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Pregnancy: How much Vitamin A and/or beta-Carotene is appropriate

Introduction:

A woman who was planning a pregnancy came to Willner Chemists and asked one of our Pharmacists for guidance on a nutritional supplement program. We recommended a broad spectrum multivitamin multimineral supplement, and essential fatty acid formula, and extra folic acid. When she showed this to her Doctor, he apparently responded in a very negative manner, frightening the woman by telling her that the product contained toxic and dangerous levels of vitamin A and beta-carotene.

The product, in fact, supplied 5,000 IU of vitamin A and 15,000 IU of beta-carotene, which is quite appropriate in a prenatal vitamin regimen.

Her Doctor, of course, is entitled to his own opinion, as misguided or ultra-conservative as some might consider it to be. But I think he did the patient a disservice by presenting his opinion in the way he did. She was, in fact, so frightened by his response, that she claimed to be considering legal action against us.

Comments:

This incident troubled me, both because I feel this particular woman has been mistreated, and perhaps ill-advised by her physician, and because she was so quick to dismiss out of hand my attempt to clarify the matter. Perhaps more importantly, however, is that if she was given conflicting information, others probably are experiencing the same problem. It is an important, and potentially confusing area of nutritional support, so is probably a worthwhile topic for both a radio show, and a reference Ahealth note@ article in the Willner Reference Catalog.

Contents:

Following the Aconclusion@ paragraph, you will find:

Appendix A. A table of Vitamin A/Carotene levels in Anatural@ PreNatal Vitamin supplements

Appendix B. An excerpt from the September 3rd, 2000 Willner Window radio program

Appendix C. A compilation of reference excerpts from a wide variety of experts and sources dealing with vitamin A and beta carotene usage during pregnancy

Conclusions:

Adequate Vitamin A intake during pregnancy and lactation is important. The amount is a matter of balance. Too much vitamin A, as actual, preformed vitamin A (vitamin A Palmitate, cod liver oil, etc) should be avoided during pregnancy and during the period of pre-conception. But the definition of Atoo much@ is primarily a matter of speculation. As will be seen from the following compilation of references, the estimate of what is safe and what is not safe is based primarily on animal data, epidemiological studies, and subject to considerable interpretive latitude and, perhaps, bias.

There is no question but that one wants to err on the side of caution when evaluating dosage levels of a nutrient that may affect fetal development. But too little vitamin A can lead to problems as well. The data that follows shows that most experts recommend a level of vitamin A during pregnancy that ranges from 4,000 IU to 10,000 IU. My personal recommendation, a bit more on the cautious side, would be 4,000 IU to 8,000 IU of vitamin A.

What is important is to avoid over-reaction. It is silly to think that 3,900 IU of vitamin A is optimal and safe, and that 4,200 IU is toxic and dangerous! It is unrealistic to believe that 4,000 IU is a safe and effective level and that 5,000 IU is dangerous and toxic.

It is also clear that there is little reason to fear taking moderate amounts of natural beta carotene. Except for the general caution that during pregnancy we should avoid massive amounts of any and all nutrients, drugs, herbs etc, there is no eviden

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