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and not less than 30 μg/L, and the serum retinyl may be marginal especially in women with more vegetarian-type diets
esters should not be above 10 percent of the sum or higher needs. Zinc deficiency can exacerbate low vitamin A intakes
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of the retinol and retinyl esters. Measuring fast- because zinc is needed in the synthesis and secretion of retinol binding
ing retinyl esters is done to check whether the protein, which mobilizes vitamin A from the liver and transports it into
capacity of the liver to store vitamin A has been circulation. Liver is an excellent source of both nutrients.
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exceeded, a rare but possible occurrence. Iron deficiency anemia during pregnancy is typically treated with
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higher doses of iron. Yet increased intakes of vitamins A and B may
6
BALANCE WITH VITAMINS D AND K 2 be required to resolve the anemia, with or without supplemental iron
Supplementing with vitamin D is a common depending on need. Vitamin A deficiency seems to impair mobilization
practice among obstetricians, often without the of iron from body stores; therefore vitamin A supplementation improves
benefit of blood testing to determine what level hemoglobin concentration. Serum retinol levels below 30 mcg/dL have
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of supplementation, if any, is optimal. More as- been associated with “vitamin A-responsive” anemia. Since blood levels
tute practitioners know that supplementing with of retinol-binding protein change with pregnancy, the serum retinol test
vitamin D, especially at levels of 5,000 IU per can yield inaccurate results. Be aware that routine iron supplementa-
22
day (which I have seen in pregnant patients) is tion is not advisable during pregnancy, since an increased iron intake in
not advisable unless attention is paid to ensuring women with an already adequate iron status may have adverse effects.
vitamin A intake is optimal. Too much vitamin Assessment of serum ferritin at the onset of pregnancy will help determine
D can deplete vitamin A. Likewise, intake of whether more iron or iron-rich foods is indicated.
vitamins A and D require balance with vitamin
K . Poultry liver, which contains all three fat- CONCLUSION
2
soluble vitamins—A, D and K —is an ideal Clearly, vitamin A plays a vital role in pregnancy nutrition and the
2
source of these synergistic nutrients. development of a healthy baby. It has been called “the concertmaster of
fetal development” because it is needed to “achieve harmonious tissue
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OTHER CONSIDERATIONS organization.”
1
Iron and zinc deficiency can affect the If still uncertain whether consuming additional preformed vitamin
conversion to vitamin A. Iron is needed for the A would be beneficial (either from cod or fish liver oil, other types of
intestinal conversion of carotenoids to retinal; supplements, or from foods like liver), discuss this with your obstetrical
zinc is required for the subsequent conversion care provider. In any case, 3000 μg RAE (10,000 IU) per day from all
from retinal to retinol. Iron deficiency is not sources during pregnancy appears to be well within a safe upper limit
uncommon during pregnancy, and zinc status according to most data; the Weston A. Price Foundation recommends at

VITAMINS A AND D IN COMMON PRENATAL VITAMINS

BRAND VITAMIN A VITAMIN D
Vitalfol-One* 1100 IU as beta-carotene 1000 IU
(label says 14 percent of daily value in pregnancy)
Prenaissance DHA* 0 IU 400 IU
Prenate DHA* 0 IU 400 IU
Vitafusion Prenatal 4000 IU as retinyl palmitate 400 IU
(label says 50 percent of DV for pregnancy)
Mega Food Baby and Me 5000 as mixed carotenoids 600 IU
Garden of Life Raw 5000 as beta-carotene 1400 IU
Thorne Basic Prenatal* 5000 IU 1000 IU
(3000 from beta-carotene and
2000 as retinyl palmitate)
Rainbow Light Just Once 4000 IU (as retinyl palmitate, beta carotene) 400 IU

* Prescription brands.

According to the FDA supplement labeling guide for industry, the daily value of vitamin A for pregnant and lactating
women continues to be 8,000 IU (www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/
DietarySupplements/ucm070620.htm. Last updated 5/27/2015).
26 Wise Traditions SUMMER 2016 Wise Traditions