Scenario: Preconceptual care

Claudia Jones confides in pharmacist Parveen that she and her husband have decided to try for a second baby...

“It’s been so long since I was last pregnant – Ella is five years old now – that I’ve lost track of the supplements I need to take,” says Claudia. “And it seems to change all the time anyway. Is it still folic acid while we are trying and for the first three months? And what about iron tablets? Maybe I should just carry on with my ‘A to Z’ supplement, as that seems to have everything in it that I could possibly want or need!”


Claudia is right that folic acid supplementation is recommended before conception and throughout the first trimester in order to reduce the risk of having a baby with a neural tube defect such as spina bifida. The usual recommended dose is 400mcg per day.

However, Claudia should not take a standard multivitamin product, as most contain vitamin A, which can be teratogenic if more than 700mcg is taken each day. For the same reason, she should avoid eating foodstuffs that are high in the vitamin, most notably liver and related products such as pate.

Claudia is also mistaken in her belief about iron supplementation. The current recommendation is that it should not be offered routinely to pregnant women as it is not beneficial to the health of the mother or the unborn child and can have unpleasant side-effects, particularly on the gastrointestinal tract.

One supplement that Parveen should recommend to Claudia is vitamin D. A daily dose of 10mcg per day will help maintain adequate stores during pregnancy and breastfeeding and is beneficial to both mother and baby. Claudia may be eligible for free supplements under a NHS scheme, or should be advised to purchase a product containing this amount.

The bigger picture

NICE has recently updated its guidance on antenatal care for uncomplicated pregnancies, which includes a new section on the role of vitamin D. As well as covering nutritional supplements, the document details the advice pregnant women should be given in order to reduce their risk of food-acquired infections, and on medicines (prescribed, OTC and complementary), exercise, alcohol consumption, smoking and sexual intercourse.

Information on the management of common pregnancy ailments, such as morning sickness, heartburn, constipation and varicose veins is also given, plus details of screening tests for foetal abnormalities and clinical conditions that can affect pregnant women; for example, gestational diabetes and pre-eclampsia.

Can you...

...name the groups who are recommended to take folic acid 5mg rather than 400mcg before and during pregnancy?

Click here for the answer

Latest discussions

  1. Pre reg exams

    Thanks for your comments both - Richard ...

  2. Pre reg exams

    Having been qualified just over 40 years...

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