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Ok, so I know this is a BIG call, but there is one thing I ALWAYS stand by when it comes to prenatal supplements.
It COMPLETELY changed the way I thought about pre-conception care and early pregnancy. And I think it will for you too.
One size doesn’t fit all.
Sounds obvious, right?
At any other stage of life, you wouldn’t start taking a Vitamin D supplement unless your Vitamin D levels were low. You wouldn’t start taking an iron supplement unless your iron levels are low. So why are women encouraged to buy a generic over the counter prenatal supplement, take it every day and expect that all of the nutritional requirements for preconception and pregnancy for mother and baby will be met?
In this episode of the podcast I’m sharing what most people get wrong about prenatal supplements. We’ll talk about whether they are always necessary, when to take them and whether they’ll actually help you to conceive. And most of all, we’ll talk about why a supplement will never be a substitute for a healthy, nourishing diet.
Let me begin with some bum-coverage and remind you that at any time of life, especially when trying to conceive or pregnant, it is best to consult your doctor or a healthcare professional before taking any supplements. Some supplements can interact with medications you may be taking, or they may mask underlying deficiencies which need to be addressed.
Here’s why you should not rely on a prenatal multivitamin alone:
There are a wide variety of supplements readily available to pregnant women, but the composition and quality will vary depending on the country of manufacture and the brand itself. Just like the nutritional guidelines change according to where you live – insane I know – not all prenatal supplements are created equal.
I always recommend speaking with a nutritionist or naturopath, getting a blood test and working out what nutrients you actually need more of and where you’re already fine. These health professionals can provide you with a practitioner-prescribed prenatal supplement that is much better quality than an over the counter option. Some providers are now offering short, 15 minute online consults purely for reviewing your supplement intake and getting you access to those practitioner-prescribed products. I have done this and I highly recommend. If you’re located in Australia please feel free to reach out and I can let you know where you can go to get this consult.
It is universally agreed that all pregnancy supplements should at the very least contain folate, calcium, iodine, vitamin D and vitamin B12. Iron is also essential for pregnancy, but a supplement should only be prescribed when a deficiency has been confirmed by your doctor. For example, some supplements don’t contain choline or DHA because these nutrients don’t make the list of what’s universally agreed as essential for pregnancy.
It is a common belief that a prenatal supplement or multivitamin has everything you need for a healthy pregnancy. However, like I said, not all prenatals are created equal and many women will still not reach their daily nutrient requirements if they rely on a prenatal and don’t actually eat a nutrient-dense diet. In other words, living on KFC but popping a prenatal will not counteract one another.
Nausea and constipation are both some common side effects of many supplements. Both of these are also pretty common during pregnancy. When you’re battling morning sickness and nausea, swallowing a prenatal can be really hard. I lost count of the number of times I threw mine back up during my first trimester!
Iron is a big one here. So if you’re iron deficient and you’ve been prescribed an iron supplement, there’s a good chance that this may not be well absorbed by the body. Iron supplements also notoriously cause constipation. So while they are absolutely necessary in some cases, sometimes increasing your iron intake from the foods you eat may be enough to avoid the threshold for requiring a supplement in the first place.
This means you’ll need to consider when during the day you are taking your supplements, remembering to take them with or after a meal. And again, if you’re feeling too unwell to fill your stomach, you may not be getting the full benefit of your supplement. In contrast, the nutrients in the foods you eat are more easily absorbed.
There are specific groups of women who would absolutely benefit from taking a supplement throughout their pregnancies – teenagers or young mothers who are still growing and developing themselves; vegetarians, vegans or anyone who has a restrictive diet; women that may have inadequate food intake for any number of reasons; women reporting high levels of stress; smokers and substance abusers; overweight or obese women who may have been advised to restrict their food intake or avoid excessive weight gain during their pregnancies.
In Australia, our healthcare system has a tendency to push prenatal vitamins on women who are trying to conceive or already pregnant without any sort of conversation around nutrition. I remember going to do a prenatal check at my GP before officially trying to conceive, and I was asked if I was taking a specific brand. I said what I was taking and that was the end of the conversation. There was no conversation about prenatal care or preparation and definitely not a conversation about nutrition for conception and pregnancy. I get it, doctors are busy, their workload is insane and nutrition probably isn’t their area of expertise. And my doctor may well have just have assumed I knew about nutrition because he’s known me all my life. But you know what they say about assuming…
Prenatal vitamins are absolutely important, don’t get me wrong, but I do feel we need to improve our approach to nourishing our bodies first. We need to be better at explaining to women who are trying to conceive, or who are pregnant, that supplements are only part of the picture. They should be seen as insurance, more of a back up, not a replacement for a nutrient-rich diet. Instead, we really need to be encouraging women to pay attention to their nutrient intake from food and eating a well-rounded diet, rather than just popping a prenatal and getting complacent.
Pregnancy puts an enormous demand on your body, so it only makes sense that your body needs more nutrients than any other time. Unlike any dietary supplements, we never get one particular nutrient from our food in isolation. Whole foods are always made up of a combination of nutrients that interact with each other to give your body what it needs. For example, Vitamin D is both fat-soluble, so it needs fat to be absorbed by the body. Salmon naturally contains omega 3 fats and Vitamin D. So Vitamin D has exactly what it needs to do its job, unlike a Vitamin D supplement. And we love vitamin D for preconception because it improves ovulatory function.
In some cases, morning sickness, food aversions, allergies or intolerances, can make it really hard to meet the nutritional demands of pregnancy with food alone. That’s where supplements play their part and they have absolutely improved health outcomes for mothers and babies. But it is so important to think about supplements as filling potential gaps in your diet rather than a sole source of all your nutrients. Conversely, if there isn’t a gap in your diet, then they may not be doing much in terms of nutrition, which is why it’s so important to consult a healthcare professional and make sure you are only supplementing based on your personal requirements.
I was really sick in my first trimester and I could not keep a lot of food down. I took a prenatal throughout my pregnancy (and still do!) and I like many women could not eat like I hoped or planned while I had my head in the toilet after every meal. Full disclosure, I ate a lots of chicken schnitzels and mashed potato while I was sick. I’ve talked a lot about this in another episode – Lessons Learnt From My First Trimester of Pregnancy – but because I was really conscious about eating wholesome, nourishing diet in the lead up to my pregnancy I felt less guilty about eating all that mashed potato because I knew I had built up my nutrient stores where possible to get me through that hard patch, and as soon as I felt better I got straight back into good, healthy nutrition and I actually enjoyed eating all those things I had missed out on for all those weeks.
One of the very earliest episodes of the podcast, I think it’s number 3 or 4 – My All-Time Top 5 Fertility Superfoods – I talk about essential nutrients for pregnancy. I have a pregnancy nutrition guide available on my website, that information is absolutely there for you if you want it. There are 2 micronutrients I want to focus on, specifically in the pre-conception phase.
Folate and iodine are 2 nutrients that are really important in early foetal development during those early weeks of pregnancy when you likely don’t know yet you’re pregnant. This is why it’s recommended that you take a daily folic acid and iodine supplement for at least a month before trying to conceive, which has helped to reduce pregnancy complications across the world. And that’s why it is universally agreed that any prenatal supplement should contain folic acid and iodine. It’s why foods like breads and cereals are fortified with these nutrients. They’re pretty important.
Folate is essential for foetal development, especially the neural tube, which will later form the spinal cord. The neural tube closes early in pregnancy, around 6 weeks, and if it doesn’t close properly it leads to complications like spina bifida. The most common recommendation is to take 400ug of folic acid daily for at least 1 month before conception and in the first 3 months of pregnancy.
Folic acid is the synthetic version of folate, so it doesn’t metabolise in our body in quite the same way as naturally occurring folate from real food does. So folic acid, the synthetic version, needs to be converted into its active form, called methylfolate, to be properly broken down and used by the body. So some prenatal supplements contain folic acid, but it’s not actually being metabolised properly. This is why it’s so important to consume natural forms of folate in your diet – legumes, liver, green vegetables, seeds, wholegrains, nuts, bananas, berries, citrus, beetroot, avocado and eggs – and to supplement with the active form, methylfolate.
It’s important to look for methylfolate under the following names:
And not to name names, but you’d be very surprised about which prenatal supplements don’t make the cut.
The other key nutrient in the preconception phase is iodine. It’s a key component of thyroid hormones that is needed for foetal brain development. Sadly, iodine deficiency is considered to be the leading cause of preventable brain damage in babies. It’s recommended to take a daily iodine supplement of 150ug during preconception and pregnancy. You can also get adequate intake from foods such as seafood, seaweed, dairy products and eggs as well as iodised salt. If you have a pre-existing thyroid condition, you should consult a doctor before taking an iodine supplement.
The most common fertility problems are issues with ovulation and these are most often cases where no definite cause is found. Lifestyle changes related to diet, exercise and reducing stress have all been found to significantly improve fertility. One study conducted by Harvard University found that a preconception protocol has been associated with lowering the risk of infertility (let’s say sub-fertility here) by 69%. That’s really significant. And a preconception protocol does not have to be fancy. Think of the four key pillars of fertility, diet, exercise, sleep and stress. These are all within our control and we can improve our fertility by 69%.
Nourishment is about giving your body nutritious food. We want to nourish your future baby with real food, unprocessed whole foods that are nutrient-dense and meet the nutritional guidelines for preconception and pregnancy. What you are about to learn is evidence-based and is the very best way to support you, your fertility and ultimately your growing baby. But the key really is simplicity. The basics. Whole, unprocessed foods, variety and eating what’s in season. Stick to that and you really can’t go wrong.
So while yes, ensuring your body is getting all the right nutrients will help you to conceive, there are a few steps in between. Positive preconception nutrition, taking a supplement as insurance and to fill in any potential deficiencies will ensure you have a healthy menstrual cycle, ovulation is optimised, hormones are balanced and yes therefore you are increasing your chances of conceiving.
There are however two other key reasons why nutrition in the preconception stage is so important:
1 – We already know that nutrition can have a really significant impact on both male and female fertility. Improving the quality of egg and sperm, which will therefore improve your chances of fertilisation and a viable pregnancy.
2 – Maximising your nutrient intake now before you’re actually pregnant will ensure your nutrient stores are optimal to support you throughout pregnancy, long before you actually confirm you are pregnant.
In the early weeks of pregnancy, before the placenta is established at around 8-10 weeks, the developing embryo gets its nourishment from a tiny yolk sac, which is essentially your nutrient stores. The first 8-10 weeks of pregnancy are also when many women don’t know their pregnant, and then get hit with morning sickness and can’t eat as well as they’d like. So these pre-conception nutrient stores are really important.
The research shows that a diet rich in whole foods, so foods that aren’t processed and are as close as possible to their natural form – so wholegrains, fruits, vegetables, nuts, seeds and unprocessed animal products (especially oily fish) have really beneficial outcomes for male and female fertility. Our bodies better absorb nutrients from whole foods compared to more processed foods.
This type of eating is similar to a Mediterranean diet, which is linked to some of the best health outcomes in the world. This diet is nutrient-dense, rich in antioxidants, minerals, fibre and essential fatty acids. There are minimal processed foods. Whole foods are also anti-inflammatory, and we know that inflammation in the reproductive system, like we see in conditions affecting fertility like polycystic ovaries and endometriosis, can have a huge impact on our reproductive processes.
So we know that a nutrient-dense, nourishing diet can optimise fertility and ovulation and help us get pregnant. What about during pregnancy?
I always recommend a minimum 3 month window of preconception preparation before actually trying to conceive. This isn’t an arbitrary number I’ve plucked from thin air, this is the time it takes to noticeably improve the quality of egg and sperm. It takes 90 days for an egg to mature inside the follicles in the ovary before it is released at ovulation. This means that you can significantly improve the quality of your eggs within this 3 month window. This time frame also allows you to balance hormones, regulate your menstrual cycle and any other potential issues that could be going on to get you in the best possible position for pregnancy, including making sure your body has all the nutrients it needs to sustain a pregnancy.
For male fertility and sperm production, this 3 month window is just as important. Most men produce millions of new sperm every single day, but it takes 74 days, or 2 ½ -3 months for these new sperm cells to fully mature. By making lifestyle changes in the 3 months before actively trying to conceive, your man is making sure he has a stock of healthy, high quality mature sperm. Male preconception care is just as important. Your baby starts as an egg and a sperm cell, 50-50. Prenatal supplements are available for men too containing the essential nutrients he needs for healthy sperm production and they are worth considering for all the same reasons.
Of course sometimes pregnancies are not planned and we don’t always have that window of time to prepare. But you are starting from behind if you only start taking a prenatal or thinking about healthy nutrition when you’re already pregnant. That’s not saying you won’t grow a healthy baby, because that baby will take everything it can from its mother’s body. So if your nutrient stores are already depleted, baby will be fine, you’ll just likely feel pretty lousy until your stores can be replaced to the extent that they can give you and your baby what you both need.
It’s also recommended that you continue to take your prenatal supplement throughout pregnancy. Some recommend only for the first trimester, but it’s still that insurance policy throughout and as hard as it is to even consider this when you’re in pregnancy mode, but post-partum and that fourth trimester is rough. Honestly, your body doesn’t really get time to recover from pregnancy and birth because you are thrown straight into caring for this tiny baby and as wonderful as that time is, you, your body and your own nutritional requirements and self-care are the last things on your mind! You are so sleep deprived and focused on baby who needs you 24/7, so those prenatal supplements are still required to give your body what it needs in that next chapter. You’re living on toast and things you can eat with one hand so my best advice is towards the end of your pregnancy to prepare healthy, nourishing meals because you will likely not be cooking for a few weeks. Get family and friends to help by preparing meals and dropping them off and stashing as much as you can in your freezer. I made so many batches of bliss balls and muesli bars and slices that were full of nuts and seeds and grains and as many of these good nutrients as I could squeeze in them and they were stored in my freezer and this is what I ate when I only had one hand free, in all those feeds in the middle of the night and my supply lasted about 3 months. I am still breastfeeding and I am still taking my prenatal supplement because breastfeeding and lactation takes even more energy and nutrient stores than pregnancy does! So that is something to keep in mind. It’s not just about when to start taking supplements, it’s when to stop.
So we’ve covered a lot in this episode, so I want to wrap up by sharing some quick tips to building out your preconception plate.
Thinking about nutrition during preconception and pregnancy doesn’t need to be complicated or fancy, because that just leads to confusion, overwhelm and then it’s just not happening! Thinking about how you build a plate for every meal is a simple way to make sure your meal is nutritionally balanced. This will help to balance your blood sugar levels, which in turn balances your hormones. Win win!
So, here’s a step by step guide to building out your plate:
1 – add half a plate of low-starch vegetables
2 – add a palm-sized source of protein, such as meat, poultry, fish, seafood, eggs or tofu.
3 – add ½- 3/4 cup of whole carbohydrates or starchy vegetables
4 – complete the meal with healthy fats, such as EVOO, avocado, full fat dairy, seeds or nuts.
So this is your reminder today that one size NEVER fits all! And while prenatal supplements are recommended and fantastic to help you to get all the essential nutrients you need for conception and throughout pregnancy, please do not just think of them as your get out of jail free card, your eat whatever I like because I take a prenatal card. They are your insurance policy, but the nutrients you truly need for balancing your hormones, optimising ovulation and actually getting pregnant, then for actually sustaining you and your baby through pregnancy and beyond – the majority of those nutrients really do need to come from your diet.
I hope it’s really clear for you that all of the preconception preparation advice I share, especially when it comes to nutrition, is so much more than just preparing for pregnancy. When you’re actively trying to conceive or struggling to conceive it feels like it is all just about getting pregnant. Pregnancy is the end-game. But it is so much more than that. Fertility is not just about making babies, it’s a state of health. When we can optimise our overall health with those pillars of fertility – diet, exercise, sleep and stress – as a secondary effect we improve ovulation and maximise our chances of getting pregnant, but the end game is about post-partum health and recovery, health for any subsequent pregnancies, and even well beyond that, supporting your cycle and ovulation for the rest of your menstruating life and improving your overall health and reducing your risk of those chronic lifestyle-associated health conditions like heart disease, diabetes and stroke.
What are your thoughts on prenatal supplements and what advice have you been given on your preconception and pregnancy journey? Let me know. I’d love to hear your experience or help in any way I can, and my inbox is always open for a chat.
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