Dietary Supplements in Pregnancy and Postpartum: Evidence, Safety Challenges and a Precision Nutrition Framework (GAPSS)

Maternal undernutrition remains a major modifiable risk factor for adverse pregnancy outcomes. Dietary supplements are widely used to bridge nutritional gaps, but their efficacy, safety, and quality control remain controversial. This review critically evaluates the mechanisms, clinical evidence, and quality assurance of key supplements (folic acid, iron, vitamin D, calcium, iodine, omega-3 PUFA, choline, and multiple micronutrients) specifically in pregnant and postpartum women. We highlight that while folic acid (400-800 µg/d) and iron supplementation reduce neural tube defects by >70% and maternal anaemia by 30-50%, respectively, high-dose antioxidant cocktails (vitamins C + E) have shown no benefit and potential harm in large RCTs. Up to 18-40% of commercially available prenatal supplements contain undeclared pharmaceuticals, heavy metals, or incorrect dosages, underscoring the urgent need for advanced analytical methods (LC-MS/MS, HRMS, NMR). We propose the GAPSS (Genotype-Analytics-Physiology-Safety-Sustainability) framework for future personalised maternal nutrition. Rigorous, pregnancy-specific quality control combined with biomarker-guided supplementation is essential to maximise benefits and minimise risks.