Nutrition During Pregnancy and Lactation Exploring New Evidence: Proceedings of a Workshop (2020) / Chapter Skim
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5 Dietary Supplements
5 Dietary Supplements
Pages 57-70
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From page 57... ...
DIETARY SUPPLEMENT USE AND ITS MICRONUTRIENT CONTRIBUTION DURING PREGNANCY AND LACTATION IN THE UNITED STATES Regan Bailey, professor in the Department of Nutrition Science at P urdue University and director of the Indiana Clinical and Translational Sciences Institute at the Purdue Nutrition Assessment Center, described findings from two National Health and Nutrition Examination Survey (NHANES) analyses (Bailey et al., 2019; Jun et al., 2020)
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From page 58... ...
. • Dietary supplements help pregnant women meet recommended targets for adequacy, but they also contribute to potentially excessive intakes for certain nutrients, including iron and folic acid (Bailey)
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From page 59... ...
For instance, approximately 70 percent of pregnant and lactating women consumed a dietary supplement containing thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, vitamin C, vitamin D, and vitamin E (Jun et al., 2020)
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From page 60... ...
MVM = multivitamin and mineral. SOURCES: Presented by Regan Bailey.
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From page 61... ...
Echoing a comment made by Caudill during the second session, Bailey also noted that only 8 percent of pregnant women have total usual choline intakes above the AI. Total usual intakes of some nutrients exceeded the TABLE 5-1 Comparison of Total Usual Intakes of Pregnant Women in the United States to Dietary Reference Intake Values Nutrient % Below EAR Nutrient % Above AI Nutrient % Above UL Magnesium 48 Vitamin K 48 Sodium 95 Vitamin D 46 Potassium 42 Folic acid 33 Vitamin E 43 Choline 8 Iron 28 Iron 36 Zinc 7 Folate 16 Calcium 3 Vitamin A 16 Calcium 13 Vitamin C 12 Vitamin B6 11 Zinc 11 NOTES: With the exception of sodium, the estimates are of only pregnant supplement users.
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From page 62... ...
Finally, she indicated that FIGURE 5-2 Prevalence of usual nutrient intake distributions less than the Estimated Average Requirement and above the Tolerable Upper Intake Level for folate/ folic acid and iron, stratified by dietary supplement use. NOTE: EAR = Estimated Average Requirement; UL = Tolerable Upper Intake Level.
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From page 63... ...
Prescription formulations, by contrast, had higher folic acid content. Approximately one-third of nonprescription PMVM products evaluated included botanical ingredients and 8 percent included probiotics.
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From page 64... ...
Based on the contents listed on the labels, most of the prescription and nonprescription PMVM products evaluated in this analysis could help a pregnant woman meet her daily recommended intake of nutrients assuming average dietary intake (95 and 88 percent of the prescription and nonprescription products, respectively)
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From page 65... ...
Borgelt said that the differences between prescription and nonprescription formulations may not be clinically significant in a healthy population, and she suggested that other factors such as cost may guide selection of products particularly when there are issues of access. Tools exist to help estimate the contents of PMVM products.
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From page 66... ...
Borgelt described some of her recommendations related to minimizing exposure to contaminants in PMVM products, including testing for toxic elements, establishing maximal acceptable levels for exposure to toxic agents, ensuring high-quality products are used, and adding additional regulations, oversight, and accountability. Differences in Sources of Nutrients Supplemented in PMVM Products Borgelt discussed the sources of nutrients contained within PMVM products, using omega-3 fatty acids and folate as examples.
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From page 67... ...
Topics covered included prescription prenatal formulations, preparations and labeling of supplements, 5-MTHF, and data on and considerations related to supplement use and total nutrient intakes. Prenatal Prescription Formulations Hatfield opened the discussion by asking Borgelt what is known about patients who use prenatal prescription formulations.
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From page 68... ...
In the United States and Canada, approximately 10 percent of the population is homozygous, and 40 percent heterozygous for the MTHFR polymorphism. Lamers indicated that, in countries without folic acid fortification, homozygous women had significantly lower red blood cell folate concentrations and that the MTHFR genotype was associated with higher risk of neural tube defects.
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From page 69... ...
Siega-Riz suggested that other data have shown that pregnant women tend to overreport their supplement use, and she wondered if we have a clear understanding of patterns of use. Angela Odoms-Young of the University of Illinois at Chicago asked if the NHANES data can be used to tell which health care providers are motivating pregnant women to take supplements, particularly if any of the information is coming from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
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From page 70... ...
Referring to evidence presented in session 1 that suggested that the Dietary Reference Intakes for protein adequacy may be underestimated, Siega-Riz showed NHANES data indicating that the usual protein intake of pregnant women is generally within the range of the higher estimates of needs. She thought the new evidence on choline was important to consider.
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