It’s time to chat on something that comes up in clinic a lot- prenatal nutrition! We work with a lot of mama’s through their fertility journey, and one of the best feelings in the world is transitioning that patient from a fertility patient to a prenatal care plan. Both of these require nutritional education. BOTH of them! Meaning not only is hormone-targeted nutrition a valuable tool while TTC, but prenatal targeted nutrition can help ease your pregnancy and nourish your little one!

First, and it must be said, a prenatal vitamin is a supplement. Meaning, in a perfect world, it’s used to supplement your nutritional intake, not to provide a safety net for Mama to live off drive-through and convenience store purchases. Truth be told, not all prenatal vitamins are created equal and there are endless healthy food choices Mama can make to improve her health and that of her unborn little babe.

First, we’re going to touch on protein. Proteins are the building blocks of cells and during pregnancy, when Mama is growing a whole lot of cells, it becomes super important that protein intake is sufficient. Research shows us that inadequate protein intake during pregnancy can contribute to low birth weight, placental growth, development, and nutrient transfer issues, and an increased risk of vascular defects in baby. On the flip side of this, higher carbohydrate intake during pregnancy can also lead to these concerns. Current research into protein intake recommendations are showing that we have perhaps underestimated need. New numbers are suggesting protein intake around 60g/day for early pregnancy and getting closer to 100g/day later in gestation to reduce and potentially prevent negative risk in both mom and baby.

Vitamins B-12 and folate (B-9) play an essential role in DNA methylation. Making sure mama is getting these nutrients can reduce the risk of negative side effects including anemia, neural tube defects, low-birth weight, placental abruption, and both developmental and long-term epigenetic adverse health outcomes for baby. It’s also important to be sure you’re consuming folate (naturally occurring), and not folic acid (synthesized), during pregnancy. Choosing a prenatal vitamin with 5-methyltetrahydrofolate optimizes Mama’s ability to use the nutrient when compared to synthesized folic acid. Folate is much more bioavailable than folic acid as it’s already in its active form and can be easily utilized by your body. It’s important for Mama to get good B-12 in while breastfeeding as well as it improves development and growth in baby earth side.

Some of our fave folate-rich foods include spinach, asparagus, broccoli, Brussel sprouts, sunflower seeds (add em to a salad!), black beans, and egg yolk.

If you’re looking for B-12 rich foods, it’s important to note this nutrient is found in meats, seafood, and poultry. It’s a little harder to achieve with a vegetarian or vegan diet.

*Both of these nutrients are plentiful in many organ meats! Many nutritionists refer to organ meats and nature’s vitamins. So if you’re feeling brave, give a little beef or chicken liver a go!

Choline is another extremely important nutrient for pregnancy and it often goes overlooked and undervalued. It plays an important role in cell division, brain development, myelination, and gene expression during pregnancy. It’s utilized in placenta formation and contributes to nutrient transport from Mama to Babe. Plus, adequate maternal choline shows beneficial cognitive function in infants! Check your prenatal because many of them don’t have choline at all (and if they do it’s probably not enough and you’ll want to take it in dietarily). Foods rich in choline include eggs, meat, yogurt, shiitake mushrooms, and, on a smaller scale, broccoli, Brussel sprouts, and quinoa. If you have an allergy to eggs or don’t consume a whole lot of animal protein, choline supplementation can be considered.

Omega-3’s are also important during pregnancy and often intake isn’t adequate. Research shows that animal sources of DHA, like what is prevalent in seafood, are important for neurodevelopment and birth weight. Fetal DHA levels are considerably more affected by animal sources of omegas than plant-based omega sources and even years later the beneficial cognitive effects of DHA were stronger in mothers who supplemented with cod-liver oil over plant sources (such as olive oil, corn oil, or flax). When choosing what seafood to consume to get all the yummy health benefits of DHA, be sure to pick seafood with lower levels of mercury. The general rule of thumb is the lower in the food chain the fish, the safer it is! Great sources of DHA include salmon, pollock, and sardines.

Vitamin D might be in your prenatal and you might enjoy a good dose of sunshine, but research shows the RDA is likely low for pregnancy and deficiency isn’t uncommon. Adequate Vitamin D has been shown to reduce the risk of gestational hypertension/ preeclampsia, gestational diabetes, preterm delivery, recurrent pregnancy loss, and postpartum depression. Maternal vitamin D intake is important for skeletal development of baby during and after pregnancy with intake deficiency showing a correlation with type one diabetes and asthma/lung health issues later in baby’s life. The 600IU recommendation appears to be outdated, with other countries and research showing levels closer to 2000-4000IU safe and beneficial.

The above nutrients are a small glimpse into prenatal nutrition. In reality, the picture is bigger than what is presented in this blog post. While following a vegetarian or vegan diet presents particular issues around conception and carrying a baby, certain steps can be taken to optimize nutrition for these individuals. The information available via the internet and social media can be useful, but also misleading, misinformed, and sometimes confusing. If you want to self-study, our favorite resource is a phenomenal book called Real Food for Pregnancy written by Lily Nichols, RDN (can be purchased along with some of her awesome recipes here https://lilynicholsrdn.com). Her book contains 32.5 pages of cited works in tiny font size so there is no lack of research behind her chapters! To get a more personalized approach if you’re struggling with fertility or prenatal nutrition we encourage you to work with a nutrition professional familiar with supporting expecting mamas!

This blog was written by Dr. Meghan Gray, DACM, MSHNFM, L.Ac.

Protein Studies:

https://www.nature.com/articles/pr2003367

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350090/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882021/

https://academic.oup.com/jn/article/145/1/73/4585822?login=true

B-12 and Folate

https://www.researchgate.net/publication/322438518_Folic_acid_vitamin_B12_and_DNA_methylation_An_update

https://academic.oup.com/aje/article/185/3/212/2918733

https://cdt.amegroups.com/article/view/24182/26221

https://journals.sagepub.com/doi/pdf/10.1177/15648265080292S117

Choline