Pregnancy vitamins

What we did

Our mystery shopper visited 20 pharmacies in the Wellington region:

• five Unichems
• four Life Pharmacies
• two Countdown Pharmacies
• nine independent stores.

Our shopper (in her early 30s and in good health) told pharmacy staff she was looking for folic acid as she hoped to get pregnant, and asked if any other supplements were necessary prior to conception. The advice provided was evaluated against Ministry of Health and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) guidelines.

Misleading information

Instead of good science-based advice, our mystery shopper was often given misleading information and upsold unnecessary products.

Our shopper received poor-quality advice at three of five Unichem stores she visited.

At Simon’s Unichem in Tawa, an assistant handed our shopper a product with an insufficient dose of folic acid – 350µg when the Ministry of Health recommends 800µg. The 800µg pills were on the same shelf.

An assistant at Unichem Kilbirnie gave confusing advice: “At the moment, I’d just take a multi, unless your midwife specifically says you’re needing folic.”

Folic acid is the most important nutrient for women in the pre-conception period. The assistant appeared to know little about the subject and didn’t refer our shopper to the in-store pharmacist for advice.

Another Unichem staff member incorrectly told our shopper Elevit multivitamins were the only product with the recommended amount of iodine. Blackmores tablets with sufficient iodine sat nearby.

In comparison, Life Pharmacy staff who helped our mystery shopper were more knowledgeable.

Unichem and Life Pharmacy are mostly individually owned and operated, though all are members of Green Cross Health. The company said it was disappointed with the experiences our shopper had in the three Unichem stores.

“When we contacted our franchise owners and partners in those pharmacies they were equally disappointed and concerned, agreeing there is no excuse for not providing the correct and complete information to all customers.” Store staff will receive additional training as a result, Green Cross Health said.

The upsell

Of the 20 stores visited, staff at 16 attempted to “upsell” our mystery shopper at least one product more expensive than plain folic acid.

Elevit was a common recommendation. At four stores, our mystery shopper was told the product had “everything you need”. One assistant called it a “brilliant product”.

It certainly comes with a brilliant (read eye-watering) price. Depending on the pharmacy, you’ll pay between $80 and $100 for about a three-month supply. Pill for pill, that’s seven times more expensive than the standard folic acid requested by our shopper.

Not once was our mystery shopper asked about her diet or lifestyle. If you follow healthy eating guidelines, you should get sufficient vitamins and minerals from your food, so a multivitamin is a waste of money.

Four stores also attempted to sell our shopper the dietary supplement Menevit for her partner’s use. Menevit, produced by Elevit-manufacturer Bayer, is described as “specially formulated to maintain sperm health”.

At one pharmacy, our shopper was told her partner would “need” to take Menevit and, at another, that the product would boost his sperm count.

The Cochrane Collaboration (an international health research group) reviewed the science and found “low-quality evidence” antioxidant supplements, such as Menevit, improved the pregnancy rates of infertile couples.

Our mystery shopper told all pharmacy staff that she and her partner were planning to try for a baby – she said nothing to suggest infertility was an issue.

Prices for Menevit ranged from $93 to $137 for a three-month supply – a potentially pricey undertaking when five in six Kiwi couples conceive naturally within a year.

Ask an expert

Pharmacy assistants were responsible for most of the incorrect advice and upselling in our mystery shop. An average shopper would have no reason to question the advice – and could’ve wasted money on supplements they didn’t need.

At just five stores, the sales assistant asked the pharmacist for help answering our mystery shopper’s questions. We think this should have occurred more frequently.

In general, pharmacists’ advice aligned with that of the Ministry of Health and obstetricians. The exception was a Countdown pharmacist who told our mystery shopper she needed to take folic acid and iodine or a multivitamin for three months prior to conception – the ministry's advice is at least four weeks before.

Countdown said the pharmacist “was trying to be helpful and recommended that the customer took a larger pack of folic acid, as in most cases it takes longer than a month to get pregnant”.

Some sales assistants were professional and informed (most Life Pharmacy staff stood out here). But given the frequency of poor guidance and upselling, we recommend speaking to a pharmacist if you’re looking for good health advice.

You can also check the Ministry of Health’s recommendations on its website. If you’re confused, ring your GP.

Do you need a multi?

Obstetrician Dr Jay Marlow says women in good health and eating a well-balanced diet mainly need two nutrients before and after they get pregnant: folic acid and iodine.

Recommended daily dose for mothers-to-be

Your doctor may also recommend:

• Calcium, if you avoid dairy

• Extra folic acid, based on your health and family history of neural tube defects

• Fish oil, depending on how often you eat fish

• Iodine prior to conception, if you have hyperthyroidism or low iodine levels

• Iron, based on risk factors and/or a blood test for anaemia

• Vitamin B12, if you’re vegetarian or vegan

• Vitamin D, based on risk factors
  and/or a blood test for deficiency

• Vitamin K, based on your health
  and pregnancy history.

These supplements – barring fish oil – are fully subsidised on prescription. You can also buy 800µg folic acid ($15.99 for 120 tablets) and 150µg iodine ($16.50 for 90) at your pharmacy.

There’s little evidence taking nutrients beyond this will be of any benefit in pregnancy, according to the latest RANZCOG review of the science.

But you wouldn’t think this from reading a packet of pregnancy multivitamins. Elevit, a commonly recommended product, claims it provides “a growing baby with the best nutritional support throughout its whole development”. Manufacturer Bayer also claims “Elevit With Iodine is based on a formulation clinically proven to reduce the risk of neural tube defects by 92%”.

Unlike the RANZCOG review, which looked at all current science, Elevit bases the latter claim on two studies run in Hungary in the ‘80s and ‘90s. Notably, Elevit has changed its formulation (removing vitamin A and adding iodine) since the trials – an admission the Hungarian studies aren’t the be-all and end-all. Bayer says it stands by its products Elevit and Menevit.

Dr Marlow says money spent on many of these types of tablets would be better spent on healthy food. “You can’t supplement your way out of a bad diet.”

Kiwi researchers looking at the diets of pregnant women found just 3% meet all Ministry of Health nutritional recommendations, which will influence their vitamin and mineral intakes. However, women who take pregnancy supplements are more likely to follow healthy eating patterns already.

A well-balanced diet – alongside folic acid and iodine tablets – is the best way to meet your body’s nutritional needs in pregnancy, unless your doctor advises you need additional supplements.

How much folic acid?

It’s no easy task buying the recommended dose of folic acid. The Ministry of Health advises women planning a pregnancy to take an 800µg tablet every day.

Despite this, several products have far less folic acid – some 500µg (Blackmores Conceive Well Gold, Swisse Pregnancy+ Ultivite) and others just 300µg (Healtheries Pregnancy & Breastfeeding Multi, Red Seal Folic Acid).

Healtheries say its multivitamin “includes 300µg of folic acid, which together with a healthy and well-balanced diet, can help support babies’ healthy development”. Red Seal advises its 300µg pills “taken before and during the first three to four months of pregnancy … [support] the healthy development of baby’s nervous system”.

But nowhere on either packet does it state this dose is less than the Ministry of Health’s recommendation.

Healtheries and Red Seal claim Medsafe rules are to blame. The regulator limits the amount of folic acid in a pill based on whether the company has an accredited factory, or decides to sell its product as a supplement or a medicine. Products sold as supplements are limited to 500µg.

Plans to review this limit are on hold while the government decides how natural health products will be regulated. Red Seal said it won’t consider reviewing the product’s dosage or advice while it waits for the government to make its decision.

Dr Cameron Grant, who studied pregnancy and nutrition, says the varying folic acid doses are a concern. “It’s really confusing. People may take too little or too much, or may delay the decision to take it.”

Folic acid is a form of folate, a B vitamin present in our diet (you may spot the terms listed on cereals and bread). If a woman takes a folic acid tablet and eats folate-rich foods a month before and three months after conception, her baby is significantly less likely to be born with a neural tube defect such as spina bifida.

In the US and the UK, pregnant women are told to take a pill of at least 400µg (500µg in Australia), but our Ministry of Health continues to recommend a higher dose. Fewer foods are fortified with folate in New Zealand.

Given the health benefits of folic acid supplements, regulations should ensure products marketed to would-be mothers provide the recommended dose. Until the rules change, manufacturers selling products with lower doses should make this clear on their packaging.

By Olivia Wannan
Investigative Writer