Do Multivitamins Reduce the Risk of Miscarriage?

Written by Dr. Steve Chaney on . Posted in Multivitamins and Miscarriage, Vitamins and Health, Weight Loss

Will A Multivitamin A Day Keep YourBaby Healthy?

Author: Dr. Stephen Chaney

multivitamins reduce risk of miscarriageThe standard medical advice for years has been to take a prenatal supplement (basically a multivitamin with extra folic acid, iron and sometimes calcium) both before and during pregnancy. Does that really make a difference? Will it reduce the risk of miscarriage? Will it give you a healthier baby?  A recent study suggests that multivitamin use may significantly decrease your risk of miscarrying, but before going into the study you need a little background.

 

It’s a new world. It used to be that a woman didn’t know for sure that she was pregnant until she had missed one or two periods and finally got an appointment with her doctor – a month or two after conception actually occurred. In today’s world accuracy in home pregnancy tests allow women to learn they are pregnant much earlier – often before the first missed period.

With the early detection of pregnancy has come the realization that miscarriage rates are much higher than previously assumed. In spite of improved prenatal care, the rate of miscarriages in the US increased by 1% per year between 1985 and 2005. In part that is because women using the in-home pregnancy tests are detecting their pregnancies much early. However, it also reflects the fact that early miscarriages are often asymptomatic. They can only be detected by negative pregnancy tests.

With that in mind, let’s look at the study.

Do Multivitamins Reduce the Risk of Miscarriage?

pregnancy and miscarriageThis study (Louis et al, Fertility and Sterility, doi.org.10.1016/j.fertnstert.2016.03.009, 2016), had a very interesting design. It enrolled 501 couples ages 18-40 from Michigan and Texas who were actively trying to become pregnant into something called the Longitudinal Investigation of Fertility and the Environment (LIFE) Study. The women in the study were instructed in the use of a commercial fertility urine test to help the couples plan their intercourse to maximize the chances of conceiving. They were also instructed in the use of a commercial pregnancy urine test to determine the onset and potential loss of pregnancy (miscarriage).

The couples were given no guidance on health practices to follow before and during pregnancy. They were interviewed individually upon enrolment to obtain sociodemographic, lifestyle, and medical history information. They were asked to keep a daily journal recording things like cigarettes use, consumption of alcoholic or caffeinated beverages, and multivitamin use (The journal did not distinguish between over-the-counter multivitamins and prescribed prenatal vitamins).

Of the couples who enrolled in the study, 347 (69%) of them became pregnant. Three of the women conceived twins and were eliminated from the study. Of the remaining 344 women, 98 (28%) of them experienced a miscarriage during the first 22 weeks. No miscarriages were observed after 22 weeks.

When they looked at risk factors that affected pregnancy loss (miscarriages):

  • The miscarriage rate was almost double for women over 35, which is consistent with previous studies.
  • Consumption of two or more caffeinated beverages/day by either partner prior to conception and during early pregnancy significantly increased the risk of miscarriage
  • Daily multivitamin use by the woman prior to conception reduced the risk of miscarriage by 55%. If the vitamin use was continued through the first 7 weeks of pregnancy, the risk of miscarriage was reduced by 79%.
  • No effect of obesity, cigarette smoking, and alcohol use on miscarriage risk was seen in this study, which is different from most previous studies.

Putting This Study Into Perspective

This was a fairly well designed study, but it is a single study.  Let’s put each of the main findings in the context of previous studies.

Multivitamin Use: Earlier studies have shown that supplements containing extra folic acid probably reduce miscarriages. However, now that foods are routinely fortified with folic acid in the US, the benefit of multivitamins and prenatal supplements has become more controversial. Some studies have shown, like this one, that multivitamins reduce miscarriage risk. Others did not. However, multivitamin use before and during pregnancy has relatively few risks, so it is still probably a good idea.

Caffeinated Beverages: There have been relatively few studies to date on the effect of caffeinated beverages on miscarriage risk, but the few that have been performed tend to agree that caffeinated beverages may increase the risk of miscarriage. While the data are far from definitive at this point, it is probably a good idea to limit your caffeinated beverages before and during pregnancy.

Age: Age is a well-established risk factor for miscarriages. While many consider 40 as the threshold for increased risk, this study and several other recent studies suggest it may be closer to 35. That doesn’t mean that you shouldn’t try to have a baby if you are over 35, but it does mean that you will probably want to avoid any lifestyle factors that might increase your risk of miscarriage.

Other Factors:This study did not find an effect of obesity, smoking or alcohol on pregnancy risk. However, many other studies have shown that each of these increases the risk of miscarriage. It’s probably a good idea to drop a few extra pounds and avoid both smoking and alcohol if you wish to maximize your chances of a successful pregnancy outcome.

If You Are Pregnant, What Does This Study Mean For You? 

preventing miscarriageThis study supports multivitamin use before and during pregnancy and suggests that excessive consumption of caffeinated beverages may have a negative effect on pregnancy outcome. However, it doesn’t significantly alter the standard medical advice for what you should do before and during pregnancy.

  • Daily multivitamin use, both prior to and during pregnancy, is probably a good idea. Not all studies agree, but some studies suggest that it will significantly decrease the risk of miscarriage.
  • Obesity and diabetes increase miscarriage risk. The good news is that even a 5-10% weight loss often is sufficient to reverse diabetes and may improve pregnancy outcome as well.
  • If you are over 35, your risk of suffering a miscarriage is significantly increased.
  • Smoking and alcohol use should be avoided. Both are likely to increase your risk of miscarriage.
  • Recent studies suggest that the consumption of two or more caffeinated beverages a day may also increase your risk of miscarriage, so don’t overindulge in caffeinated beverages. Be aware that it’s not just coffee and tea that are caffeinated. Many sodas are caffeinated as well.

 

The Bottom Line

 A recent study showed:

 

  • Daily multivitamin use by the woman prior to conception reduced the risk of miscarriage by 55%. If the vitamin use was continued through the first 7 weeks of pregnancy, the risk of miscarriage was reduced by 79%.
  • Consumption of two or more caffeinated beverages/day by either partner prior to conception and during early pregnancy significantly increased the risk of miscarriage
  • The miscarriage rate was almost double for women over 35, which is consistent with previous studies.
  • No effect of obesity, cigarette smoking, and alcohol use on miscarriage risk was seen in this study, which is different from most previous studies.
  • This study reinforces the recommendation for multivitamin or prenatal vitamin use, but the standard medical advice for a successful pregnancy isn’t really changed:
  • Daily multivitamin use, both prior to and during pregnancy, is probably a good idea. Not all studies agree, but some studies suggest that it will significantly decrease the risk of miscarriage.
  • Obesity and diabetes increase miscarriage risk. The good news is that even a 5-10% weight loss often is sufficient to reverse diabetes and may improve pregnancy outcome as well.
  • If you are over 35, your risk of suffering a miscarriage is significantly increased. That doesn’t mean that you shouldn’t try to have a baby if you are over 35, but it does mean that you will probably want to avoid any lifestyle factors that might increase your risk of miscarriage.
  • Smoking and alcohol use should be avoided. Both are likely to increase your risk of miscarriage.
  • Recent studies suggest that the consumption of two or more caffeinated beverages a day may also increase your risk of miscarriage, so don’t overindulge in caffeinated beverages. Be aware that it’s not just coffee and tea that are caffeinated. Many sodas are caffeinated as well.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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