RECOMMENDATIONS FOR DIETARY SUPPLEMENT USE DURING PREGNANCY
The American Dietetic Association and the Institute of Medicine recommend that all pregnant women who smoke or abuse alcohol or drugs take multivitamin and multimineral supplements as should those with iron deficiency anemia or poor-quality diets (2, 27). This recommendation also applies to vegans and women carrying ≥2 fetuses. In addition, because of the convincing evidence that periconceptional folic acid supplementation can decrease neural tube defects in some women, many health organizations recommend routine folic acid supplementation during this period. For example, the US Centers for Disease Control and Prevention (CDC) recommends that all women of childbearing age who are capable of becoming pregnant should consume 0.4 mg/d folic acid. This recommendation has been adopted by several clinical practice associations, such as the American Academy of Pediatrics and the National Healthy Mothers, Healthy Babies Coalition (28, 29). Similarly, the Institute of Medicine recommends that “to reduce the risk of neural tube defects, women able to become pregnant should take 0.4 mg of folic acid daily from fortified foods, supplements, or both, in addition to consuming food folate from a varied diet” (30). Data from the 2005 March of Dimes Gallup survey indicated that only 33% of US women of childbearing age reported taking supplemental folic acid daily (31).
Furthermore, because of the recognized benefits of additional iron during pregnancy, the World Health Organization recommends daily iron supplementation (60 mg/d) for all pregnant women for 6 mo or, if 6 mo of treatment cannot be achieved during the pregnancy, either continuation of supplementation during the postpartum period or an increased dosage of 120 mg/d iron during pregnancy (32, 33). Other recommendations include that of the CDC, which advises that oral, low-dose (30 mg/d) supplements of iron be provided to all pregnant women at the first prenatal visit (34). To our knowledge, the only other essential nutrient for which there is a recommendation for supplementation during pregnancy is iodine: the American Thyroid Association recommends that all pregnant women living in the United States or Canada consume 150 μg/d of supplemental iodine (35).