Vitamin C Deficiency and Its Role in Immunity

Vitamin C, also known as ascorbic acid, is a water-soluble vitamin and powerful antioxidant that plays a critical role in immune function, collagen synthesis, wound healing, and the absorption of non-heme iron from plant-based foods. During pregnancy, adequate vitamin C supports the development of the baby's bones, cartilage, and connective tissues while helping the mother's body cope with the increased physiological demands of gestation.

The recommended daily intake of vitamin C during pregnancy is approximately 80-85 milligrams, slightly higher than the 65-75 milligrams recommended for non-pregnant women. Because the body cannot store vitamin C in large amounts and it is water-soluble, daily intake through diet is necessary to maintain adequate levels.

Vitamin C deficiency, while less common than some other nutritional deficiencies, can still occur during pregnancy, particularly among women with limited fruit and vegetable intake, those with malabsorption conditions, or those who smoke (including passive smoking exposure). Severe deficiency leads to scurvy, though this is rare in modern settings with any dietary diversity.

The most common cause of vitamin C deficiency is a diet low in fresh fruits and vegetables. Women who consume primarily cooked or processed foods without adequate raw produce may fall short of their daily requirements. Vitamin C is highly sensitive to heat, light, and air, meaning that prolonged cooking, reheating, and storing of foods can significantly reduce their vitamin C content.

Smoking and exposure to secondhand smoke increase vitamin C requirements because the oxidative stress caused by tobacco depletes the body's antioxidant reserves. Smokers require an additional 35 milligrams per day to compensate for this increased utilisation. Chronic stress and environmental pollution can also increase the body's demand for vitamin C.

Medical conditions that impair nutrient absorption, including Crohn's disease, ulcerative colitis, and chronic kidney disease requiring dialysis, can contribute to vitamin C deficiency. Additionally, women experiencing severe nausea and vomiting during the first trimester may have difficulty consuming enough fruits and vegetables to maintain adequate vitamin C levels.

Early symptoms of vitamin C deficiency include fatigue, weakness, irritability, and a general sense of feeling unwell. You may notice that minor cuts and bruises take longer to heal, or that your gums bleed easily, especially when brushing your teeth. Dry, rough, or bumpy skin and hair that breaks easily can also indicate insufficient vitamin C intake.

More advanced deficiency can manifest as swollen and bleeding gums, joint pain, easy bruising even from minor contact, and poor wound healing. In severe and prolonged cases, scurvy can develop, characterised by widespread bruising, bleeding, tooth loosening, and extreme fatigue. While full-blown scurvy is rare, subclinical deficiency with milder symptoms is more common and often goes unrecognised.

For the mother, vitamin C deficiency impairs immune function, making her more susceptible to infections at a time when the immune system is already naturally suppressed to accommodate the pregnancy. Poor collagen synthesis can affect skin integrity, gum health, and wound healing, which becomes particularly relevant if a caesarean delivery or episiotomy is needed. Importantly, vitamin C significantly enhances the absorption of non-heme iron from plant foods, so deficiency can indirectly worsen iron deficiency anemia.

For the developing baby, vitamin C supports the formation of collagen, which is essential for developing skin, blood vessels, bones, and cartilage. Some research suggests that maternal vitamin C deficiency may be associated with complications such as premature rupture of membranes and preterm birth, though the evidence is still evolving. The antioxidant properties of vitamin C also help protect developing cells from oxidative damage.

Ensuring adequate vitamin C intake during pregnancy provides a cascade of benefits, from stronger immunity to better iron absorption to healthy tissue development in the baby. Given its wide availability in common foods, meeting vitamin C requirements is achievable with mindful dietary choices.

India offers an abundance of affordable, vitamin C-rich foods. Amla (Indian gooseberry) is one of the richest natural sources of vitamin C in the world and can be consumed fresh, as juice, in pickles, or as murabba. Guava, another excellent source, is readily available in Visakhapatnam markets and provides more vitamin C per serving than many citrus fruits.

Citrus fruits including oranges, sweet limes (mosambi), and lemons are well-known sources. Other excellent options include papayas, strawberries, kiwi, tomatoes, capsicum (bell peppers), broccoli, and cauliflower. Including a serving of raw fruit or a fresh salad with lemon juice at each meal can help ensure consistent vitamin C intake. Drinking a glass of amla or orange juice alongside iron-rich meals is a practical strategy that simultaneously supports vitamin C and iron status.

To preserve vitamin C content in your food, minimise cooking time, use minimal water, and prefer steaming or stir-frying over prolonged boiling. Consume fruits and vegetables as fresh as possible rather than storing them for extended periods. Unlike some nutrients, vitamin C supplementation is rarely necessary if you consume a varied diet with adequate fruits and vegetables, but your doctor may recommend it if your dietary intake is consistently low.

Consult your healthcare provider if you experience persistent bleeding gums, easy bruising, slow wound healing, or frequent infections during pregnancy. These symptoms may indicate vitamin C deficiency or other nutritional concerns that warrant evaluation. A serum vitamin C level can be tested, though it is not part of routine prenatal screening.

Discuss your fruit and vegetable intake with your obstetrician, especially if morning sickness or food aversions are limiting your diet. Your doctor in Visakhapatnam can suggest practical strategies for incorporating vitamin C-rich foods into your meals even when appetite is poor. If supplementation is needed, follow your doctor's guidance on dosage, as very high doses of vitamin C during pregnancy are not recommended and can cause gastrointestinal discomfort.