Imagine there was an easy way to reduce your risk of having a baby with autism. What if it reduced the risk of severe learning disabilities and birth defects in your child at the same time - that it also made women 40 percent less likely to suffer from ovulatory infertility and infertile men four times as likely to successfully impregnate their partner. And that it can lower both the risk of miscarriage and childhood cancer.
That is what I would call real prevention.
The humble prenatal vitamin does all this. Multivitamins have gotten a bad reputation in recent years, with headlines at a minimum calling them a waste of money, and more dramatically, suggesting they increase the risk of death (Iowa Women's Health Study.)
However, all experts agree to their value in pregnancy. But here's the rub: Most of the health benefits described above are derived when vitamins are taken from three months prior to conception to the first month of pregnancy. The majority of women are fanatics about their health once they know they are pregnant. Behaviors that at other times seem impossible to modify, such as quitting smoking or giving up fast food, often melt away in service to the gestating new life. For the healthiest baby, these changes need to occur before conception.
Since half of all pregnancies in the United States are unplanned, the most effective public health strategy is to have all adults of childbearing age take a prenatal multivitamin.
The 2010 Affordable Care Act mandates that beginning this month health insurance plans cover women's preventive services with no co-payments or deductibles to reduce barriers to prevention. Required services include well-woman visits, contraception, screening for breast and cervical cancer as well as for domestic violence. But it does not include multivitamins.
Given their great potential to reduce human suffering and health-care costs, let us advocate that our new health-care-reform mandate reconsider, and include, provision of free multivitamins to women (with iron) and men (without). That would be meaningful prevention, indeed.
Check your preconception multivitamin for the following ingredients:
• Vitamin A: maximum of 2500 IU as Vitamin A palmitate or acetate, or retinol palmitate. Up to 15,000 IU of beta carotene is allowable
• Iron 18 mg (for women only)
• Iodine 150 mcg
• Folic acid 400 mcg
• Vitamin D 1000 IU
• Small amounts of copper, zinc, magnesium, potassium and calcium.
Dr. Victoria Maizes is executive director of the Arizona Center for Integrative Medicine and a professor of medicine, family medicine and public health at the University of Arizona. Her book "Be Fruitful: The Essential Guide to Enhancing Fertility and Giving Birth to a Healthy Child" will be published in January 2013.