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go a step further and designate it as one of the women. Yet the CDC acknowledges that: “[s]erum retinol values do not
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“nutrients of concern” which would indicate a always reflect total body status because of homeostatic control and there-
substantial public health risk. fore are often not useful for assessing the vitamin A status of individuals.
13
The FDA provides guidance to manufactur- Additional tests may be required to confirm vitamin A deficiency when
ers regarding vitamin supplement labeling: the 20 µg/dL is used as a cutoff.”
FDA’s “daily value” of vitamin A for pregnant According to a WHO report, in the U.S. vitamin A status can be
and lactating women continues to be 8,000 IU, poor, especially among low-income populations. In children qualifying
since publication in the Federal Register in for the Special Supplemental Nutrition Program for Women, Infants, and
1993. Recently, the FDA removed vitamin A Children (WIC), 32 percent were in the “uncertain area” for the modi-
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from its mandatory Nutrition Facts Label for fied relative dose response (MRDR) values (an indication of low vitamin
packaged foods, a move they made because A stores). Furthermore, an assessment of low-income pregnant women
they claim “[i]n the early 1990s, American diets showed that an alarming 9 percent were above the international MRDR
lacked Vitamins A and C, but now Vitamin A cut-off of 0.060 for vitamin A adequacy (frankly vitamin A deficient).
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and C deficiencies in the general population The MRDR cut-off is a more accurate method of determining vitamin
are rare.” It is unclear how the U.S. diet has A status, as explained below.
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changed to contain more vitamin A. However, While stating that “high-dose” vitamin A should be avoided in
because “vitamin A” on a label does not usu- pregnancy, particularly between day fifteen and day sixty following
ally indicate the presence of true vitamin A, but conception, the WHO recommends vitamin A supplementation in re-
rather carotenoids, this omission may not matter. gions where deficiency is common for the prevention of night blindness.
According to the CDC, more than 95 per- Supplementation of 10,000 IU/day or 25,000 IU/week is recommended
cent of the U.S. population has adequate serum for pregnant women in these areas, beginning after day sixty of gesta-
vitamin A levels of 20 µg/dL or greater, in line tion and continuing for at least twelve weeks or until delivery. (Note
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with the World Health Organization (WHO) that “high dose” vitamin A of 50,000 to 400,000 IU has typically been
standard of less than 20 µg/dL used to define administered within six to eight weeks postpartum in areas of endemic
public health problems. The CDC has estimated vitamin A deficiency, with the higher amount being more effective at
the prevalence of low serum vitamin A among raising breast milk concentrations. ) Perhaps it would be wise to consider
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females to be 0.2 percent, or 317,000 American the real probability that many “well-nourished” American women are

THE ROTHMAN STUDY

The study usually cited in support of warnings against vitamin A during pregnancy was carried out by KJ Rothman and
his team in 1995 at the Boston University School of Medicine and published in The New England Journal of Medicine.
1
In the study, researchers asked over twenty-two thousand women to respond to questionnaires about their eating habits
and supplement intake before and during pregnancy. Researchers found that cranial-neural crest defects increased with
increased dosages of vitamin A; but neural tube defects decreased with increased vitamin A consumption, and no trend
was apparent with musculoskeletal, urogenital or other defects.
This study is a poor rack on which to hang the myriad warnings that have kept pregnant women from eating liver
and taking cod liver oil. Researchers made no distinction between synthetic vitamin A derived from multivitamins and
processed foods like margarine, and natural vitamin A from food; nor did they take blood samples to determine vitamin
A status. Food recall surveys are a notoriously inaccurate method of determining nutrient intake.
Subsequent studies found that high levels of vitamin A did not increase the risk of birth defects. A 1998 study from
Switzerland looked at vitamin A in pregnant women and found that a dose of 30,000 IU per day resulted in blood levels
that had no association with birth defects. 2
A 1999 study carried out in Rome, Italy found no congenital malformations among one hundred twenty infants
whose mothers consumed an average of 50,000 IU of vitamin A per day. Some participants consumed up to 300,000
3
IU vitamin A daily during pregnancy with no birth defects in the offspring. An average of 50,000 IU vitamin A per day is
consistent with WAPF recommendations of cod liver oil to supply 20,000 IU per day plus additional vitamin A in liver,
butter, seafood and egg yolks.

REFERENCES
1. Rothman KJ and others. Teratogenicity of high vitamin A intake. N Engl J Med. 1995 Nov 23;333(21):1369-73.
2. Wiegand UW and others. Safety of vitamin A: recent results. Int J Vitam Nutr Res. 1998;68(6):411-6.
3. Holmes LB. Need for inclusion and exclusion criteria for the structural abnormalities recorded in children born from exposed pregnancies. Teratology. 1999
Jan;59(1):1-2.
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