The current guidelines on folic acid are that women should begin to take folic acid 400 µg daily before becoming pregnant and should continue for the first 12 weeks of pregnancy in order to reduce the risk of neural tube defects. The dose should be increased to 5 mg daily when a pregnant woman is –

• on anti-epileptic medication
• obese (BMI >30)
• has a history of neural tube defects in a previous pregnancy
• has coeliac disease, diabetes, sickle cell anaemia, thalassaemia
• or her partner has spinal cord defects,

It has been recommended that all women of childbearing age should take folic acid regularly on the assumption that they might become pregnant unless they are actively using contraception (NICE PH11). Currently, neural tube defect affects 800 pregnancies each year in the UK.

There has been an unexpected increase over the past 15 years in the number of babies found to be suffering from rickets or symptoms of decreased bone mass which demonstrate poor levels of vitamin D (NICE PH11). Vitamin D deficiency is unusual in babies born at term to mothers with adequate vitamin D status. Some women enter pregnancy with low vitamin D levels. This may be due to:

• lack of exposure to sunlight due to wearing concealing clothing for cultural reasons
• inadequate consumption of foods containing vitamin D e.g. oily fish
• Inadequate consumption of dairy (prevalent particularly in adolescent girls)
• BMI greater than 30
• Women who spend a lot of time indoors or use sun creams limiting the absorption of ultraviolet (UV) light
• living in the northern hemisphere where levels of UV light are only sufficient to stimulate vitamin D production in the summer months
• having dark skin, which prevents absorption of available UV light in the UK climate.

Currently recommendations are that breastfed babies from birth to one year of age should be given a daily supplement containing 8.5 – 10mcg of vitamin D as a precaution (until/unless they are drinking 500ml of infant formula a day) and that breastfeeding mothers should also take a daily Vitamin D supplement of 10 µg per day. This in no way suggests that the breastmilk of a mother does not have all the other health advantages but is a reflection of current awareness of the risk of burning in sunlight balanced with the UK climate and poor levels of sunshine for the majority of the year. Vitamin D is a fat-soluble vitamin that is found in food and can also be made in the body after exposure to UV rays from the sun. Fortified foods are common sources of vitamin D but without sunshine exposure, it is difficult to achieve maximal intake. More than 90% of mankind’s vitamin D supply is derived from UVB sunlight exposure.

• Oily fish including trout, salmon, mackerel, herring, sardines, anchovies, pilchards and fresh tuna or fish oils
• Egg yolk – 0.5 µg (20 IU) per yolk
• Mushrooms
• Supplemented breakfast cereals, (2 – 8 µg (80-320 IU) per 100 g)
• Margarine

In a fair-skinned individual, exposure of the face and forearms to 20–30 minutes of sunlight at midday is estimated to generate the equivalent of 2000 IU vitamin D. Between April and October 90% of the UK (roughly north of Birmingham) is above the latitude where exposure to sufficient UVB is possible (Pearce 2010).

Vitamin D and folic acid are necessary and beneficial supplements. However, some pregnant women may need to take other medication for health issues during their pregnancy too.

Extracts taken from “Why Mothers Medication Matters” Jones W Pinter and Martin 2017

• Bastow BD et al, Teratology and Drug Use During Pregnancy
• Cain MA, Bornick P, Whiteman V. The maternal, fetal, and neonatal effects of cocaine exposure in pregnancy. Clin Obstet Gynecol. 2013;56(1):124-132.
• Ebrahimi, N., Maltepe, C. and Einarson, A. ‘Optimal management of nausea and vomiting of pregnancy’ Int. J. Womens Health 2010; 2: 241–248.
• Hale TW Medications and Mothers milk 2017 (online access)
• Hudak, M.L., Tan, R.C., ‘The Committee on Drugs and The Committee on Fetus and Newborn. Neonatal drug withdrawal’. Pediatrics 2012;129(2):e540-60.
• Koren, G., Moretti, Kapur, B. ‘Can Venlafaxine in Breast Milk Attenuate the Norepinephrine and Serotonin Reuptake Neonatal Withdrawal Syndrome?’ JOGC 2006 April; 28(4):299-302
• Mazzotta, P.L., Magee, L.A. ‘A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy’. Drugs 2000;59(4):781-800. As reported in Festin, M. ‘Nausea and vomiting in early pregnancy’. BMJ Clin Evid 2009; 2009: 1405.
• National Institute for Health and Clinical Excellence (NICE) 2008. Maternal and Child Nutrition, Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households.
• National Institute for Health and Clinical Excellence (NICE) 2013. Clinical Knowledge Summary Nausea and Vomiting in Pregnancy.