Vitamin A during pregnancy - what you need to know.

Disclaimer:  The following is meant for use as general nutrition educational content only. A woman, pregnant, breastfeeding, or trying to conceive, is strongly advised to discuss her need for vitamin A, or any specific nutrient, with her obstetrical/gynecological care provider. This is not meant to replace the advice of an individual’s qualified healthcare provider.

I have written a detailed article published in the Wise Traditions Journal, Summer 2016 available at: http://www.westonaprice.org/health-topics/abcs-of-nutrition/fat-soluble-activators/the-scarlet-nutrient/.

However, I realize that many of you may just want the “talking points.”  So here they are:

1. Vitamin A is absolutely essential for the proper development and growth of a baby, before and after birth.

2. Vitamin A is now considered a nutrient to be avoided during pregnancy, largely based on one weak study and concerns about very large intakes leading to birth defects.

3. Most prenatal vitamins do not contain true vitamin A, also known as retinol, retinyl esters, or retinyl palmitate; some do contain beta-carotene, a vitamin A precursor.

4. Beta-carotene cannot meet the vitamin A needs of many individuals, whether from food or vitamin sources.  Genetic variation largely accounts for this, but health status is a factor.

5. Liver is the best dietary source of vitamin A, around 3-4 oz a week will usually be sufficient to meet dietary needs, yet women are being advised not to eat liver.  High quality cod liver oil is also an excellent source; traditionally both were consumed by pregnant women as late as the mid-20th century.

6. Vitamin A regulates cellular replication and the processes that cause a cell to become a certain type of cell to form tissues, such as a brain cell, a heart cell, a liver cell, etc.

7. In animal studies, marginal vitamin A intakes lead to a variety of “fetal malformations” including defects in kidneys, lungs, and eyes. 

8. The human studies we have indicate that low vitamin A intakes are linked to low birth weight, premature birth, poor kidney, eye, and lung development or maturation; in developing countries it manifests as blindness and increased infant mortality. Very large doses are safely given to newborns in these countries.

9. Governmental and medical recommendations are fairly similar across countries:  about 2500 IU per day for pregnant women, only about 10% more than for a non-pregnant women.

10. There are public health agencies that continue to recommend that pregnant women consume liver, mainly for its iron content to prevent or treat anemia. Not well know is the fact that vitamin A, B6, and B12 in liver are also required for the production of red blood cells.

11. Over half of American women ages 18-30 do not meet vitamin A requirements from diet, using an EAR of 1670 IU, not the RDA of 2570 IU. There is evidence that lower-income women have intakes low enough to warrant serious concern.

12. The FDA’s daily value for pregnant women is 8,000 IU, used for supplement and food labeling (and based on the RDA’s established in 1968, now replaced). This was also considered a safe intake according to the CDC’s scientists.

13. There is a widespread and unfounded fear among obstetricians that vitamin A is to be avoided; they prescribe or recommend prenatal vitamins very low in vitamin A which are largely what pharmaceutical companies make.

14. It is thought that all babies are inherently born with low vitamin A stores, but it has been shown that in developing countries stores are even lower, indicating the mother’s intake does affect the stores.  Correlations between mothers’ vitamin A levels and fetal levels/growth have been shown.

15. Breast milk is affected by the vitamin A status of the mother; colostrum can contain 10 times more vitamin A than more mature breast milk.

16. It is not easy to assess the vitamin A status of an individual; serum retinol does not go to low levels until the liver is virtually depleted.  Methods of assessment are discussed in the article. There are tell-tale physical signs, such as hyperkeratosis, night blindness, and acne.

17. Iron and zinc play roles in vitamin A metabolism.  However, routine iron supplementation may not be advised depending on the iron stores of the women as there is a risk for an increase of gestational diabetes.

18. Very importantly – an excessive intake of vitamin D from supplements is potentially dangerous for a pregnant woman because of the need to balance with vitamin A and K2. It is not unusual for an OBGYN to recommend 5000 IU of vitamin D per day, in addition to the amount in the prenatal.

19. Vitamin A intakes of 10,000 IU per day from food are generally agreed to be safe; however, it a women is anticipating pregnancy and wishes to avoid this intake, she can build up her stores pre-conceptually. The consensus is any risk of birth defects exists between day 15 and day 60 following conception.

20. Traditional societies consumed foods rich in vitamin A including fish eyes and organ meats, and valued these as special foods for couples wanting to have children.