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Key Nutrients During Pregnancy 65
●● oranges and orange juice Babies born to women with low vitamin D levels
are at higher risk of:
●● green leafy vegetables (brussels sprouts, spinach
and broccoli) ●● seizures (hypocalcaemic fits) and breathing
problems as young infants
●● potatoes.
●● rickets and growth delay as older infants and
Liver is a rich source of folate but is not recommended toddlers.
during pregnancy because it has very high levels of
retinol (vitamin A). The incidence of these preventable diseases appears
to be rising in the UK and other northern European
Vitamin D countries (Ahmed et al. 2011).
Women have a higher dietary requirement during In addition, children born to mothers with low
pregnancy and NICE recommend that: vitamin D levels during pregnancy have been found
to be more likely to have lower levels of bone minerals
●● all women should be informed at the booking at 9 years of age than children born to mothers with
appointment about the importance for their normal vitamin D levels (Javaid et al. 2006).
own and their baby’s health of maintaining
adequate vitamin D stores during pregnancy Folic acid and vitamin D supplements are listed
and while breastfeeding (NICE 2008b) in Table 3.2.2.
●● all pregnant and breastfeeding women should Supplements for pregnant women
be advised to take 10 µg vitamin D daily in a
dietary supplement (NICE 2008a). The availabilities and relative costs of suitable
supplements for women who may become
Skin synthesis alone is not always enough to pregnant and who are pregnant are listed in
achieve the optimal vitamin D status for all Table 3.2.3.
pregnant women: the ‘National Diet and Nutrition
Survey of British Adults’ (Ruston et al. 2004) Iron
showed that about a quarter of British women aged
19–24 and a sixth of those aged 25–34 are deficient Women with good iron status prior to
in vitamin D. This rises to 1 in 2 women with dark conception and who eat a healthy balanced diet
skins who require more exposure to sunlight to will not need extra iron during pregnancy
make the same amount of vitamin D in their skin because the rising demands of iron by the
(Datta et al. 2002). growing fetus are met by:
During pregnancy, lack of vitamin D may ●● diminished losses from the mother as menstrual
adversely affect fetal bone mineralization and the bleeding is absent during pregnancy
accumulation of vitamin D stores for the early
months of life. ●● increased iron absorption during pregnancy –
the level of absorption increases progressively as
The following groups of women are particularly pregnancy advances. Also a greater percentage
at risk of low vitamin D status: increase in absorption will occur in anaemic
than in non-anaemic women.
●● those with black or dark skin (e.g. of Asian,
African, Caribbean and Middle Eastern The fetus accumulates most of its iron during the
origin) last trimester, laying down stores for about the first
6 months of life.
●● those who have limited skin exposure to
sunlight (e.g. those who remain covered when Routine iron supplementation is not
outside or are housebound) recommended for all women (NICE 2008b) and is
usually only recommended for those with a history
●● obese women – those with a body mass index of anaemia who are likely to have low iron stores or
(BMI) >30 kg/m2.
