baby to deformities. However, nearly 6% of future mothers take it in the 3rd trimester of pregnancy *! Also worrying is the high number of pregnant women who take vitamin E supplementation. Nearly 30% during the second trimester. Again, a recent study shows that beyond 2 mg per day, there is a nine-fold greater risk for the child to subsequently develop coronary heart disease.
As for food supplements based on plants, around 11% of expectant mothers consume it, while some assets can be toxic. This is the case with red yeast rice, psynephrine, present in the peel of bitter orange, and caffeine. ANSES particularly advises against the ingestion of these supplements for pregnant women, but above all warns against the cocktail effect of all these products. To avoid the occurrence of these side effects, it is therefore recommended to take only what is really useful and prescribed by the practitioner who is monitoring your pregnancy. No more no less.
The essential supplements for pregnancy: folic acid and vitamin D
In principle, a balanced and diverse diet provides the body with everything it needs. The French College of Gynecologists-Obstetricians (CNGOF) and the Haute Autorité de Santé (HAS) recommend systematic supplementation of only two vitamins during pregnancy. B9 (folic acid) and vitamin D. Numerous studies have shown that B9 is essential for the proper development of the fetal nervous system. Deficiency increases the risk of malformations, especially neural tube closure abnormalities (AFTN), also called spina bifida.
If this vitamin is found in many foods, such as green leafy vegetables (spinach, cabbage, chicory, etc.) or in eggs and cheese, About 25% of pregnant women do not reach the recommended daily allowance. Doctors therefore recommend that all mothers-to-be supplementation with 400 micrograms per day of folate. The best is to take it at least two months before conception, because it is from the beginning of the first month of pregnancy that the nervous system of the embryo is formed. For those with a history of AFTN, the dose is also multiplied by 12,5. Despite these recommendations, only 50% of future mothers benefit from this boost during the first trimester!
The other vitamin officially recommended by doctors is vitamin D. It is also essential during pregnancy. It contributes to the good development of the baby’s skeleton and various studies seem to indicate that an insufficient level would play a role in the occurrence of pre-eclampsia, gestational diabetes, or even intrauterine growth retardation (IUGR ). An Italian study published last August ** also suggests that women who lack it are twice as likely to conceive following in vitro fertilization. Vitamin D intake by pregnant women could also reduce the risk of low birth weight and preterm delivery, according to a study published in 2016 ***. However, when vitamin D and calcium are combined, the risk of preterm labor is increased.
Some foods provide a little (especially sardines, salmon, tuna and dairy products fortified with vitamin D), but most of it is synthesized by the skin under the action of ultraviolet B rays. Suffice to say that for women who live in regions with little sun or who give birth between the months of March to June, it is often lacking in the approaching the term. Also, doctors advise all expectant mothers to take a dose of vitamin D in the 6th or 7th month of pregnancy. For other vitamins or minerals, it is only after measuring a deficiency and on prescription. As with iron, for example.
This is because the needs increase considerably during pregnancy, not only to allow the development of the placenta and the fetus, but also due to the increase in blood volume.
Food supplements & pregnancy: respect the dosage and duration of treatment
Some expectant mothers are more at risk of running out of iron. This is the case if you had a very heavy period. if you eat little or no food of animal origin, if you are expecting twins or have had closely spaced pregnancies… If a blood test reveals a level of iron that is too low, the doctor may prescribe iron tablets, the time to replenish sufficient reserves. According to the results of the study coordinated by Inserm * researchers, 64% of pregnant women take an iron supplement in the 3rd trimester. But, again, caution. It is necessary to respect the dosage and the duration of the treatment to avoid an overload.
Likewise, the doctor may need to prescribe iodine. This trace element is essential for the proper development of the baby’s brain. In mothers at risk of deficiency (geographical area, close pregnancies, smoking, veganism, etc.), a daily supplement is offered throughout the pregnancy. For others, it is simply advisable to boost your intake by consuming products rich in iodine (cooked shellfish, sea fish, iodized salt, eggs and dairy products). Beyond these specific cases, validated by a doctor, a pregnant woman who eats normally does not need supplements.
* NutriNet-Santé study, Plos One, August 2013.
**The Journal of Clinical Endocrinology & Metabolism, 2014.