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Author: admin, 01.07.2013
Most pregnant women take a daily prenatal vitamin, but advising the patient can be difficult because so many different formulations are available. Prenatal vitamins generally contain a variety of vitamins and minerals and may be similar to multivitamins used outside of pregnancy, with some notable differences. Pregnancy represents a time of rapid change in maternal physiology and nutritional requirements. The gold standard for the evaluation of causality is the randomized trial, and 4 major randomized trials have evaluated the use of fish oil supplements during pregnancy and lactation.11-14 These trials, none of which was performed in the United States, failed to show a consistent benefit of supplementation.
Similar to the lack of effect of DHA during pregnancy, fish oil and DHA supplementation during lactation also achieved no significant differences in primary neurodevelopmental outcomes, according to a Cochrane review of 6 randomized trials.25 In 2 trials, head circumference was larger among infants exposed to supplements.
Vitamin D is an essential fat-soluble nutrient and has been the focus of considerable media attention over the past few years. Proposed perinatal effects of vitamin D deficiency include increased risk of preeclampsia, cesarean delivery (CD), intrahepatic cholestasis of pregnancy, preterm birth, small for gestational age (SGA), gestational diabetes, and others.30,31 The data regarding these associations are limited and conflicting, and the biologic mechanisms through which vitamin D deficiency mediates these effects are theorized. There is not enough data to support the use of vitamin D supplements to decrease the risk of adverse perinatal outcomes.31 The current recommendations regarding vitamin D intake are geared toward the maintenance of bone health in the mother, fetus, and newborn. A Cochrane review of 49 trials involving more than 20,000 pregnant women showed that although prophylactic iron supplementation was associated with higher hemoglobin levels in the peripartum period, there were no differences in maternal or neonatal clinical outcomes.40 In addition, significant adverse effects were noted, especially hemoconcentration and constipation. Several trials have explored the efficacy of increased amounts of vitamin C (1,000 mg) and vitamin E (400 IU) for the prevention of preeclampsia.42 When the data were pooled, these studies demonstrated that not only were the vitamins not protective but also that women who received the supplements actually had increased risks of gestational hypertension and premature rupture of membranes.
Women whose diets are high in processed meats and high-fat dairy foods (compared with those who eat more fruits, vegetables, and fish) have a higher risk of having infants who are small for gestational age (SGA).45 However, given that observational studies are at risk for significant bias because of confounding factors, attempts have been made to perform randomized trials. In the developing world, where the risk of malnutrition is high, multiple trials have been performed to assess the effects of prenatal multimicronutrient supplementation.

Vitamin and mineral supplements cannot replace a healthy diet, and there are not enough high-quality data to recommend multivitamin supplements for all American women. Overland Park’s Wojo Nutrition puts its spin on supplements with liquid formulas for energy, calm and more. The options were perplexing to Carol Knowles, despite her career in vitamin ingredient sales.
After lots of research, a successful crowdfunding campaign on Indiegogo and plenty of trial and error, Overland Park-based Wojo Nutrition was born. Because it’s a liquid, the vitamins and supplements enter the blood stream more quickly than if you were to take a pill, Knowles explains. Some of these vitamins have been studied directly (eg, folic acid), and their recommended allowance comes from sound evidence.
In some circumstances, the Food and Nutrition Board did not have enough data to determine RDAs, and therefore, the available information combined with expert opinion, was used to develop adequate intake values. This review was limited by significant heterogeneity in the study populations because the authors included trials from a variety of countries in different phases of economic development. Most US women do achieve adequate vitamin A intake from their diets, and prenatal vitamins contain 4000 to 5000 IU; therefore, additional supplementation is not advised.
The differences between prenatal vitamins are slight, and no particular vitamin can be recommended over another. The company does the legwork for customers, determining which vitamins and extracts are most beneficial and combining them into blends packaged in single-serving pods that can be squeezed into the user’s liquid of choice.
WojoEnergy and WojoCalm are currently available, with formulas for focus, wellness, mood and sun (which includes Vitamin D) coming soon.

But for most vitamins, data are limited, and for multivitamins (also referred to as multimicronutrient supplements), study results can be biased by confounding variables. Pregnant women should stay below the upper limits of supplementation per IOM guidelines (Table 1, page 78).1 Folic acid is the 1 vitamin for which definitive evidence supports preventive supplementation in the periconceptional period. Effect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children: a randomized controlled trial. Maternal supplementation with docosahexaenoic acid during pregnancy does not affect early visual development in the infant: a randomized controlled trial.
A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy.
Supplementation with vitamins C and E during pregnancy for the prevention of preeclampsia and other adverse maternal and perinatal outcomes: a systematic review and metaanalysis. Effect of a cholesterol-lowering diet on maternal, cord, and neonatal lipids, and pregnancy outcome: a randomized clinical trial.
The discussion focuses primarily on data retrieved from the developed world, because the nutritional challenges of the developing world are distinct. It just may be that healthier women take vitamins, and healthier women have better pregnancy outcomes.

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