Wednesday, February 17, 2016

Vitamin A ~ is is safe in pregnancy?

The new year has started off with a bang! Lots of clients who have been working with me for 3 months or more are now pregnant – Yay! As most are new mums a few have got in touch about Midwives and Drs misconceptions and concerns about vitamins and minerals, as this is where the medical community start to get involved. One of the concerns is about Vitamin A and its ability to cause birth defects; so let me respond and shed some light on this.

I have looked into this issues myself quite thoroughly and the research links I have cited below mention that the research is over 30 years old in regards to the potential causes of birth defects. I will say that again.... In time frame only 18 cases have been cited where this has caused deformities. 

I’m sure you are aware that any adverse reaction to drugs need to be reported.  All medicines are reported under the medical misuse category.

Drugs cause death and other health conditions by the hundreds of thousands annually. vitamins don't cause death  We don’t have anything for supplements to report on this, but as always if anything does show ‘Teratogenicity ie potential for birth defects it has to be reported as such.

A basic look into drugs commonly used to help women conceive and to help those with sticky platelet, such as Aspirin have far more potential to cause birth defects, and not to mention fertility drugs that many use unwittingly without looking into the small print, that can also cause deformities and also death.  My point here, is many of my clients are getting all wound up about something, without looking into the issues more closely, and colleagues in the medical profession are making a point of issuing notice on Vitamin A without also mentioning that drugs, many of them used in fertility circles, have far more of a chance of giving ladies birth defects,  And those were taken at the correct dosage!

Of the 18 reported cases over the last 30 years who had babies with deformities all of the women in regards to Vitamin A took over 25,000IUs of Vitamin A, which exceeds the RDA on this by an exponential amount. As always the devil is in the detail. Most  supplements will show 2 forms of Vitamin A – the one that can cause more damaging effects at high levels  is retinol only and not a mixed between Retinol and beta carotene,  which is what most supplements have in them.

It is worth noting also in this instance that Natural Vitamin A ( retinol) is found in high doses in organ meat, such as liver. Which up until the 1970s was consumed and readily available. Many children, like our parents who, were born after the war were given cod liver oil daily, to ensure they didn't have deficiencies. This form of fish oil has a much higher form of Vitamin A.

One of the sources of this information is NHS choices website. In this website, which I find extremely unhelpful and very uniformed it says things like ‘ you should be able to get all you need nutrients from your diet and don’t need any extra vitamin A’. Also rather unhelpfully in the article they put the measurement in Mgs not IUs, which is the standard international unit used to measure Vitamin A, so right from the start shows a fundamental misunderstanding about vitamin A.

In terms of its use in pregnancy it is vital and essential nutrient and the most important and well known role of vitamin A is in relation to eye function. Vitamin A is necessary to prevent drying of the eye ( Xerophthalmia) and corneal changes. It is also used for retina function. 500,000 people lose their site each year due to vitamin A deficiency. Vitamin A levels are also inportant in thyroid health as it is needed for the uptake of idone and is required for thyroid hormone triiodothyroxine (T3) to bind to intracellular receptors. 

Vitamin A is needed in pregnancy for:  - Growth, Immunity, epithelial tissue maintenance and during cell proliferation, ie foetal growth!

I work with many clients and look into deeper analysis of fertility issues and pregnancy complications and one area I am fascinated in is Epigenetics. Many people who have polymorphisms in their BCMO1 gene have an issue converting beta carotene into retinol. So I welcome the use of mixed vitamin A for them in a retinol base, as they will have a problem converting Beta Carotene in the body  Many of the studies on the populations in the human genome project also had the potential for poor eye sight also so were really in need of vitamin A, should the gene express.

I ask questions about eyesight as part of my consultations and also look at this from a family health position, as there is the potential here also to pass this on to off spring! One anecdotal thing I’m noticing much more than when I was a child is that there seems to be a huge amount of kids with glasses at a young age. I only remember a few in my whole school growing up, so I’m wondering if reduced amounts of vitamin A in pregnancy are a result of this?

WHO recommendations. More recent than 1995
American Teratology Society information on Vitamin A

On a personal note. I have used many American supplements for the last 8  years of working with women all of which have mixed vitamin A around 5000IUs and I have confidence on these levels of Vitamin A.  I have worked with hundreds of ladies and so far no issues with this, with my recommendations!

I hope this helps you to make a more informed decision about vitamin A and its use in pregnancy and preconception.


2.Teratogenicity of high vitamin A intake. N Engl J Med. 1995 Nov 23 ;333(21):1369-73 
Wiegand, et al. 
3.Safety of vitamin A: recent results. Int J Vitam Nutr Res. 1998;68(6):411-6. Rothman, et al. 
4.Teratogenicity of high vitamin A intake. NEJM. 1995 Nov 23;333(21)1369-73. 3. Miller, et al.
5.Preconceptional vitamin A use. Reprod Toxicol. 1998 Jan-Feb; 12(1)75-88