When was prenatal vitamins invented

This is especially important to help prevent anemia iron deficiency. Vitamin D: Helps with bone health and calcium absorption.

Also helps support immune system function. However, omega-3 fatty acids are not always included in prenatal vitamins, in which case an omega-3 supplement should be taken for a more comprehensive prenatal regimen. B complex: While folic acid B9 is the leader of the bunch, the other B-complex vitamins to note are thiamine B1 , riboflavin B2 , niacin B3 , pantothenic acid B5 , pyridoxine B6 , biotin B7 and cobalamin B Vitamin C helps iron absorption.

Magnesium, sodium, potassium: These electrolytes help maintain hydration, which is important during pregnancy. Electrolytes are also crucial in muscle contractions and nerve impulse transmissions. Adequate magnesium can also aid in preventing premature uterine contractions.

Zinc: Helps immune function in mom and aids with the rapid cell growth that occurs during pregnancy. Copper: Helps with red blood cell formation. When should you begin taking a prenatal vitamin? How long should you take a prenatal vitamin? Related Articles. Latest News. Alternative Medicine. Looking for a Powerful Low-Vision Device? Turn to Your Smartphone. In The Know. Seeing a Sparkly Visual Disturbance?

In the s, the paediatrician Richard Smithells collaborated with local obstetricians in researching folate metabolism in reproduction in Liverpool, noted for its high NTD prevalence. Smithells had set up a congenital abnormalities register and genetic counselling service for Liverpool in Smithells, and became the leading British expert on thalidomide diagnostics.

Thalidomide had revealed that drugs could harm the developing fetus, but could a pharmaceutical product be shown to prevent birth defects? Such an experiment was plausible only in a British medical and social landscape transformed by thalidomide and the legalization of abortion. The rapid expansion of prenatal diagnosis in the ten years after the Abortion Act consolidated the genetic counselling clinics from which women with a history of an NTD pregnancy could be recruited.

Each woman agreed to take three tablets a day for no fewer than 28 days before conception, up until the date of the second missed period. A second group of women who were already pregnant when referred to the study or who declined to take supplements were used as controls. The preliminary findings, published in the Lancet in , suggested that the NTD recurrence rate in supplemented mothers was around half that of the control group Smithells et al.

Even as medical practitioners prescribed vitamins to high-risk mothers, the debate over the credibility of existing data intensified. The epistemological success of the multi-centre RCT in Britain was largely the achievement of the MRC, whose pioneering trials of the anti-tuberculosis drug streptomycin in the late s laid the parameters for biomedical research during a period of increased centralization of health policy and planning. Research into the role of folate deficiency in reproduction had certainly been located in heterogeneous disciplinary traditions that served various academic, clinical, and charitable agendas.

The suggestion that pre-conceptional vitamins could reduce NTD prevalence by half now had such significant health policy implications as to push the MRC to become involved. Should the state fund the provision of folic acid supplements, or a proprietary multivitamin at more than 35 times the cost? Official recognition of the need for a multi-centre RCT not only reflected the view that previous studies, with their diverse sources of funding and research protocols, were too inconclusive to inform such major policy decisions as the national healthcare budget contracted under the Conservative government of Margaret Thatcher.

It also reinforced the position of the MRC as the pre-eminent producer of medical knowledge and arbiter of best practice in the UK. Yet even as the MRC and other organizations consolidated the status of the RCT, controversies over human experimentation through the late s and s began to change the landscape of clinical research Cooter, , pp.

In response to mounting critiques of risky clinical experimentation without informed consent, British hospitals set up specific committees to oversee the ethics of medical research. Amendments to the Helsinki code at the WMA assembly in , the first of eight subsequent revisions to date, placed particular emphasis on tightening definitions of informed consent Faulder, , pp.

Through the s and s, new procedures for the oversight of the profession emerged alongside rising appeals for lay involvement in the administration of clinical research in the form of patient activists and advocates, consumer groups and the independent discipline of bioethics Dawes, ; Epstein, ; Wilson, The MRC trial launched just as the long-running public controversy over claims that large doses of vitamin C could cure cancer was about to reach its climax Richards, Symptoms of all these trends can be seen in the design of and response to the MRC vitamin study.

The MRC steering committee established to design and coordinate the trial first convened in February From the outset the MRC was sensitive to the ethical implications of enrolling women who had previously had an NTD baby and were planning another pregnancy into a controlled trial.

This would mean randomly allocating subjects into one of three control groups: the first to take a daily Pregnavite multivitamin, the second a 5-milligram dose of folic acid, and the third a placebo.

The debate spilled into public view early in as journalists picked up on expert disagreement over the feasibility and ethics of a placebo-controlled trial.

The pre-conceptional vitamin study set a precedent for well-known controversies over placebo-controlled trials of the AIDS drug AZT later in the s Berridge, , p. The most stringent opposition came from clinicians concerned that they could not subject women to the risk of a placebo without violating ordinary responsibilities of patient care, not least because vitamins, including folic acid, were already so widely recommended in pregnancy.

Disagreement hinged above all on whether women recruited to the trial should be considered pure research subjects or patients, a distinction that would in turn determine the necessity of obtaining explicit informed consent Davis, c. Lack of clarity on this issue provoked concern that doctors who participated in the study could be liable to charges of negligence Leahy Taylor, A year into the MRC study, participating centres had managed to recruit a total of just women, far short of the minimum target Abel, Although the possibility of recruiting subjects from outside Britain had been mooted from the start, the study ultimately relied upon 16 centres in Australia, France, Israel, Hungary and the then USSR.

Moreover, claims that the statistical rigour of the trial produced definitive answers overlooked the vital role of groups other than MRC epidemiologists in tipping the balance of certainty and uncertainty. The new identity of folic acid as a risk-reducing drug depended on the agency of non-experts.

First, the media, as discussed above, played a major part in the controversy, not merely communicating expert disagreement, but also shaping both professional and lay perceptions of risk and uncertainty. Medical researchers and practitioners used the media to declare their support or opposition to the trial and journalists intervened directly, too.

The feminist health rights activist and journalist Carolyn Faulder, for instance, framed the trial as part of a patient-consumer struggle for informed consent. Second, industry had a vested interest in the design and interpretation of the trial. Within months of the publication of the vitamin study in , food manufacturers announced plans to fortify proprietary products with folic acid.

Third, charities, patient advocates and consumer groups were deeply involved in the controversy from the start, actively influencing the design of the trial. While the MRC won the support of ASBAH by revising the trial protocols, the maternity groups remained critical, arguing that the study ignored the real problem of dietary deficiency among socio-economically disadvantaged women National Childbirth Trust, This campaign framed broader debate over the importance of pre-conceptional nutrition and the prevention of disability.

The crucial role of these groups in the public construction of certainty and uncertainty is essential for understanding the emerging identity of folic acid as a risk-reducing drug.

Immediately following the publication of the MRC study, the UK Chief Medical Officer issued a circular recommending that all women of childbearing age significantly increase their daily folate intake Acheson, This innovation provoked mixed responses.

New guidelines about preconceptional and prenatal nutrition came as medical research and related advice concerning pregnancy in general, including the risks maternal drinking, smoking and drug taking posed to the fetus, proliferated in the s and s Daniels, The trajectory of folic acid from experimental drug to necessary pre-conceptional supplement was negotiated over several decades by the medical researchers, healthcare industry, the media, consumer groups and activists.

Debates over folic acid need to be placed more fully in relation to the wider politicization of food and nutrition in this period Nestle, ; Scrinis, Medical research into folic acid was, perhaps above all, stimulated by the emergence of spina bifida as a political concern in Britain around By the context was entirely different; the birth prevalence of NTDs had declined significantly and spina bifida was far less visible than it had been even ten years earlier.

Yet its publication merely opened up a new phase of controversy. Yet consumer groups and food campaigners accused the FDA of mass-medicating the American population without thoroughly understanding the long-term effects of folic acid consumption and working in the interests of manufacturers of often expensive processed foods. Similar arguments have been raised in opposition to mandatory fortification in the United Kingdom Blythman, , ; Nestle, , pp.

As of , over 65 countries worldwide had followed the US lead. Scientific disagreement, in addition to perceived governmental recalcitrance, has made folic acid enormously contentious in Britain over the last two decades.

The tumultuous trajectory of pre-conceptional folic acid supplementation invites comparisons with other postwar medical interventions, particularly those concerned with reducing the risk of congenital and genetic disability and disease. Like prenatal diagnosis, these innovations have contributed to the inexorable rise of the fetus in medical practice and public debate. Continuing disagreement among health policy makers over folic acid also open up further questions about varied public responses and assessments of success or failure in different national contexts.

In particular, the ways in which the fate of pre-conceptional vitamin supplementation was tied to other modalities of reducing birth defects—specifically, prenatal testing and selective termination—and controversies around them demand further study.

Like many recent public health innovations, folic acid was scaled up from an individual treatment for selected, high-risk individuals into a means of accomplishing population health goals. As public health experts continue to debate the risks and benefits, it nonetheless remains an experiment-in-progress. Research was funded by the Wellcome Trust Grant No.

All contained both iron and calcium. National Center for Biotechnology Information , U. Sponsored Document from. Salim Al-Gailani. Author information Copyright and License information Disclaimer. Salim Al-Gailani: ku. This article has been cited by other articles in PMC. From Marmite to folic acid: vitamin supplements in pregnancy Dietary prescriptions had long been a staple of informal health guidance to expectant and nursing mothers before rising concern about infant mortality around consolidated the status of nutritional advice in voluntary and statutory systems of maternal and child welfare Cody, ; Dwork, ; Oakley, Monitoring, treating and preventing NTDs after thalidomide Revelations in the early s that the anti-nausea drug thalidomide had caused birth deformities on a huge scale, prompted widespread discussion about the permissibility of abortion across Western Europe and North America.

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The ethical body. In: Cooter R. Medicine in the twentieth century. Harwood; Amsterdam: Czeizel A. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. New England Journal of Medicine. Daniels C. Harvard University Press; Cambridge: Davis, J. Letter to N. The researchers also examined published research examining the potential health benefits during pregnancy of taking individual vitamins and minerals such as folic acid, vitamin D and iron, along with vitamins C, E and A.

With the exception of folic acid and vitamin D, the authors of the review found no evidence that women who were well-nourished had gained any clinical benefit from taking the other supplements examined.

The researchers found that the recommendation to take folic acid during pregnancy was supported by the strongest scientific evidence, compared with the evidence for other vitamins and minerals.

The researchers also found some scientific evidence showing a benefit from taking vitamin D supplementation during pregnancy, but that evidence was less clear-cut, the researchers said. The researchers still recommended that pregnant women take a daily dose of 10 micrograms of vitamin D, which equals international units, throughout pregnancy and breast-feeding This is also the average dose of vitamin D found in prenatal supplements in the U. However, Bruce W. Hollis, a professor of pediatrics at the Medical University of South Carolina MUSC who was not involved with the study, said he thinks that this dose of vitamin D is not sufficient to provide optimal benefits for pregnant women's health or their children's health.

A growing body of research, including his own studies, has suggested that taking as much as 4, international units of vitamin D per day during pregnancy is linked to health benefits such as a lower risk of preterm birth and preeclampsia, and a lower risk of asthma in children, he said.