Vitamin A Supplementation During Pregnancy & Breastfeeding

in Nutrition, Postpartum Recovery, Pregnancy, Vitamins & Minerals

Vitamin A is required for healthy prenatal and postnatal infant development and immune function. However, there is a risk for toxicity at high levels so some experts recommend avoiding it completely during pregnancy to avoid harming the developing child. While high doses of vitamin A carry potential risks, moderate consumption of vitamin A is not only safe, it is essential during pregnancy and breastfeeding. 

This article covers vitamin A requirements and upper limits while offering information about how to safely consume vitamin A from supplements, food, beef liver, and cod liver oil

Vitamin A Intake In The United States

According to research published in 2020, 45% of Americans do not consume enough vitamin A in their diets. This usually doesn’t lead to an outright vitamin A deficiency as seen in developing nations, but it does lead to what we call vitamin A insufficiency or inadequacy. 

Dr. Green Mom Vitamin A Foods

Vitamin A Insufficiency 

Vitamin A insufficiency or inadequacy occurs when the daily intake of vitamin A falls below the recommended daily allowance (RDA). This is more difficult to diagnose than vitamin A deficiency because it isn’t detectable on lab tests and the symptoms are fairly non-specific and include fatigue, increased susceptibility to infections, infertility, night blindness, and dry skin. Therefore, vitamin A insufficiency is evaluated through the amounts consumed in the diet through food and supplements. 

Vitamin A Requirements & Upper Limit During Pregnancy

The recommended daily allowance for vitamin A during pregnancy is 750 mcg (2500 IU). This is the lower limit for vitamin A consumption. This limit can be achieved by consuming both preformed vitamin A (retinol) and provitamin A (beta carotene and other carotenoids). Beta carotene can be converted to vitamin A in the liver. 

The upper limit for vitamin A supplementation in pregnancy is 3,000 mcg (10,000 IU) of preformed retinol. There is no upper limit to beta carotene because it carries no reproductive risk to the mom or baby. 

Therefore, pregnant moms should aim for 750-3,000 mcg (2,500-10,000 IU) per day of vitamin A from all sources. 

In my opinion, getting nutrients from food is ideal but not always realistic. Supplements are great because they fill in gaps in our diets as needed. 

This article discusses Dr. Green Mom brand supplements and gives information about different ways that they can be used; however, this shouldn’t be taken as medical advice. Keep in mind that the amounts of vitamin A in different supplements vary widely. One brand of prenatal vitamin will likely contain a different amount of vitamin A than another. Therefore, always read labels carefully and discuss all supplementation choices with a qualified healthcare provider.

Vitamin A Needs Change Throughout Pregnancy

Though the standard recommended intake of vitamin A throughout pregnancy is 750-3,000 mcg (2,500-10,000 IU) per day, actual vitamin A needs vary throughout pregnancy.

First 60 days of pregnancy: evidence indicates that this is the time when the risk of reproductive toxicity due to excess vitamin A is highest. The WHO recommends a maximum supplement of 10,000 IU (3,000 mcg) per day of preformed vitamin A during this time. In my clinical practice, I usually have mamas on just a prenatal multivitamin for the first 60 days of pregnancy, unless they are fighting a viral illness or are having trouble consuming vitamin A containing foods due to aversions or morning sickness. See these protocols at the end of the article. 

Third trimester: the rate of vitamin A deficiency increases. This likely happens because maternal blood volume is rapidly increasing and the baby is quickly growing. Both of these processes require vitamin A. When my patients are in the third trimester, I may discuss adding cod liver oil or a beef liver supplement. However, this depends on the mother’s diet and overall health. (Beef liver capsules and cod liver oil are discussed in more depth below.)

Dr. Green Mom Prenatal & Postnatal Daily Nutrients contains 1,500 mcg of vitamin A (300 mcg of preformed vitamin A + 1200 mcg of vitamin A equivalents from natural carotenoids including beta carotene). This supplement allows women to meet their minimum requirement of vitamin A without risk of toxicity or needing additional supplementation. 

Vitamin A Needs Increase During Viral Infections

Vitamin A levels go down during viral infections due to decreased consumption (appetite) and increased use and urinary excretion. Increased vitamin A must be consumed to maintain healthy vitamin A levels, which are needed to mount a robust immune response. 

In my practice, I often recommend a large dose of vitamin A at the beginning of certain viral infections like Covid-19. However, large doses of vitamin A are not recommended during pregnancy, and I don’t ever recommend a vitamin A megadose for pregnant women. 

My favorite option for increasing vitamin A levels during viral infections in pregnant women is to have them continue taking their prenatal multivitamin and add a half dose of Essential Immune Support™ (Adolescents & Adults) at the first sign of illness and for up to two weeks after recovery. This provides an additional 1,500 mcg of preformed vitamin A plus other immune-enhancing nutrients. Alternatively, liquid vitamin A, taken on its own could be used, or vitamin A containing foods could be mindfully increased. 

Vitamin A Requirements & Upper Limit During Breastfeeding

Creating and nourishing a baby takes a massive amount of nutrients, including vitamin A. Breast milk supplies a significant amount of vitamin A to your baby. Vitamin A requirements are the highest during breastfeeding; the minimum amount of vitamin A required daily is 1,300 mcg (4,333 IU) and the recommended upper limit remains the same at 3,000 mcg (10,000 IU)

Dr. Green Mom Vitamin A Breastfeeding

Megadoses of vitamin A have been studied in lactating women and do not pose a risk to infants when properly dosed. See this article for more information: Vitamin A Megadose For Viral Infections – Dr. Green Mom.

Vitamin A Supplementation While Breastfeeding

Because lactating moms have multiple increased nutrient needs, in my clinical practice I usually have them continue taking Prenatal & Postnatal Daily Nutrients for at least 6 months postpartum. Dr. Green Mom Prenatal & Postnatal Daily Nutrients provides 1,500 mcg of vitamin A (300 mcg of preformed vitamin A + 1200 mcg of natural carotenoids including beta carotene). On a personal note, I continued taking a prenatal vitamin for two years after both of my pregnancies! 

I often recommend adding beef liver capsules and/or cod liver oil alongside Prenatal & Postnatal Daily Nutrients during the postpartum period. The dose depends on energy levels, red blood cell status, and diet. I discuss how to safely combine these supplements below.

Vitamin A Supplement Options

In the Dr. Green Mom store, several different supplements contain vitamin A. I often get questions about whether or not they can be taken together. In this section, I will cover the vitamin A content of each supplement and when to consider taking them together.

Prenatal & Postnatal Daily Nutrients

Prenatal & Postnatal Daily Nutrients is a supplement that was designed to support the nutritional requirements of pregnancy, postpartum recovery, and lactation. In my clinical practice, I usually recommend this supplement to women who are pregnant, trying to conceive, or lactating as well as those who have recently given birth or had a miscarriage. 

A serving (3 capsules) of Dr. Green Mom Prenatal & Postnatal Daily Nutrients contains 1,500 mcg of vitamin A (300 mcg of preformed vitamin A + 1200 mcg of natural carotenoids including beta carotene).

Grass Fed & Finished Beef Liver Capsules

Grass Fed & Finished Beef Liver Capsules contain highly bioavailable nutrients including vitamin A, B complex vitamins, folate, iron, copper, manganese, zinc, selenium, hyaluronic acid, and more. This is a supplement that I consider when people need extra nourishment but aren’t able to get enough from food. This includes people who don’t eat much meat; people who have weak digestion, anemia, fatigue, or frequent infections; and those who are recovering from serious illnesses. This also includes postpartum and lactating women.

A serving (4 capsules) of Dr. Green Mom Grass Fed & Finished Beef Liver Capsules contains 3000 mg of desiccated beef liver (which is equivalent to 1 ounce of fresh beef liver). Though the exact amounts will vary from batch to batch, 1 ounce of beef liver contains approximately 1400 mcg (4667 IU) of preformed vitamin A. 

Oh My Cod! Liver Oil (Infants, Kids, & Adults)

Oh My Cod! Liver Oil (Infants, Kids, & Adults) contains naturally occurring omega 3 essential fatty acids alongside naturally occurring vitamins A and D. This is a supplement that I use for people who don’t have strong fat digestion or consume much fish in their diets; those who have gallbladder concerns*; and those who need extra neurological or mood support or extra inflammation support. 

A serving (1 tsp) of Dr. Green Mom Oh My Cod! Liver Oil (Infants, Kids, & Adults) contains 540 mcg (1,800 IU) of preformed vitamin A. 

*People with gallbladder concerns are often low in omega-3 fatty acids and fat-soluble vitamins. Generally, the gallbladder symptoms need to be under control before adding an omega supplement to avoid aggravating the problem.

Essential Immune Support™ (Adolescents & Adults)

Essential Immune Support™ (Adolescents & Adults) is an immune support supplement that I formulated using research that looked into the most promising nutrients for the treatment of Covid-19, including vitamin A, vitamin C, vitamin D, vitamin K, zinc, selenium, quercetin, turmeric, and L-glutathione. In my practice, I often give this supplement to people when they come down with any viral respiratory infection. It can also be used preventatively during cold and flu season and/or in situations with a high risk for infection (eg. air travel, looking after sick family members, etc). 

A serving (2 capsules) of Essential Immune Support™ (Adolescents & Adults) contains 1500 mcg (5000 IU) of vitamin A.  

Neuroimmune Liquid Vitamin A

Neuroimmune Liquid Vitamin A contains pure vitamin A. This is a supplement that I use when I need targeted vitamin A dosing. Most often I use it for kids around vaccinations, as part of dermatological protocols, and for the megadose immune protocol

A serving (1 drop) of Neuroimmune Liquid Vitamin A contains 1500 mcg (5,000 IU) of preformed vitamin A plus 7 mcg of vitamin A equivalents from beta carotene. 

Combining Vitamin A Containing Supplements

Safely combining vitamin A supplements requires a little math. The maximum daily supplemental dose of vitamin A is 3,000 mcg (10,000 IU). Remember that only the preformed vitamin A is included in the calculation for the max dose and beta carotene is not.  

  • I aim for vitamin A supplemental doses closer to the maximum in the postpartum period or during times of sickness and for people who do not consume a lot of animal-based foods. 
  • I aim for supplemental doses closer to the minimum recommended doses described above during the first trimester of pregnancy and for people who regularly consume animal-based foods. 
  • People with a varied diet and strong digestion do not necessarily need vitamin A supplements. 

Below are some of my vitamin A protocols. These would not be appropriate for all individuals and it is important to always speak with a physician before starting on any supplement protocol, especially during pregnancy and lactation. 

Standard Pregnancy Supplement Protocol

1 Serving (3 capsules) of Prenatal & Postnatal Daily Nutrients + Prenatal & Postnatal Omega-3 + Women’s Health Probiotic  + Liquid Iron/Iron Gummies if indicated by laboratory testing. 

Low Meat Pregnancy Supplement Protocol

1 Serving (3 capsules) of Prenatal & Postnatal Daily Nutrients + Prenatal & Postnatal Omega-3 + Women’s Health Probiotic + ½- 1 serving (2-4 capsules) of Grass Fed & Finished Beef Liver Capsules  + Liquid Iron/Iron Gummies if indicated by laboratory testing. 

Third Trimester Fatigue Supplement Protocol

1 Serving (3 capsules) of Prenatal & Postnatal Daily Nutrients + Prenatal & Postnatal Omega-3 + Women’s Health Probiotic + ½- 1 serving (2-4 capsules) of Grass Fed & Finished Beef Liver Capsules + Liquid Iron/Iron Gummies if indicated by laboratory testing. 

Viral Infection During Pregnancy Supplement Protocol

1 Serving (3 capsules) of Prenatal & Postnatal Daily Nutrients + Prenatal & Postnatal Omega-3 + Women’s Health Probiotic + 1 serving (2 capsules) of Essential Immune Support™ (Adolescents & Adults)

Standard Breastfeeding Supplement Protocol

1 Serving (3 capsules) of Prenatal & Postnatal Daily Nutrients + Prenatal & Postnatal Omega-3 + Women’s Health Probiotic + ¼-½ serving (1-2 capsules) of Grass Fed & Finished Beef Liver Capsules

Breastfeeding Fatigue Or Illness Recovery Supplement Protocol

1 Serving (3 capsules) of Prenatal & Postnatal Daily Nutrients + Prenatal & Postnatal Omega-3 + Women’s Health Probiotic + 1 serving (4 capsules) of Grass Fed & Finished Beef Liver Capsules + Liquid Iron/Iron Gummies if indicated by laboratory testing. 

Viral Infection While Breastfeeding Supplement Protocol

1 Serving (3 capsules) of Prenatal & Postnatal Daily Nutrients + Prenatal & Postnatal Omega-3 + Women’s Health Probiotic + ¼-½ serving (1-2 capsules) of Grass Fed & Finished Beef Liver Capsules + 1 serving (2 capsules) of Essential Immune Support™ (Adolescents & Adults)

Summary

Vitamin A is essential for reproduction, development, blood cell production, vision, neurological function, immune function, and more. Getting adequate amounts during pregnancy and lactation is especially important for both mom and baby. 

Unfortunately, fear of vitamin A toxicity has scared some people away from vitamin A, especially during pregnancy. While vitamin A toxicity is real, there are established upper limits to vitamin A supplementation during pregnancy and breastfeeding. With education and awareness of proper dosage, it is safe to consume this crucial vitamin.

Read more about foods that contain vitamin A: Top Food Sources of Vitamin A Plus Family Friendly Recipes – Dr. Green Mom.

References

Vitamin A and Carotenoids – Health Professional Fact Sheet 

Vitamin A | Linus Pauling Institute 

Bastos Maia, S., Rolland Souza, A. S., Costa Caminha, M. F., Lins da Silva, S., Callou Cruz, R. S. B. L., Carvalho Dos Santos, C., & Batista Filho, M. (2019). Vitamin A and Pregnancy: A Narrative Review. Nutrients, 11(3), 681. https://doi.org/10.3390/nu11030681 

Cañete, A., Cano, E., Muñoz-Chápuli, R., & Carmona, R. (2017). Role of Vitamin A/Retinoic Acid in Regulation of Embryonic and Adult Hematopoiesis. Nutrients, 9(2), 159. https://doi.org/10.3390/nu9020159

Wiseman, E. M., Bar-El Dadon, S., & Reifen, R. (2017). The vicious cycle of vitamin a deficiency: A review. Critical reviews in food science and nutrition, 57(17), 3703–3714. https://doi.org/10.1080/10408398.2016.1160362

Chagas, C. B., Saunders, C., Pereira, S., Silva, J., Saboya, C., & Ramalho, A. (2013). Vitamin a deficiency in pregnancy: perspectives after bariatric surgery. Obesity surgery, 23(2), 249–254. https://doi.org/10.1007/s11695-012-0822-x

Fulgoni, V. L., 3rd, Keast, D. R., Bailey, R. L., & Dwyer, J. (2011). Foods, fortificants, and supplements: Where do Americans get their nutrients?. The Journal of nutrition, 141(10), 1847–1854. https://doi.org/10.3945/jn.111.142257

Tepasse, P. R., Vollenberg, R., Fobker, M., Kabar, I., Schmidt, H., Meier, J. A., Nowacki, T., & Hüsing-Kabar, A. (2021). Vitamin A Plasma Levels in COVID-19 Patients: A Prospective Multicenter Study and Hypothesis. Nutrients, 13(7), 2173. https://doi.org/10.3390/nu13072173 

Weber, D., & Grune, T. (2012). The contribution of β-carotene to vitamin A supply of humans. Molecular nutrition & food research, 56(2), 251–258. https://doi.org/10.1002/mnfr.201100230

Bezerra, D. S., de Melo, A. T. A., de Oliveira, K. C. A. N., de Araújo, K. Q. M. A., Medeiros, M. S. M. F., Santos, F. A. P. S. D., Medeiros, J. F. P., Lima, M. S. R., da Silva, A. G. C. L., Ribeiro, K. D. D. S., Dimenstein, R., & Osório, M. M. (2022). Breast Milk Retinol Levels after Vitamin A Supplementation at Different Postpartum Amounts and Intervals. Nutrients, 14(17), 3570. https://doi.org/10.3390/nu14173570

da Cunha, M. S. B., Campos Hankins, N. A., & Arruda, S. F. (2019). Effect of vitamin A supplementation on iron status in humans: A systematic review and meta-analysis. Critical reviews in food science and nutrition, 59(11), 1767–1781. https://doi.org/10.1080/10408398.2018.1427552 

Strobel, M., Tinz, J., & Biesalski, H. K. (2007). The importance of beta-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women. European journal of nutrition, 46 Suppl 1, I1–I20. https://doi.org/10.1007/s00394-007-1001-z

Strobel, M., Tinz, J., & Biesalski, H. K. (2007). The importance of beta-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women. European journal of nutrition, 46 Suppl 1, I1–I20. https://doi.org/10.1007/s00394-007-1001-z

Sommer, A., & Vyas, K. S. (2012). A global clinical view on vitamin A and carotenoids. The American journal of clinical nutrition, 96(5), 1204S–6S. https://doi.org/10.3945/ajcn.112.034868

Milani, A., Basirnejad, M., Shahbazi, S., & Bolhassani, A. (2017). Carotenoids: biochemistry, pharmacology and treatment. British journal of pharmacology, 174(11), 1290–1324. https://doi.org/10.1111/bph.13625

Hodge, C., & Taylor, C. (2022). Vitamin A Deficiency. In StatPearls. StatPearls Publishing.

Zhang, X., Zhang, R., Moore, J. B., Wang, Y., Yan, H., Wu, Y., Tan, A., Fu, J., Shen, Z., Qin, G., Li, R., & Chen, G. (2017). The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies. International journal of environmental research and public health, 14(9), 1043. https://doi.org/10.3390/ijerph14091043

Tang G. (2012). Techniques for measuring vitamin A activity from β-carotene. The American journal of clinical nutrition, 96(5), 1185S–8S. https://doi.org/10.3945/ajcn.112.034603

Lemke, S. L., Dueker, S. R., Follett, J. R., Lin, Y., Carkeet, C., Buchholz, B. A., Vogel, J. S., & Clifford, A. J. (2003). Absorption and retinol equivalence of beta-carotene in humans is influenced by dietary vitamin A intake. Journal of lipid research, 44(8), 1591–1600. https://doi.org/10.1194/jlr.M300116-JLR200

Grune, T., Lietz, G., Palou, A., Ross, A. C., Stahl, W., Tang, G., Thurnham, D., Yin, S. A., & Biesalski, H. K. (2010). Beta-carotene is an important vitamin A source for humans. The Journal of nutrition, 140(12), 2268S–2285S. https://doi.org/10.3945/jn.109.119024

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