Vitamin A in Pregnancy

Organ meats are some of the most nourishing, nutrient-dense foods on the planet. They’ve been treasured, savoured and even celebrated in traditional cultures for generations because of their incredible nutrient density, and it really wasn’t that long ago that liver was a regular part of the Western diet too.

Organ meats contain generous amounts of some of the most vital nutrients. Liver in particular is nothing short of nature’s multivitamin. It’s packed with vitamin A, iron, zinc, choline, folate, vitamin B12 and copper, which are some of the very nutrients that matter most when you’re growing a little human. So if pregnancy is one of the most important times to be nutritionally replete, why are so many women told to steer clear of liver altogether?

The short answer: you don’t have to avoid it. You just need to know how to enjoy it wisely.

Where did the fear come from?

Do you remember the acne medication Accutane? Isotretinoin, the active ingredient in Accutane, is a pharmaceutical drug derived from vitamin A, and it’s well known for causing serious birth defects when taken during pregnancy. Alongside this, research found that high-dose vitamin A supplements in early pregnancy were linked to an increased risk of birth defects.

Understandably, this led to a lot of caution around vitamin A in general, especially when it came to pregnancy. Unfortunately, that caution spilled over into fear mongering of vitamin A-rich foods, and liver tragically became one of the first things crossed off the pregnancy menu by governing bodies.

But here’s the thing. A prescription drug and a high-dose synthetic supplement are not the same as a serve of food like beef liver. In fact, one study comparing liver with a vitamin A supplement at similar doses found that the supplement produced higher blood levels of the vitamin A metabolites associated with birth defects than liver did. This highlights just how important the food matrix is, and how vitamin A is delivered to the body, with its nutritional cofactors, can make a real difference.

So rather than only asking “should I avoid liver?”, let’s start asking better questions like:

• “How can I include liver suitably in pregnancy?”
• “How much is the right amount for me?”
• “What happens if I don’t get enough vitamin A?”

Why do we need vitamin A?

Vitamin A is an incredible nutrient for conception, pregnancy, breastfeeding and postpartum. It plays a key role in:

• Foetal development, including the eyes, heart, lungs, diaphragm and nervous system
• Immune function and healthy mucous membranes
• Vision, especially in low light
• Iron metabolism, with research showing adequate vitamin A supports haemoglobin levels and iron utilisation, which is important for mums at risk of anaemia
• Skin, skeletal and soft tissue health

That’s why getting enough matters. Vitamin A isn’t a nutrient to fear. It’s one we need to get just right, for both mum and bub.

Research has observed links between low maternal vitamin A intake and developmental issues, including an association with congenital diaphragmatic hernia. Ironically, the fear around vitamin A may be leaving some women falling short, and too little vitamin A can affect the very same areas of foetal development that people are trying to protect by avoiding it. This is a risk that’s rarely spoken about. One could even suggest that the benefit of having adequate vitamin A status in pregnancy carries more weight than the fear of getting too much, particularly when it comes from food.

Preformed vitamin A vs carotenoids:

Vitamin A comes in two main forms in our diet.

Retinol (preformed vitamin A) is found only in animal foods like liver, egg yolks, dairy and oily fish. It’s ready for the body to use straight away, which is what makes these foods such efficient sources.

Carotenoids (like beta-carotene) are found mostly in orange colourful plant foods such as sweet potato, carrot, pumpkin and leafy greens. The body can convert these into vitamin A, but the conversion can be surprisingly poor for some people. Only 8% is converted generally, but can often be as little as under 2% in some individuals depending on their genetics, gut health and how much fat is eaten alongside them.

This is why animal foods are such a valuable part of the picture, and why those following mostly plant-based diets may find it harder to meet their nutritional needs, especially when it comes to vitamin A. Much of the fear-based marketing around vitamin A focuses on beta-carotene rich foods being the solution, but they really aren’t.

How much do we need?

Here are the Australian and New Zealand Nutrient Reference Values for women aged 19-50:

• RDI for women: 700 µg/day
• RDI in pregnancy: 800 µg/day
• RDI while breastfeeding: 1,100 µg/day
• Upper Level of Intake: 3,000 µg/day of preformed vitamin A (approx. 10,000 IU)

*Different values apply for women aged 14-18.
*1 µg retinol ≈ 3.33 IU.

Notice how much vitamin A needs increase while breastfeeding? This is a nutrient that supports you well beyond pregnancy too.

And notice how high the upper limit is? It is very rare to come close to this level of intake daily through food alone. You might be surprised by how many vitamin A-rich foods you can consume before even coming close to the upper limit.

And, the Upper Limit or Upper Level of Intake (UL) isn’t the point where toxicity suddenly kicks in. It’s the highest average daily intake considered unlikely to cause harm, and it has a safety margin built in. The Recommended Dietary Intake (RDI) is not an upper limit, nor is it an optimal or “thriving” dose. It’s the amount set to meet the basic nutritional needs of 97-98% of healthy people in a particular life stage, so think of it as a baseline rather than a goal. Somewhere between the two is where most of us want to sit.

Now let’s talk about beef liver

Beef liver is one of the richest food sources of retinol you can find, containing several thousand micrograms per 100g. Lamb liver is even higher, while chicken liver is a little gentler. Because it’s so concentrated, a little goes a long way, and that’s actually the beauty of it. You don’t need much to get a meaningful nutritional boost.

Some easy ways to enjoy it:

• Grated into bolognese, meatballs, burgers or slow-cooked mince. It’s practically undetectable and a great way to start.
• Pan-fried with onions for the liver lovers out there
• Liver pâté on crackers or sourdough
• Liver capsules or freeze-dried liver powders for those who can’t get past the taste

Because liver is so rich, think of it as a regular “little and often” food rather than a whopping daily serve. A small portion a couple of times a week can be a beautiful way to support your vitamin A, folate, B12 and copper intake, just to name a few. And if using capsules daily instead, this is a great way to be able to monitor your intake.

Getting it just right

The key is to look at your whole dietary intake, not just one food. If you’re consuming many sources throughout the week, it’s simply worth checking labels and knowing what you’re getting.

Some simple ways to keep it balanced:

• Check the vitamin A content of your prenatal if you are choosing to take one (although this is beta-carotene)
• Check the vitamin A content of your cod liver oil and any beef liver supplements
• Enjoy liver in small, regular amounts rather than large daily serves
• Build your plate with other vitamin A-rich foods like eggs, butter, ghee, cheese and oily fish
• Add plenty of colourful veggies for carotenoids

What does this look like on your plate?

Let’s look at the vitamin A content of some everyday nourishing foods that might land on your pregnancy plate:

• 2 egg yolks: ~130 µg / ~433 IU
• 10g ghee: ~84 µg / ~280 IU
• 30g cheddar cheese: ~80 µg / ~266 IU
• 1 serve (e.g. 5 capsules) of beef liver capsules: ~280 µg / ~933 IU (differs depending on brand and how it’s processed, always check label)
• 1 serve of pâté (~30 g): ~350 µg / ~1,165 IU (differs depending on brand, recipe and type of liver)
• 1 tsp cod liver oil: ~1,100 µg / ~3,663 IU (differs depending on brand)
• 1 serve of bolognese with liver grated through (~12 g liver per serve): ~600 µg / ~2,000 IU (differs depending on the liver used)

If you ate ALL of these in ONE day, you’d reach roughly 2,624 µg / 8,740 IU of vitamin A, comfortably under the upper limit of 3,000 µg / 10,000 IU.

That’s eggs, ghee, cheese, liver capsules, pâté, cod liver oil and a liver bolognese, all in a single day, and you still haven’t gone over the upper limit. Realistically, very few people would eat this much liver and liver-based foods every single day throughout pregnancy.

So there’s lots of room to enjoy liver and other vitamin A-rich foods regularly in pregnancy. The key is knowing where your vitamin A is coming from and being mindful of the most concentrated sources, like liver and cod liver oil.

It’s also worth remembering that the research behind the upper limit was largely based on high-dose supplemental vitamin A. Food-based vitamin A from liver is handled differently in the body. So enjoying these foods in sensible amounts is a world away from the high-dose synthetic forms that started the fear in the first place.

Food for Thought from Foraged

Vitamin A is a critical nutrient for overall health and wellbeing, whether you’re trying to conceive, pregnant or postpartum. It’s one of those nutrients you want to truly optimise, but without overdoing it.

Liver and other vitamin A-rich foods don’t need to be feared, despite common misconceptions. When enjoyed in sensible amounts, they’re some of the most nourishing foods you can bring to your pregnancy and postpartum plate. It’s all about understanding the difference between food and high-dose synthetic forms, and knowing how to make these foods work for you.

Food and high-dose synthetic supplements simply aren’t the same thing, and it’s time we stopped putting them in the same basket. Nature packages vitamin A alongside the cofactors your body needs to use it, and that’s something a synthetic pill made in a laboratory just can’t replicate.

We hope this has given you some peace of mind, some empowering information and a little more confidence to embrace nutrient-dense foods during your pregnancy journey.

As always, everyone’s needs are different, so chat with your GP, midwife, naturopath or clinical nutritionist about your individual vitamin A requirements. Our online clinic is always here to support you.