Dietary supplement use and folate status during pregnancy in the United States
Open accessAbstract
Adequate folate and iron intake during pregnancy is critical for maternal and fetal health. No previous studies to our knowledge have reported dietary supplement use and folate status among pregnant women sampled in NHANES, a nationally representative, cross-sectional survey. We analyzed data on 1296 pregnant women who participated in NHANES from 1999 to 2006 to characterize overall supplement use, iron and folic acid use, and RBC folate status. The majority of pregnant women (77%) reported use of a supplement in the previous 30 d, most frequently a multivitamin/-mineral containing folic acid (mean 817 μg/d) and iron (48 mg/d). Approximately 55-60% of women in their first trimester reported taking a folic acid- or iron-containing supplement compared with 76-78% in their second trimester and 89% in their third trimester. RBC folate was lowest in the first trimester and differed by supplement use across all trimesters. Median RBC folate was 1628 nmol/L among users and 1041 nmol/L among nonusers. Among all pregnant women, median RBC folate increased with trimester (1256 nmol/L in the first, 1527 nmol/L in the second, and 1773 nmol/L in the third). Given the role of folic acid in the prevention of neural tube defects, it is notable that supplement use and median RBC folate was lowest in the first trimester of pregnancy, with 55% of women taking a supplement containing folic acid. Future research is needed to determine the reasons for low compliance with supplement recommendations, particularly folic acid, in early pregnancy.
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In both groups, average iron intake from cereals and supplements across pregnancy exceeded the Tolerable Upper Intake Limit for iron, yet matched national supplement-intake estimates for pregnant women (48 mg/day) and women of childbearing age (18 mg/day).
“Average iron intake from cereals and supplements throughout pregnancy for both groups in this study was above the Tolerable Upper Intake Limit for iron (40) but was in line with national estimates of intake from supplements for pregnant women (48 mg/day) (41) and women of childbearing age (18 mg/day) (42).”
From Maternal Intake of Supplemental Iron and Risk of Autism Spectrum Disorder (2014) · cites this paper as [41]
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- Authors
- Branum, A. M., Bailey, R., & Singer, B. J.
- Affiliations
- Centers for Disease Control and Prevention (US)
- National Institutes of Health (US)
- University of Maryland, Baltimore (US)
- Corresponding author
- Branum, Amy M.
- ORCID
- Bailey, Regan
- Venue
- The Journal of Nutrition
- Publisher
- Elsevier BV
- Published
- 2013-04
- Volume
- 143
- Issue
- 4
- Pages
- 486-492
- ISSN
- 0022-3166 (ISSN-L)
- PMC
- PMC4745881
- OpenAlex
- W2160195996
- Cited by
- 152
- References
- 32
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 8 · 2023: 7 · 2022: 12 · 2021: 12 · 2020: 14 · 2019: 10 · 2018: 18 · 2017: 14 · 2016: 16 · 2015: 15 · 2014: 12 · 2013: 6
- FWCI
- 13.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Health Sciences › Medicine › Rheumatology › Folate and B Vitamins Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- supplement use, folate status, pregnancy, folic acid supplementation, iron supplementation, red blood cell folate, multivitamin and mineral supplements, trimester differences, neural tube defects, supplement compliance, NHANES
- MeSH terms
- Adult, Age Factors, Educational Status, Erythrocytes, Ethnicity, Female, Folic Acid, Humans, Iron, Nutrition Surveys, Nutritional Status, Pregnancy, Pregnancy Trimester, First, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Prenatal Care, Dietary Supplements
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