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least 20,000 IU during pregnancy from foods Dietary Guidelines for Americans on providing adequate essential nutri-
such as liver or high vitamin cod liver oil along tion at all stages of life. Her contact: womenfamilynutrition@gmail.com
with 2,000 IU vitamin D (if sun exposure is lim-
ited) and vitamin K from aged cheese, animal REFERENCES
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fats and fermented foods. 1. Azaïs-Braesco V.Pascal G. Vitamin A in pregnancy: requirements and safety limit. Am
J Clin Nutr. 2000;71:1325S-1333S.
If you choose to avoid this or any amount 2. Price WA. Nutrition and Physical Degeneration: 6th Edition. La Mesa, CA: Price-Pot-
of preformed vitamin A during pregnancy, it is tenger Nutrition Foundation (2004) pp. 339-349. - See more at: http://www.westonaprice.
org/childrens-health/vitamins- for-fetal-development-conception-to-birth/
advisable to build up your own liver stores by 3. Masterjohn C. Vitamins for Fetal Development: Conception to Birth. http://www.we-
consuming more vitamin A-rich foods during stonaprice.org/childrens-health/vitamins-for-fetal-development-conception-to-birth/
the six to twelve months prior to conception. A 4. The RDA is the recommended intake needed by nearly all of the population to ensure
adequate liver stores of vitamin A in the body (20 μg/g for four months if the person
woman considering pregnancy or already preg- consumes a vitamin A-deficient diet) to support normal reproductive function, immune
nant can also discuss her vitamin A needs with function, gene expression, and vision. http://lpi.oregonstate.edu/mic/vitamins/vitamin-
her obstetrical care provider and see whether 5. A#RAE
The AI for infants is based on the average amount of retinol supplied by human milk.
further evaluation is warranted. Keep in mind http://www.nap.edu/read/10026/chapter/6#109
22
that most obstetricians will not be aware of the 6. Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S.
Population, 2012. http://www.cdc.gov/nutritionreport/pdf/Nutrition_Book_com-
controversy surrounding the limits on vitamin plete508_final.pdf
A—sharing this article with them could help 7. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper,
iodine, iron, manganese (TRUNCATED), 2001, National Academy Press, Washington,
increase their awareness. D.C. http://www.nap.edu/read/10026/chapter/6#141
The controversial Rothman study concluded 8. Kemmann E, Pasquale SA, Skaf R. Amenorrhea associated with carotenemia. J Am Med
that the risk of birth defects was more frequent 9. Assoc. 1983;249(7):926-929.
Harrison et al. Naturally occurring eccentric cleavage products of provitamin
when women supplemented with high dose vi- A: β-carotene function as antagonists of retinoic acid receptors. J Biol Chem.
2012;4;287(19):15886-95.
tamin A before the seventh week of gestation. 10. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Part E.Section 2.1.
Be aware that some women in this study were Appendix E-2.1: Usual Intake Distributions, 2007-2010, by Age/Gender Groups. http://
likely taking in more than 25,000 IU per day health.gov/dietaryguidelines/2015-BINDER/meeting2/docs/refMaterials/Usual_In-
take_072013.pdf
from supplements and/or fortified foods and 11. Scientific Report of the 2015 Dietary Guidelines Advisory Committee.Part E. Section
that these findings have been criticized by other 2. Usual intake distributions, 2007-2010, for pregnant and nonpregnant women in the
researchers who have found no such correla- U.S. ages 19-50 years. http://health.gov/dietaryguidelines/2015-scientific- report/PDFs/
Appendix-E- 2.4.pdf
tion. 3,66 Although the fetus is undergoing rapid 12. Intake data on pregnant women is also concerning, with 26% below the EAR of 550 μg,
developmental change during the first trimester a figure the USDA says is less reliable due to a very small sample size of n=133.
of pregnancy, nutrient needs generally do not 13. Scientific Report of the 2015 Dietary Guidelines Advisory Committee.Part D.Ch 1.Nutri-
ent Intake and Nutrients of Concern. http://health.gov/dietaryguidelines/2015-scientific-
significantly increase above the nonpregnant report/06-chapter- 1/d1-2.asp
state in this early stage. Yet, without pre- 14. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInforma-
67
tion/DietarySupplements/ucm070620.htm. Last updated 5/27/2015.
formed vitamin A, it is possible for liver stores 15. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInforma-
to become relatively depleted in less than seven tion/LabelingNutrition/ucm385663.htm
months. The World Health Organization recom- 16. Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S.
population. http://www.cdc.gov/nutritionreport/pdf/Nutrition_Book_complete508_final.
mends vitamin A supplementation of 10,000 IU pdf
per day after day sixty of gestation for women 17. Tanumihardjo SA. Biomarkers of vitamin A status: what do they mean? In: World
Health Organization. Report: Priorities in the assessment of vitamin A and iron status
who are deficient. Ensuring adequate preformed in populations, Panama City, Panama, 15–17 September 2010. Geneva, World Health
vitamin A intake in the second or third trimester Organization, 2012. http://www.who.int/nutrition/publications/micronutrients/back-
ground_paper2_report_assessment_vitAandIron_status.pdf
is beneficial for these reasons, and may reduce 18. World Health Organization. Vitamin A supplementation during pregnancy. Guidance
complications at birth, especially if a pre-term summary. who.int/elena/titles/guidance_summaries/vitamina_pregnancy/en/
delivery is anticipated. 22 19. Rice AL, et al. Maternal Vitamin A or B-carotene supplementation in lactating Bangla-
deshi women benefits mothers and infants but does not prevent subclinical deficiency. J
Nutr. 1999;129:356-365.
Pam Schoenfeld, MS, RD, LDN is a registered 20. Koletzo B, et al. German National Consensus Recommendations on Nutrition and Life-
dietitian whose practice, Women and Family style in Pregnancy by the ‘Healthy Start - Young Family Network’. Ann Nutr Metab.
2013;63:311-322.
Nutrition, in Raleigh, North Carolina, focuses 21. Strobel M, Tinz J, Biesalski H-K. The importance of β-carotene as a source of vitamin A
with special regard to pregnant and breastfeeding women. Eur J Nutr. 2007;46:(S1)1-20.
on issues relating to reproductive health. She 22. Gluckman, Peter, Mark Hanson, Chong Yap Seng, and Anne Bardsley. Nutrition and
is the executive director of the Healthy Nation Lifestyle for Pregnancy and Breastfeeding. Oxford: Oxford UP, 2015.
Coalition, which has a mission to refocus the 23. British Nutrition Foundation : Nutrition and Development : Short and Long Term Con-
sequences for Health (1). Somerset, GB: Wiley-Blackwell, 2013. ProQuest ebrary. Web.
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