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Question answered:15/04/08
NICE have recently updated their guidance on antenatal care [1] and this states:
“1.3.2 Nutritional supplements
1.3.2.1 Pregnant women (and those intending to become pregnant) should be informed that dietary supplementation with folic acid, before conception and throughout the first 12 weeks, reduces the risk of having a baby with a neural tube defect (for example, anencephaly or spina bifida). The recommended dose is 400 micrograms per day.
1.3.2.2 Iron supplementation should not be offered routinely to all pregnant women. It does not benefit the mother’s or the baby’s health and may have unpleasant maternal side effects.
1.3.2.3 Pregnant women should be informed that vitamin A supplementation (intake above 700 micrograms) might be teratogenic and should therefore be avoided. Pregnant women should be informed that liver and liver products may also contain high levels of vitamin A, and therefore consumption of these products should also be avoided.
1.3.2.4 All women should be informed at the booking appointment about the importance for their own and their baby’s health of maintaining adequate vitamin D stores during pregnancy and whilst breastfeeding. In order to achieve this, women may choose to take 10 micrograms of vitamin D per day, as found in the Healthy Start multivitamin supplement. Particular care should be taken to enquire as to whether women at greatest risk are following advice to take this daily supplement. These include:
- women of South Asian, African, Caribbean or Middle Eastern family origin
- women who have limited exposure to sunlight, such as women who are predominantly housebound, or usually remain covered when outdoors
- women who eat a diet particularly low in vitamin D, such as women who consume no oily fish, eggs, meat, vitamin D-fortified margarine or breakfast cereal
- women with a pre-pregnancy body mass index above 30 kg/m2.”
With regard to breastfeeding, the NLH Q&A Service answered the same question in 2007 [2]. However, it should be noted that the NICE guidance, highlighted in that answer, is now due imminently [3]
References
1) http://www.nice.org.uk/nicemedia/pdf/CG062NICEguideline.pdf
2) http://www.clinicalanswers.nhs.uk/index.cfm?question=5993
3) http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11677
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