How much vitamin A do you really need during pregnancy?

Unfortunately, we’ve believed that vitamin A is dangerous in pregnancy. This belief has made us stay away from some of the most nutritious foods we can nurture such as liver. However, vitamin A is a crucial nutrient for fetal development; for example, it prevents deafness, blinternal organ displacement and ocular integrity . It can be toxic in extremely high doses when vitamins K2 and D are inadequate, but when these vitamins are sufficient, the toxicity risk is very low. 

But where did this theory against vitamin A come from? 

In 1995, a study conducted by a group of researchers led by Dr. Kenneth Rothman of Boston University claimed that intakes of vitamin A over 10,000 IU per day increase the risk of birth defects. The researchers followed almost 23,000 women over the course of their pregnancies and found that women who consumed more than 10,000 IU of vitamin A during the first trimester gave birth to offspring with a 2.4-fold greater risk of total birth defects and a 4.8-fold greater risk of cranial-neural-crest defects (a rather broad group of defects whose classification is controversial). Among the 188 women who consumed this amount of vitamin A from “food” alone, there was an 80 percent increase in the risk of total birth defects and two times the risk of cranial-neural-crest defects. Because there were so few women consuming vitamin A from “food” alone, however, the researchers could not conclusively distinguish the association from the effect of chance.

Several experts have found discrepancies in the study. For example, most of the vitamin A supplemented to these women came from multivitamins and the authors did not distinguish between various food sources—and most “food” vitamin A comes from fortified breakfast cereals. Also, the rate of total birth defects among the 20,000 women consuming less than 10,000 IU was only 1.5 percent; by contrast, the generally accepted background rate is 3-4 percent. The rate of defects among the 3,000 women consuming more than 10,000 IU of vitamin A was 3 percent—on the lower end of normal.

Additionally, other studies have controverted this research:

• An earlier 1990 study conducted in Spain found that among 25,000 births, doses of vitamin A over 40,000 IU per day carried a 2.7-fold higher risk of birth defects, but doses of vitamin A up to 20,000 IU or between 20,000 and 40,000 IU both carried a 50 percent lower risk of birth defects compared to no supplementation.
• A 1996 study of 522,601 births found that the children of women supplementing with at least 10,000 IU of vitamin A in addition to a multivitamin had a lower risk of birth defects than those of women who did not supplement, although the association could not be distinguished from the effect of chance.
• A 1997 study of 1,508 births found no relationship between birth defects and use of vitamin A supplements, fortified breakfast cereals, organ meats or liver.
• Prof. Fernando Figueira from the Instituto de Medicina Integral (IMIP) in Brazil, followed a cohort of pregnant women over a year, in view of the outbreak of microcephaly that reached its peak in January/February 2016. This study found that Maternal Vitamin A deficiency was possibly one of the main causes of fetal growth restriction and of the subsequent risk of insulin resistance and glucose intolerance in adulthood

The evidence clearly favours the view that 20,000-25,000 IU of vitamin A during pregnancy is safe and may even reduce the risk of birth defects.

If you want to learn more about this, take a look at Chris Masterjohn’s article called “Vitamins for Fetal Development: Conception to Birth”.

Another factor to consider is that Vitamin A deficiency remains among the major collective health priorities in the world today, together with iron-deficiency anemia and iodine deficiency are prevalent in a large number of pregnant women. 

What does this mean for you?

Focus on eating rich Vitamin A foods. The food which contains the most bioavailable Vitamin A is liver. If liver is not your cup of tea, try the following recipes and I promise you won’t even realise the taste. Alternatively, you could include a daily intake of Rosita Cod Liver Oil or a premium quality oil. 

Dark leafy greens, orange and yellow vegetables (sweet potatoes, carrots, squash, and peppers), cantaloupe, apricots and mangoes contain beta-carotene, and although you probably can’t eat enough of them to meet all your Vitamin A needs, they contain a lot of additional micronutrients which are beneficial during pregnancy.

Vitamin A, D, and K2-Rich Foods:

Liver, beef, and goose (A, K2)

Full-fat dairy products (A, K2)

Cod liver oil (A,D)

Salmon (D)

Dark leafy greens, including kale, spinach, and collard, mustard, and beet greens (A,K2)
Additional recommendations on nutrients intake during pregnancy are in this fantastic article by Functional Medicine Doctor, Chris Kresser Diet and Pregnancy: How to Eat Healthy When You’re Expecting.