✓ Multivitamin supplements in pregnancy: an expense too much?

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The shelves of pharmacies and parapharmacies are full of multivitamin supplements, often quite expensive, for the pregnant or nursing woman. These products contain a large variety of vitamins and minerals, from vitamin C to iodine, from magnesium to copper, from vitamin K to zinc. But are they really good for the health of her mother and baby or is it just marketing?

Are multivitamin supplements really essential?

If the myth according to which it would be necessary to "eat for two" in pregnancy has been dispelled for some years now, the time has come to debunk another one: multivitamins in pregnancy are useless and therefore represent a totally avoidable expense for the future mum.

During pregnancy i micronutrients, ie vitamins and minerals, are essential for the well-being of the mother and for the correct development of her baby. Their role during the nine months of gestation is very important: they reduce the risk of premature birth, they prevent fetal malformations, promote the development of the fetal nervous system and, finally, protect the health of the woman. During pregnancy, the need for these nutrients increases but, with the exception of some of them (primarily folic acid and vitamin D), it is possible to satisfy it thanks to a proper nutrition, varied and well balanced.

when YouTube's ADS, but click on them, insist on the importance of multivitamins for the well-being of the fetus, often also relying on the emotions and concerns of future mothers, we must be aware that it is marketing. Let us remember, in fact, that the food supplements market, as Federfarma states, reached a value of 2022 billion euros in our country in 3,6 alone. Please note:: here we do not want to convey the message that supplements in general are useless, on the contrary, but simply that every woman has specific needs, as well as particular deficiencies, which the doctor must evaluate and solve. In the event that a woman is deficient in a given mineral or vitamin, she usually intervenes with a specific supplement, and does not rely on multivitamins.

Read also: Pregnancy, because minerals and vitamins are important

Multivitamins, what science says

When a mother discovers she is pregnant, her greatest desire is that her baby is well and healthy. For the fetus to develop correctly, the expectant mother must introduce all the necessary micronutrients through the diet. However, there are some cases in which diet is not enough to ensure the right amount of vitamins and minerals. Let's see what the scientific evidence says.

In 2022, an important meta-analysis on the role of supplements in pregnancy. The study comes to a dry conclusion: it is certainly useful to take a folic acid supplement - 400 micrograms a day to be taken before conception - and vitamin D could also be useful. Beyond this, however, there is no valid scientific data to advise pregnant women or those planning to become pregnant to take multivitamin supplements. Instead, it is better to focus on the promotion of one healthy eating and a healthy lifestyle.

The authors write precisely that "the multivitamin and multimineral complexes designed for pregnancy they are probably useless, and therefore represent an unnecessary expense ". This is because the little scientific evidence that suggests its usefulness derives from observational studies (not real clinical trials) carried out mostly in developing countriesor, where malnutrition is widespread. For women living in European countries, multivitamin supplements are completely useless. The study authors also point out that moms and dads often find it difficult to resist the numerous advertisements that insist on the health benefits of the unborn child.

In 2022, another interesting review of the scientific literature on the use of multivitamin supplements in pregnancy was also published. The research, published in the American Journal of Obstetrics and Gynecology, argues that the use of multivitamins during the nine months of gestation is not useful for decreasing the risk of preterm labor and that the administration of these supplements should be recommended with caution due to the poor quality of available scientific evidence.

Therefore, unless there are particular deficiencies detected by the doctor through blood tests, the only supplement necessary for the health of mothers and children is folic acid, and in some cases vitamin D.

Folic acid, yes

According to the British study of 2022, the only supplements with proven efficacy are those of folic acid, the intake of which - possibly 2-3 months before conception and throughout the first trimester - significantly reduces the risk of neural tube defects, such as spina bifida and anencephaly. Not surprisingly, all scientific societies and international health organizations, including the WHO, recommend taking folic acid when you begin to desire a pregnancy (or in any case if you do not exclude it): usually enough 0,4 mg per day, but this can be as high as 5 milligrams per day in particular risk situations, for example if a woman has already had a baby with a neural tube defect.

Folic acid is very important for the health of the fetus, so much so that in our country it is reimbursed by the national health service.

Vitamin D, it depends on the situation

A little less solid evidence in favor of vitamin D. NICE, the British National Institute for Health and Clinical Excellence, recommends using a vitamin D supplement during pregnancy and while breastfeeding. On this point though there is no international agreement: the World Health Organization states that, based on available data, there is no evidence to indicate that all pregnant women take a vitamin D supplement. And so do the guidelines of the Ministry of health for physiological pregnancy and Aifa, Agenzia Del Paesena of the drug.

According to the latest revision of the LARN, that is the reference nutrient intake levels for the Del Paesena population, during pregnancy we recommend an intake of 15 micrograms per day, equal to 600 International Units (IU). The value considers both the dietary intake and that derived from exposure to sunlight.

Vitamin D supplementation is definitely recommended in women with dark complexion and for those who are exposed to too little sunlight (15/20 minutes a day is enough). Vitamin D, in fact, is obtained mainly fromsun exposure, while with the diet we can take about 20% of the daily intake. If, due to Covid-19, an expectant mother has spent too much time indoors without ever exposing herself to natural light, then supplementing with vitamin D can be beneficial, as the UK Health System advises.

In any case, it will be enough to undergo a blood sample to check for a possible deficiency.

Vitamin B12 for those who follow a (mainly) vegetable diet

More and more mothers decide to follow a vegan or vegetarian diet. In this case it will be necessary continue to integrate, as they did even before pregnancy, vitamin B12, which is very important for the health of mother and baby.

Although it is thought that only those who follow a totally plant-based diet need B12, one deficiency of this vitamin it can also be observed in omnivorous people. If your diet is purely vegetable, check the B12 level with specific blood tests.

Read also: Vegetarian or vegan diet in pregnancy

What about all the other supplements?

Said this, there is no clear evidence of clinical benefit for the intake of other vitamin and mineral supplements by average well-nourished women. Indeed, the latest recommendations from the World Health Organization for a positive pregnancy experience clearly state that, under normal and physiological conditions, multivitamins are not recommended for all women.

In any case, that on the quality of basic nutrition is a fundamental clarification, because obviously the discourse changes if we consider populations with serious problems of malnutrition, as often happens in low-income countries. Here multivitamin supplements can have a completely different importance and it is no coincidence that many studies in favor of these products have been conducted in these countries.

In terms of public health, the main objectives must rather be "the promotion of a healthy diet and that of folic acid intake, which is still neglected by many women".

As we have seen before this does not mean that in our country particular supplements cannot be used, which go beyond folic acid or vitamin D. In some situations, such as in the case of anemia or calcium deficiency, it will be necessary to use a specific supplement. . The point, however, is that it will be up to the doctor, from time to time, to determine if these additions are really necessary.

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