It’s been a long time since I posted on here (March to be exact!). I fell pregnant with my second child in May, and over Summer have just felt a pull away from blogging/social media, and a complete lack of motivation to write up and share things. As summer is winding down, and I have a little more free time, I’ve been drafting up a few blog posts. First, I wanted to do a post on prenatal nutrition – a subject I think is extremely important, and too-oft ignored in discussion and healthcare. Doctors and midwives in this country generally offer very little helpful advice in terms of what to eat during pregnancy, deferring instead to “take a prenatal multivitamin, folate to prevent neural tube defects, and eat a standard healthy diet”. Never mind that most prenatal multivitamins are woefully inadequate in both number and quantity of nutrients needed, there are other nutrients just as important as folate, and that “healthy diet” guidelines are pretty rubbish to start with.
So what do I think is important to know, and what do I try to tell my pregnant patients?
1) Eat real food
Pregnancy is a time to focus on trying to have the healthiest diet possible. This means focusing on whole unprocessed foods like fresh fruit and veg, grass-fed meat, legumes, nuts, seeds, healthy fats etc, and avoiding processed seed oils, junk food, and excess sugar. This can be particularly difficult in the first trimester with nausea and food aversions (I struggled a lot), but just do the best you can do. Focusing on healthy food well BEFORE pregnancy (which is important for a healthy egg) means you’ll have nutrient stores to pull on when you can’t eat much of anything. As well as trying to have a generally healthy diet, it’s important to be aware that certain nutrients need particular attention during pregnancy as it is very easy to become deficient in them (see below). However I think it’s important to have a “food first” approach, and not rely only on supplements to meet needs; this is because there are thousands of compounds in food that we don’t even know of that may be vital to a healthy pregnancy. That said, supplementing is an important “insurance” , and is particularly important if you are vegetarian.
2) Specific nutrients
It can be really easy to be deficient in certain nutrients during pregnancy due to either not eating certain foods (like fatty fish) or due to nutrient depletion in todays soils (eg magnesium). Here are a few key nutrients that are vital during pregnancy and may need extra care and thought to obtain.
Iron – Important to prevent anaemia during pregnancy which can increase the risk of the child having neurodevelopmental delay, low birth weight and preterm delivery. Anaemia will also cause weakness and tiredness in the mother, and increase the risks from postpartum haemorrhage. Iron is in many foods but animal foods are superior, because the iron is in a form called heme iron which is absorbed much better than plant iron (20-30% vs 1-10%). Plants also tend to contain antinutrients which inhibit iron and other mineral absorption.
Choline – This is an nutrient important for brain and eye development as well as placental function; it is required for cell membranes, lipid transport, neutrotransmitter production and more. It works synergistically with DHA (below). Choline is also important for healthy gene expression and epigenetic programming. Low choline has also been linked to pre-eclampsia, acute fatty liver of pregnancy, and inadequate foetal brain development. Choline is present in small amounts in various foods especially meat and eggs, but egg yolks and sunflower lecithin are the most concentrated sources. Choline requirements are about 425mg/day for pre-menopausal women, 450mg for pregnant women and 550mg/day for lactating women. However it is likely that higher amounts are better. For example in one study 930mg vs 480mg/ day in the third trimester mediated stress reactivity in the babies, and resulted in lower cortisol levels in the new-borns. This decreased stress reactivity may mean a lower likelihood of mental and metabolic disorders later in life. It’s worth noting that most pre-natals don’t include choline, which is a huge problem because of how vital it is and the fact less than 10% of women get the adequate amount.
Omega 3 fatty acids – Vital for foetal brain development, especially DHA. You cannot get these particular omega 3s from foods like flax, chia or walnuts. You must get them from either fish/fish oil or algae oil. An ideal dose is about 1-3 grams per day, and needs increase later on in pregnancy when the brain is growing rapidly. In one study, mothers who supplemed 2.2g of DHA per day in the last 20 weeks of pregnancy, had children who scored significantly better on hand eye coordination tests at age 2.5, compared to placebo (olive oil), and another study showed better problem solving skills in 4 year olds if their mothers supplemented with 1.2g DHA during pregnancy. You can test your omega 3 index before or during pregnancy, to make sure it is at least 8%. Getting omega 3 from both fish oil and fish itself is a good idea as fish has lots of other important nutrients like iodine, selenium and iodine. Because of contamination concerns in fish, it’s best to get smaller wild fish such as sardines, mackerel and salmon, however it’s worth remembering that studies show that despite mercury in fish, eating fish during pregnancy is still protective.
Glycine – This is the most abundant amino acid in collagen, which means it is essential to support growth of baby’s skeletal system, skin, teeth, hair and nails. It also supports the mother’s stretching skin, growing uterus and placenta. It also acts as a neurotransmitter! Glycine is normally considered “non essential” as you can make it from other amino acids, however during pregnancy it is considered “conditionally essential” meaning the requirements are so high you need to get some from your diet. The foods most abundant in glycine are animal foods rich in collagen, such as slow cooked stews, oxtail, and bone broth. Some plant foods contain glycine but are far too low to meaningfully contribute to dietary requirements. It is unknown what the minimum requirement is, but eating the above animal foods or supplementing with 5-10g of powdered glycine as a supplement per day should suffice – especially in later pregnancy when glycine needs skyrocket.
Iodine -Vital for thyroid health, which in turn is essential for development of the baby’s brain and thyroid. Iodine requirements go up over 50% during pregnancy, and low intakes are associated with maternal and fetal hypothyroidism (which can cause cretinism if very severe), increased risks of perinatal and infant mortality, and delayed neurological development. Good food sources are seafood, algae and seaweed. (I personally use Aquasource Sea power algae)
Vitamin D – vital for a whole host of processes in the body including immune function, bone health and mental health. Studies show that correcting vitamin D deficincy reduces the risk of pre-eclampsia, preterm birth, gestational diabetes, fetal growth restriction, ADHD and low bone mineral deficiency, and more. A dose of 1000-4000 IU per day is associated with better outcomes than the measly 600IU which is recommended. It’s usually best to test your vitamin D levels to make sure they’re optimal, as people vary so much in sun exposure, skin colour and absorption of vitamin D. However without testing, I’d say 4000IU/day is a good bet, and bear in mind during breastfeeding that a study showed that 6,400 U per day is enough to ensure adequate levels of vitamin D in breast milk. It’s a good idea to take vitamin K2 also, as it is essential to bone mineralization and works synergistically with vitamin D, calcium and magnesium. Vitamin K2 is found in many fermented cheeses, full fat dairy, egg yolks and natto (a fermented soybean product) but it’s often a good idea to take a supplement.
Vitamin A – This is required for gene expression, and the development of the eyes, heart, ears, limbs and immune system. Too little can be dangerous but so can too much, which is why it’s best to get it from food rather than supplements. We are told that plant foods like carrots and pumpkins are good sources of vitamin A but these contain beta-carotene which is a precursor to true preformed vitamin A (retinol), We can convert it to retinol in the body but many people convert it very poorly due to nutritional status, general heralth and genes. Pregnant women are often advised to avoid liver during pregnancy due to the high vitamin A content, but I think this is misguided – small amounts of liver (eg 2 ounces a week) doesn’t contain enough vitamin A to be dangerous, but rather provides huge amounts of many beneficial nutrients for pregnancy like iron, folate, B12, choline and protein.
Summary
All these nutrients need to be started before pregnancy to build up stores, and requirements tend to increase as pregnancy progresses (especially choline, glycine, DHA and iron). Also women who exclusively breastfeed often need even MORE of many of the aforementioned nutrients – remember you are still growing a baby! And let’s not forget, these nutrients are vital for our baby but also our own health – anything we are deficient in, the growing baby may pull from our own stores. A healthy mum and a healthy baby require mum to eat the most nutrient dense diet possible, and to supplement wisely as needed.
Finding a prenatal that has adequate amounts of a range of nutrients can be really difficult; I personally take Seeking health prenatal (the dose is 8 tablets a day which gives you an idea of the quantity and variety of nutrients it contains!), and I’ve also taken Thorne prenatal in the past. For a good well researched read on pregnancy nutrition I would also recommend the book “Real food for pregnancy” by Lily Nichols.
MODERN PRIMAL 