Fish Liver Oil In Pregnancy- Is It Safe? | What Doctors Want You To Know

You might see cod liver oil or other fish liver oil capsules on a shelf and assume they are perfect for pregnancy. They promise omega-3s, vitamin D, and general wellness, and the label often feels reassuring. The detail that matters most in pregnancy, though, is the heavy load of vitamin A that usually comes with oil made from fish liver.

This article walks through what fish liver oil actually is, why pregnancy guidelines treat it differently from regular fish oil, and how to get the benefits of omega-3s without adding avoidable risk. By the end, you will know exactly what to ask your doctor, which numbers to check on labels, and safer ways to nourish both you and your baby.

What Is Fish Liver Oil And How Is It Different From Fish Oil?

Fish liver oil is made from the liver of fish such as cod, halibut, or shark. The liver stores fat-soluble vitamins, especially vitamin A and vitamin D, so the oil extracted from it carries high levels of these nutrients along with omega-3 fatty acids.

Regular fish oil, on the other hand, comes from the flesh of oily fish like anchovies, sardines, and mackerel. That oil contains omega-3s but only traces of vitamin A. Many pregnancy-safe omega-3 supplements on the market use this type of body oil or algae-based DHA instead of liver oil for exactly that reason.

This difference in origin matters. The main concern in pregnancy is not the omega-3s themselves but the dose of preformed vitamin A (retinol) that rides along with oil made from liver.

Why Fish Liver Oil During Pregnancy Raises Safety Questions

Vitamin A helps with vision, immune function, and fetal development. The form that comes in fish liver oil is preformed vitamin A, also called retinol. In normal dietary amounts it helps normal growth, but once intake climbs past a certain level, the risk of malformations rises.

Several national health services advise against cod liver oil or any supplement that contains vitamin A during pregnancy because too much vitamin A can harm the developing baby. The concern centers on intake coming from supplements and liver products, not from beta-carotene in fruits and vegetables, which the body converts to vitamin A more gently.

How Vitamin A Becomes A Problem In Pregnancy

Preformed vitamin A is fat soluble and stored in the liver. When a person takes high-dose fish liver oil each day, retinol builds up. During early pregnancy, especially in the first trimester, that stored vitamin A can reach levels linked with birth defects that affect the brain, spine, heart, and other organs.

Scientific reviews and expert groups suggest that doses of retinol above roughly 10,000 IU per day (about 3,000 micrograms of retinol) can push risk higher, especially when taken around conception and early organ formation. Many cod liver oil products deliver a large share of that amount in a single daily spoonful or capsule, and the total climbs further once diet and prenatal vitamins are added on top.

Guidelines On Vitamin A, Pregnancy, And Supplements

Public health agencies across several countries give closely aligned advice:

• Standard prenatal vitamins supply vitamin A at or below recommended daily allowances and are checked for safety before sale.
• Extra supplements that contain retinol, including fish liver oil or standalone vitamin A tablets, are not recommended in pregnancy unless a specialist has a clear reason and monitors the dose.
• Women are often advised to avoid liver and liver products such as pâté during pregnancy because they are extremely rich in vitamin A.

An example is the NHS pregnancy vitamins guidance, which clearly tells women not to take cod liver oil or other supplements that contain vitamin A while pregnant. Similar wording appears in NHS Wales advice on supplements in pregnancy, which recommends products designed for pregnancy instead of standard multivitamins with retinol.

These messages come from large reviews of vitamin A safety, teratology case reports, and long-standing nutrition policies for pregnant women. There is a narrow window between enough and too much, and fish liver oil makes it easy to cross that line without real benefit.

Fish Oil Versus Fish Liver Oil In Pregnancy

On the shelf, the words “fish oil” and “cod liver oil” often sit side by side. For pregnancy safety, they belong in two different boxes. The table below lays out the practical differences.

Feature	Fish Oil (Body Oil)	Fish Liver Oil (Cod Liver Oil)
Main Source	Pressed from the flesh of oily fish	Extracted from the liver of fish
Omega-3 Content	Rich in EPA and DHA	Rich in EPA and DHA
Vitamin A Content	Typically low or none added	Often high in preformed vitamin A (retinol)
Vitamin D Content	May contain added vitamin D	Naturally high in vitamin D, sometimes with extra added
Common Label Wording	“Fish oil,” “omega-3,” “DHA from fish”	“Cod liver oil,” “fish liver oil,” “vitamin A and D”
Pregnancy Guidance	Often suitable in pregnancy-specific formulations	Commonly advised against because of vitamin A level
Check With Health Professional	Still wise, especially if you already take a prenatal	Strongly advised before any use, and usually discouraged

Why People Reach For Fish Liver Oil In Pregnancy

Many women have grown up seeing cod liver oil as a household tonic. Families pass down the habit for joint comfort, immunity, and winter health. When pregnancy begins, it can feel natural to keep taking the same spoonful out of habit, especially when the bottle lists omega-3s and vitamin D that sound helpful for a growing baby.

The benefits often described for fish liver oil fall into three main areas:

• Omega-3 fatty acids that help build the baby’s brain and eyes.
• Vitamin D for bone health in mother and baby.
• A sense of “covering all bases” nutritionally during a demanding time.

The first two effects matter for pregnancy, but there is no requirement to obtain them from fish liver oil. The third point rests mostly on tradition and marketing. You can reach those same goals with a mix of diet, a well-chosen prenatal supplement, and, if needed, a pregnancy-safe omega-3 capsule made without liver oil.

Safer Ways To Get Omega-3s While Pregnant

If your main goal is DHA and EPA for your baby’s brain and eye development, you have several safer options that keep vitamin A intake within a safer window.

Low-Mercury Oily Fish

Most national guidelines suggest one or two portions of low-mercury oily fish per week in pregnancy, such as salmon, sardines, trout, anchovies, or herring. This pattern supplies omega-3s from whole food along with protein, iodine, and other nutrients.

Check your country’s specific advice on safe fish types and portion limits, as guidance may differ slightly between regions. Many women use the same national pregnancy pages that list safe fish to confirm which species are suitable before planning meals.

Pregnancy-Specific Omega-3 Or DHA Supplements

Many brands now sell omega-3 capsules that are labeled for pregnancy and do not contain fish liver oil or extra vitamin A. They use purified fish body oil or algae-derived DHA instead. Labels often state that vitamin A is absent, and some combine DHA with iodine or choline to match pregnancy needs.

When choosing a product, look for supplements that are clearly labeled as suitable for pregnancy and that spell out “no vitamin A” or “beta-carotene only” on the label. That simple step keeps the focus on omega-3s without the extra risk that comes with retinol from liver.

Diet And A Good Prenatal Vitamin

A balanced pattern with fruits, vegetables, whole grains, dairy or alternatives, lean protein, and healthy fats, together with a prenatal vitamin designed for pregnancy, already covers most micronutrient needs. Many prenatal vitamins either exclude vitamin A entirely or provide it in mixed forms with a limited amount of retinol and some beta-carotene to stay on the safe side.

The NCBI Nutrition During Pregnancy chapter on vitamin A notes that routine retinol supplements are usually unnecessary in countries where diet is adequate and that extra preformed vitamin A in early pregnancy is discouraged unless there is clear deficiency. If you are already taking a prenatal that follows this pattern, an added fish liver oil capsule may tip total vitamin A above safe daily limits. It makes far more sense to add a vitamin-A-free DHA capsule if you and your doctor feel that your diet alone is not enough.

How To Read Labels On Fish Liver Oil And Other Supplements

Supplement labels can feel dense, but a few specific lines make all the difference when you are pregnant.

• Ingredient Source: Look for words such as “cod liver oil,” “fish liver oil,” or “vitamin A (as retinol).” Any of these should raise a red flag in pregnancy.
• Vitamin A Per Serving: The panel may list vitamin A in micrograms (µg), micrograms of retinol activity equivalents (RAE), or international units (IU). The tolerable upper intake from all sources for adults is around 3,000 µg of retinol per day, and many pregnancy guides advise staying below that figure.
• Form Of Vitamin A: Retinol, retinyl palmitate, or retinyl acetate are preformed vitamin A. Beta-carotene and other carotenoids do not carry the same teratogenic risk, though they still count toward overall intake.
• Other Vitamin A Sources In Your Day: Add up what comes from your diet, prenatal vitamin, and any other fortified foods before you even consider a product based on fish liver oil.

If the maths looks tight, or you feel unsure, take the bottle along to your midwife, obstetrician, or pharmacist and ask them to walk through the numbers with you.

Common Vitamin A Sources To Track In Pregnancy

Vitamin A risk in pregnancy does not come from fish liver oil alone. The table below shows common sources that can stack together.

Food Or Supplement	Vitamin A Level (Approximate)	Pregnancy Note
Cod Liver Oil Capsule Or Spoonful	Often several thousand IU of retinol per serving	Can push intake near or above upper limit in one dose
Beef Or Chicken Liver Portion	Contains a large amount of vitamin A per serving	Often advised only rarely or avoided during pregnancy
Liver Pâté Or Liver Sausage	Rich in preformed vitamin A	Usually on the “avoid” list in pregnancy booklets
Standard Multivitamin With Vitamin A	May contain retinol above pregnancy-safe levels	Not always suitable once you are pregnant
Pregnancy-Specific Prenatal Vitamin	Formulated to stay within pregnancy-safe ranges	Best taken as directed without extra vitamin A products
Carrots, Sweet Potatoes, Leafy Greens	High in beta-carotene, converted as needed	Generally safe as part of a balanced diet
Fortified Breakfast Cereals And Spreads	Varying amounts of added vitamin A	Add to total intake when combined with other sources

When Might Fish Liver Oil Still Be Used?

There are parts of the world where vitamin A deficiency remains common and severe. In those settings, public health programmes sometimes use vitamin A supplements under strict protocols to protect maternal sight and reduce infection risk.

The World Health Organization guideline on vitamin A in pregnancy reserves supplementation for areas where deficiency is a severe public health problem and limits both dose and timing. Those programmes are designed, monitored, and adjusted by medical teams who weigh the benefits of improving vitamin A status against the risk of birth defects.

For a healthy pregnant woman in a country where diet is varied and prenatal vitamins are widely available, routine fish liver oil use rarely brings extra benefit. In most cases, it just adds another unpredictable source of retinol on top of an already adequate intake.

Practical Steps Before Taking Any Fish Oil In Pregnancy

If you are standing in front of the supplement shelf or scrolling through online listings, these steps can help you stay on the safe side:

• Check whether your current prenatal vitamin already includes vitamin A, and in what amount and form.
• Choose omega-3 products that clearly state “fish oil” or “algal DHA” without mentioning fish liver oil or cod liver oil.
• Look for pregnancy-specific labelling and third-party testing for purity and heavy metals where available.
• Bring any supplement you are considering to your midwife, GP, or obstetrician and ask if it fits with your overall vitamin A intake.
• If you ever feel unsure, err on the side of skipping a product that contains liver oil and focus on food, prenatal vitamins, and safer omega-3 options instead.

Fish liver oil has a long history as a home staple, but that tradition does not automatically make it suitable during pregnancy. Paying close attention to vitamin A sources, checking labels with care, and leaning on pregnancy-specific guidance lets you capture the benefits of omega-3s while keeping both you and your baby safer.