Should women take multivitamins
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Should Women Take Multivitamins?
Multivitamins for Pregnant Women: Benefits and Safety
Importance of Multivitamins During Pregnancy
Multivitamin/mineral supplements (MVMs) are widely recommended for pregnant women to improve birth outcomes and reduce the risk of low birth weight and miscarriage1. Studies have shown that multivitamin use, particularly when combined with iron and folic acid, can significantly decrease the risk of adverse pregnancy outcomes, including neural tube defects and other congenital anomalies8. This is particularly important as many pregnancies are unplanned, and women's health status may not be optimal at conception8.
Efficacy in High-Income Countries
In high-income countries, where a healthy diet is generally accessible, multivitamin use during pregnancy has been associated with a reduced risk of small-for-gestational-age infants, neural tube defects, cardiovascular defects, urinary tract defects, and limb deficiencies3. However, the quality of evidence supporting these benefits is often low, and more rigorous studies are needed to confirm these findings3.
Multivitamins and HIV-Infected Pregnant Women
For HIV-infected pregnant women, multivitamin supplementation has been shown to reduce the risk of adverse pregnancy outcomes. A study in Tanzania found that both single and multiple doses of the Recommended Dietary Allowance (RDA) of multivitamins were effective in decreasing the risk of low birth weight and preterm birth2. Additionally, multivitamin supplementation improved weight gain during pregnancy, which is crucial for the health of both the mother and the baby9.
General Population: Safety and Long-Term Use
Safety of Long-Term Multivitamin Use
Long-term use of multivitamins within the Dietary Reference Intake (DRI) range is generally considered safe. Studies have reported only minor adverse events, such as gastrointestinal symptoms, with no significant differences between treatment and placebo groups1. This indicates that multivitamins can be safely used for extended periods, even beyond ten years1.
Multivitamins and Cardiovascular Health
In a study involving Swedish women, long-term use of multivitamins was associated with a reduced risk of myocardial infarction (MI) among women with no history of cardiovascular disease (CVD)5. However, this benefit was not observed in women with a history of CVD, suggesting that the protective effects of multivitamins may be more pronounced in healthy individuals5.
Multivitamins and Hypertension
Despite the widespread use of multivitamins, their effects on blood pressure and the development of hypertension are not well understood. A prospective study found no significant association between multivitamin use and the risk of developing hypertension among middle-aged and older women7. This suggests that while multivitamins may offer other health benefits, they do not appear to influence blood pressure regulation.
Preconception and Pre-Pregnancy Considerations
Preconception Multivitamin Use
Preconceptional use of multivitamins has been linked to a reduced risk of preterm birth. Women who took multivitamins before pregnancy had a lower risk of delivering preterm compared to non-users4. This highlights the importance of multivitamin supplementation even before conception to optimize maternal and fetal health outcomes.
Factors Influencing Multivitamin Use
Certain demographic factors influence multivitamin use among women of childbearing age. Overweight and obese women are less likely to adhere to multivitamin recommendations compared to women with normal weight6. Additionally, younger, less educated, and unmarried women, as well as those participating in Women, Infants, and Children (WIC) programs, are at higher risk for nonuse of multivitamins10. These findings underscore the need for targeted education and intervention strategies to promote multivitamin use among these groups.
Conclusion
Multivitamins play a crucial role in improving pregnancy outcomes and supporting overall health in women. They are particularly beneficial for pregnant women, including those with HIV, by reducing the risk of adverse birth outcomes and supporting healthy weight gain. Long-term use of multivitamins is generally safe and may offer cardiovascular benefits for healthy individuals. However, their impact on hypertension remains unclear. Preconceptional use of multivitamins is also important for reducing the risk of preterm birth. Health professionals should focus on promoting multivitamin use, especially among high-risk groups, to ensure optimal maternal and fetal health.
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Most relevant research papers on this topic
Multivitamin/mineral supplements: Rationale and safety.
Multivitamin/mineral supplements can be safely used for long-term use (>10 years) with only minor adverse events and do not increase mortality.
Systematic ReviewA randomized trial to determine the optimal dosage of multivitamin supplements to reduce adverse pregnancy outcomes among HIV-infected women in Tanzania.
A single dose of the Recommended Dietary Allowance may be as effective as multiple doses in decreasing the risk of adverse pregnancy outcomes among HIV-infected women.
RCT
Large Human Trial
Very Rigorous JournalMultivitamin use and adverse birth outcomes in high‐income countries: a systematic review and meta‐analysis
Routine multivitamin use in high-income countries can be recommended but with caution due to low quality evidence.
Meta-Analysis
Rigorous JournalMultivitamin use and the risk of preterm birth.
Women who take multivitamin supplements prior to conception may have a reduced risk of preterm birth compared to nonusers.
Observational StudyRigorous JournalMultivitamin use and the risk of myocardial infarction: a population-based cohort of Swedish women.
Multivitamin use is inversely associated with myocardial infarction risk in women with no history of cardiovascular disease.
Observational StudyVery Rigorous JournalPre-pregnancy obesity and non-adherence to multivitamin use: findings from the National Pregnancy Risk Assessment Monitoring System (2009–2011)
Overweight and obese women are less likely to follow the recommendation for preconception multivitamin use compared to normal weight women.
Observational StudyRigorous JournalMultivitamin use and the risk of hypertension in a prospective cohort study of women
Multivitamin use in middle-aged and older women is not associated with the risk of developing hypertension.
Observational StudyVery Rigorous JournalPre-conceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies.
Folic acid and multivitamin supplementation before pregnancy can help prevent neural tube defects and other congenital anomalies.
Systematic Review
Highly CitedEffect of multivitamin and vitamin A supplements on weight gain during pregnancy among HIV-1-infected women.
Multivitamin supplementation during pregnancy improves the pattern of weight gain and reduces the risk of low weight gain in HIV-infected women.
RCTLarge Human TrialPreconceptional and prenatal multivitamin-mineral supplement use in the 1988 National Maternal and Infant Health Survey.
Black mothers, those with lower education, younger age, unmarried status, and non-smokers are at higher risk for nonuse of multivitamin-mineral supplements during pregnancy.
Observational Study