Should You Take Pre & Postnatal Supplements
Article by Kaylee Slater APD
Emerging research suggests that dietary intake in the months leading up to conception can impact not only your ability to fall pregnant, but also the outcome of your pregnancy and future health of your baby1. With approximately 50% of pregnancies being unplanned, it is a great idea to start developing good habits long before you start planning for a baby, as well as becoming educated on the recommended supplements to look out for. Luckily, this blog will get you started!
Why is nutrition important for preconception and pregnancy?
The preconception period is known as the 3-12 months prior to falling pregnant (i.e, sperm meets egg, becomes an embryo and your baby starts growing). We think of this period as the optimal time to start enhancing your nutrition, in both natural (food) and elemental (supplement) form. This is because your egg cells are starting to develop and mature before you ovulate (and this can take up to 3 months)2. And similarly, sperm regenerates every 72 days, so it’s the perfect window to optimise both egg and sperm quality.
Inadequate nutrition and nutrient deficiencies in both men and women prior to conception can also have negative impacts on the pregnancy and can affect the development of the placenta, blood supply to the growing baby, and brain and spinal cord development, to name a few1. These can also affect your baby’s long-term health, as well as the health of their children, yes, your future grandchildren’s health can be impacted during this crucial time period.
Should you be supplementing for fertility and in pregnancy?
Let me preface that as a Dietitian and Nutritionist, I always advocate for food first! However, it is recommended worldwide that women planning to become pregnant should be taking a prenatal supplement, or at the least, folic acid2. Interestingly, most women of reproductive age are not meeting their requirements for folate, iodine and iron (all essential nutrients in the preconception period)3.
Prenatal supplements can:
• Reduce the risk of neural tube defects by optimising folate, vitamin B12 and choline status
• Fill dietary gaps for key nutrients
• Boost the status of key nutrients that support and enhance egg quality, namely zinc, omega-3 and folate
• Support a healthy thyroid function, by increasing iodine and zinc
Wherever possible, I recommend starting a prenatal supplement 3-6 months before conception and continue all the way through pregnancy. Sometimes that is not possible, so the earlier the better! It can be hard to choose which prenatal supplement to go with as the options are becoming endless! So, here are some of the key nutrients to be looking out for. Note that I always recommend you go see a health professional before starting any supplementation, as forms and dosages may vary significantly based on your unique health circumstances.
What to look for in a prenatal supplement?
Folate (or folic acid)
Folate is an essential nutrient for the development of the neural tube, and is well known for its role in preventing neural tube defects4. This structure often begins forming before women find out they’re pregnant and is generally closed by the 12th week of pregnancy4! The recommended daily intake (RDI), which might be called something different in various countries, seems to be consistent worldwide and is 400 mcg preconception and 600 mcg during pregnancy6. When looking for a prenatal supplement, look for one that contains at least 400 mcg (many on the market nowadays seem to have 500 mcg or more)! In some circumstances, folic acid requirements are well above 600 mcg, such as with a family history of neural tube defects (among other things), so please check in with a health professional before starting supplementation!
With the rising awareness of the MTHFR gene mutation, which is short results in a reduced ability to activate folic acid, you may want to look for a prenatal vitamin that contains the activated version. This is commonly labelled as methylfolate or folinic acid.
Vitamin B12
Inadequate levels of B12 can effect egg development and ovulation. This B-vitamin is also crucial for the brain and nervous system function7. Vitamin B12 is also involved in the metabolism of folate in our body, and therefore an important nutrient during pregnancy. When looking for B12 in a prenatal supplement, look for cobalamin, or preferably the activated form methylcobalamin. Note that B12 is found in animal-based products or by-products (eggs and dairy), so if you are following a vegetarian or vegan diet you may need extra B12 to meet your needs.
Choline
You may not have heard of this nutrient before! This vitamin-like nutrient, commonly found in eggs, meat, legumes, beans and mushrooms, is responsible for the baby’s neural tube and brain development and works together with folate in the early stages of pregnancy8. Unfortunately, a large number of prenatal vitamins on the market do not contain choline, so be sure to look out for it on the packaging!
Iodine
Low levels of iodine leading into pregnancy can affect the growth and development of your baby’s tissues, and result in developmental abnormalities. Iodine is also vital for a healthy thyroid and thyroid hormone production9. It is safe to say that iodine is essential prior to and during pregnancy. When choosing a prenatal supplement, it should contain at least 150 mcg, but ideally 220 mcg. If you have a history of thyroid concerns, check with your doctor and dietitian prior to commencing iodine-containing supplementation.
Vitamin D
Vitamin D is a fat-soluble vitamin, which is important in hormone and immune system functioning, cell division and bone health for you and your baby! Many of us know that you can get vitamin D from short and sensible sun exposure, however even in very sunny parts of the world, it can be hard to get enough!
There are two main forms of vitamin D; ergocalciferol (vegetarian form) and cholecalciferol (animal-based form). It is recommended that vitamin D is supplemented in addition to a prenatal vitamin, as most don’t contain enough, with research suggesting that amounts of up to 4000 IU are safe all the way up to second and third trimester of pregnancy10.
Zinc
Emerging research from animal studies suggests that optimal levels of zinc can assist you in making a healthy egg11. Zinc is also well known for rapid cell division and growth in your baby.
While zinc can be found in oysters, beef, chicken, eggs and fish, as well as milk, cheese, lentils and legumes, your prenatal vitamin should also contain around 11 mg of zinc. Vegans and vegetarians may require more zinc than those who do eat animal proteins.
Iron
Iron is one of the most imperative nutrients for women trying to conceive, as well as during pregnancy. Research suggests that iron deficiency can make it difficult to conceive, and can result in failure to ovulate12. Iron requirements almost double during pregnancy (18 mg to 27 mg) to produce more blood for your growing baby.
Supplementation can be tricky as constipation is a common side effect and iron absorption is easily inhibited by other nutrients commonly found in prenatal supplements, such as calcium and zinc. In some cases it is best to take an iron supplement at a different time of the day than your prenatal.
Omega-3 fatty acids
Research suggests that omega-3s (especially DHA) are key in optimising egg quality and are beneficial for female fertility due to their anti-inflammatory properties13. Pregnant women with a good omega-3 status have shown a reduced risk of going into early labour by a massive 10-fold14. The American Pregnancy Association recommends at least 300mg of DHA per day, so check your prenatal or consider supplementing on the side.
Other nutrients to look out for:
While there is simply not enough space to name every nutrient, others that you may want to look out for in your prenatal supplement are niacin (vitamin B3), selenium, magnesium, vitamin K and calcium.
Calcium requirements are 1000 mg/day and do not increase during pregnancy. However, it is important to ensure you are getting enough to maintain your own bone health, as well as the building of your baby’s skeleton, plus some research suggests a reduced risk of developing pre-eclampsia in those with optimise calcium status15.
Always get personalised advice!
As I mentioned previously, it is always important to seek personalised advice from a health professional before taking any supplements.
This blog post was written by Kaylee Slater APD, a fertility & pregnancy dietitian and nutritionist at The Dietologist and PhD Candidate at the University of Newcastle, Australia. Kaylee is an expert on all things pre-conception and pregnancy nutrition, having published her work in 2020 showing that the majority of pregnant women are not meeting their requirements for critical nutrients from folic acid to iodine, zinc to fibre! Alongside her work at The Dietologist, Kaylee is also pursuing a doctor of philosophy (PhD), investigating the impact that diet and lifestyle changes can have on preventing heart disease amongst women who experience high blood pressure or pre-eclampsia in their pregnancies. You can find Kaylee on Instagram at @grownutrition.au and @the_dietologist.
References :
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2. Davies, P., Funder, J., Palmer, D., Sinn, J., Vickers, M., & Wall, C. (2016). Early life nutrition and the opportunity to influence long-term health: An Australasian perspective. Journal of Developmental Origins of Health and Disease, 7(5), 440-448. doi:10.1017/S2040174415007989
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4. Queensland Health (2018). Why do you need to take folic acid when pregnant? Queensland Government, Queensland Health.
5. Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A., & Willett, W. C. (2008). Use of multivitamins, intake of B vitamins, and risk of ovulatory infertility. Fertility and sterility, 89(3), 668–676. https://doi.org/10.1016/j.fertnstert.2007.03.089
6. National Health and Medical Research Council (2014). Folate. Nutrient Reference Values for Australia and New Zealand. Australian Government. Found at: https://www.nrv.gov.au/nutrients/folate.
7. Bernard, D. J., Pangilinan, F. J., Cheng, J., Molloy, A. M., & Brody, L. C. (2018). Mice lacking the transcobalamin-vitamin B12 receptor, CD320, suffer from anemia and reproductive deficits when fed vitamin B12-deficient diet. Human molecular genetics, 27(20), 3627–3640. https://doi.org/10.1093/hmg/ddy267
8. Wallace, Taylor C. PhD, CFS, FACN; Blusztajn, Jan Krzysztof PhD; Caudill, Marie A. PhD, RD; Klatt, Kevin C. MS; Natker, Elana MS, RD; Zeisel, Steven H. MD, PhD; Zelman, Kathleen M. MPH, RD, LD Choline, Nutrition Today: 11/12 2018 - Volume 53 - Issue 6 - p 240-253. doi: 10.1097/NT.0000000000000302
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12. Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A., & Willett, W. C. (2006). Iron intake and risk of ovulatory infertility. Obstetrics and gynecology, 108(5), 1145–1152. https://doi.org/10.1097/01.AOG.0000238333.37423.ab
13. Lass, A., & Belluzzi, A. (2019). Omega-3 polyunsaturated fatty acids and IVF treatment. Reproductive biomedicine online, 38(1), 95–99. https://doi.org/10.1016/j.rbmo.2018.10.008
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