Around the world, obstetricians that are taught nutrition in medical school tend not to recommend prenatal vitamins to their patients

Confessions of an Obstetrician: I never took a prenatal vitamin

The American Congress of Obstetricians and Gynecologists recommends that women take a prenatal vitamin during pregnancy in order to ensure they get an adequate amount of folic acid and iron every day.  However they do acknowledge that women can get these substances through their diets.  Interestingly, obstetricians in France, Sweden, and Germany do NOT recommend that their patients take a prenatal vitamin. 

When I was pregnant with my son, I dutifully went for my prenatal checkups, did the blood tests, diabetes screen etc.  But those prenatal vitamins just sat there on my kitchen counter.  After taking a few of them and experiencing horrible stomach pains and constipation from them, I decided I really didn’t need them.   I ate tons of fruits, vegetables, grains, and lentils before, during, and after pregnancy. 

After the United Nations was established and the World Health Organization created in the 1950s, one of their most pressing concerns was the high infant mortality rates in certain parts of the world.  Countries ravaged by war, bad governance, poor economies, and malnutrition were struggling with infant and child mortality.  Even in the United States, in the 1950s, there were segments of the population that were experiencing higher rates of infant and child mortality than other segments of the country.  The World Health Organization identified lack of proper nutrition and lack of prenatal care as key factors.  The lack of proper nutrition facing these countries was not because their indigenous diets were poor but because these countries were unable to supply enough food to meet the needs to their people.  In India, for instance, the problem of malnutrition was not because the traditional Indian diet, rich in vegetables and lentils, was nutritionally poor.   The problem was that there was not enough food to meet the demands of many people; so in fact, infant mortality was high because Indian women were NOT eating enough of their indigenous diets.  In addition, problems like anemia were not caused by an iron-deficient indigenous diet but more because of rampant infections with intestinal worms due to poor sanitation.  Cereals and grains as well as other foods were fortified with iron, thiamine, vitamin D, folic acid, etc as a way of improving the nutritional value in the foods available.  Prenatal vitamins were another way to ensure people in developing areas were getting enough vitamins and iron.  The approach the World Health Organization took to deal with malnutrition in developing countries and high infant mortality rates soon became adopted by many other countries in the developed world.  Certainly fortifying grains and cereals with iron, folic acid, and vitamins, fortifying dairy with vitamin D, etc became standard in the United States. 

Around the 1950s, medical journals and medical organizations started getting support through advertising dollars.  The number one advertisers were tobacco companies and pharmaceutical companies.  Initially their support was limited to medical journals and organizational meetings but then the pharmaceutical companies started meeting with doctors in their offices and clinics.  Pharmaceutical companies would take doctors out to lunch or dinner, leave lots of free samples, pens, etc.  But they soon realized that they could bypass the middle man and start advertising to patients directly.  They started supporting publications for lay people.  Direct-to-consumer advertising by big pharma takes many forms, some very subtle. The magazines that fill your doctor’s waiting rooms are actually marketing ploys of pharmaceutical companies that push their agenda and medications including prenatal vitamins.  Pharmaceutical companies have a great deal of influence over what an organization like the American Congress of Obstetricians and Gynecologists recommends.  Lastly, nutrition is not taught in most medical schools in the United States whereas it is taught in medical schools in Sweden.  This might explain why Swedish OBs don’t recommend a prenatal vitamin. 

The downsides to prenatal vitamins include the heartburn and constipation they cause.  They are an added expense especially if you or your doctor believes that the more expensive vitamins are better than a Flintstones chewable (they are absolutely not).  Plus there are studies showing that prenatal vitamins can actually cause some harm.  For instance, in a review conducted by the World Health Organization, there were a few studies showing that use of prenatal vitamins caused increased birth weights leading to more difficult deliveries.  Link below:

http://www.who.int/bulletin/volumes/89/6/10-083758/en/

Today many American women are malnourished but the reasons are very different from those in the past.  American women are malnourished because of a lack of fruits, vegetables, and fiber in their diets. You are better off spending your money eating a whole grain, unprocessed, plant-based diet rich in fruits, vegetables, flax seeds, and walnuts than on prenatal vitamins.

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