Nutrition in Pregnancy
Fuelling your body to grow a baby...
Pregnancy comes with a huge set of challenges- physically and emotionally. So having an “ideal” diet is not always an easy thing to do. In saying that, we are discovering more and more the impact that a mothers’ nutrition during pregnancy has on the unborn child – no pressure hey!
But as I always say, knowledge is power, and even making small changes during this challenging time will help set your little one up for a healthier future. And on those days when it all becomes too hard to get your food optimal, at least trying to optimise things through several well proven supplements.
A Few Handy Tips...
Whole food is always going to be the most powerful influencer of our nutritional status, something we have become a bit detached from in the western world. Most of us, surrounded by multiple pressures, reach for the package. I am guilty of this too.
So let’s start simply- When choosing snacks, there are some simple unprocessed foods that are actually easy and require no time preparation- nuts, dried fruit, handful of sunflower seeds or pumpkin seeds, toasted chickpeas, air popped popcorn and fresh fruit are great options. There are some vegetables that don’t require too much time in preparation- munching on a washed piece of celery or carrot is quick and easy, although often doesn’t seem like the most appetising option. Adding a nut butter or a predominantly avocado containing guacamole dip may make the vegetables a little more appetising and also adds to your nutrient intake for the day.
Meals get harder when we are exhausted and wanting something quickly. Trying to optimise fresh vegetables is important for their nutrient rich properties, and if no time, frozen ones are always going to be superior over buying a processed food with multiple ingredients on the label.
When it comes to eating well in pregnancy, there can be many barriers. So on a bad day you can at least have the daily “back-up” of a few supplements that have proven benefit in pregnancy. These include a good quality prenatal vitamin/mineral including iodine and folate (or its activated form- folinic acid or Methylfolate), vitamin D, zinc, a clean filtered fish oil, a broad spectrum high count probiotic and iron (if deficiency is evident).
Fortunately the good quality prenatal vitamin supplements include proven doses of folate and now include a great does of iodine, so that makes life easy for us. Folate is vital to reduce the risk of neural tube defects, and iodine is vital because deficiency causes intrauterine growth restriction, birth complications and cretinism.
When it comes to the lesser known nutrient supplementation in pregnancy, there are few important bits to know. Let’s start with vitamin D. As many of you know, our Vitamin D comes predominantly from the sun, with food sources not supplying a significant amount. When it comes to Vitamin D in pregnancy- it has been shown to increase bone ossification, improve tooth enamel and improve growth of the foetus (Javaid, Lancet 2006). Inadequate vitamin D has an association with pre-term labour (Suzuki 2011).
Higher levels of the mother’s intake of vitamin D has been shown to correlate with reduced risk of wheezing in children (Graham Devereux et. Al. 2007) and also reduces risk of language impairment (Andrew J.O. Whitehouse Et Al. 2012). So making sure your vitamin D is checked and getting it to an optimal level is important, either with extra sunshine and/or a supplement. Most prenatal vitamins only contain 800-1000IU of vitamin D, which may not be adequate for a significant proportion of pregnant mothers to get optimal vitamin D levels, so a further vitamin D supplement may be necessary.
Iron is the most common mineral deficiency in pregnancy, and the daily requirement increases from 18mg to 27mg during pregnancy. Food sources include red meat, sardines, turkey, clams, molluscs, mussels, chicken, fish, lentils, beans and spinach. Deficiency can cause immune problems for the mother, increase risk of premature labour and growth restriction, and also contribute to delay in motor and cognitive development in the child (Lozoff 2003 and 2011, Grantham-McGregor 2001, Scholl 1992). Therefore iron is essential to have at an optimal level during pregnancy, so make sure you get it checked with your routine blood tests. If levels are inadequate, supplementation is usually necessary. Interestingly, iron bisglycinate is just as well absorbed as the common popular brands of iron sulfate (Milman et.al. 2014) and iron bisglycinate is far less likely to cause constipation and other gut upset, and is easy to source at any health food store.
Omega 3 fatty acids is essential for brain and retinal development in the foetus and there is some research linking omega 3 supplementation with augmentation of IQ in the child (Helland et.al). Omega 3 is also shown to reduce birth complications in low and medium fish consuming mothers. Interestingly, there is also research that shows Omega 3 reducing the risk of depression of mothers during pregnancy (Freeman Et.Al 2006). Eating low mercury fish twice a week provides great omega 3. Examples of low mercury fish are salmon (Fresh caught), mackerel (N. Atlantic and Chub), anchovies, sardines and herring. To make things a bit easier, the acronym SMASH can be used. If you’re not a fish fan, or eat it rarely, it is worth considering a high quality fish oil- one that is sourced, treated and tested to ensure the lowest possible peroxides, heavy metals, PCBs and dioxins.
Taking a good quality broad spectrum high count probiotic is also worth considering. They are proven to reduce risk of allergy and improve immune function in the child (Rautava 2002). Looking for a broad spectrum, high count probiotic is worthwhile. There are also some research suggesting that probiotic use in pregnancy may reduce the risk of gestational diabetes (Wickens KL Et.Al. 2017).
Zinc deficiency is associated with an increased risk of intrauterine growth restriction, premature birth, Pre-ecclampsia and reduced immunity. (Mahomed 2011, Kiiholma 1984, Yoshida 1999). Also when it comes to zinc, it has been found that oocytes with the highest zinc levels are the healthiest. Zinc is important for immune health, body tissue healing and also supports mood. Zinc rich foods include seafood, red meats, spinach, pumpkin and squash seeds, cashews and chickpeas. So if your diet is low in zinc rich foods, considering trying to squeeze a few extra of these foods, and considering a zinc supplement may be worthwhile. Zinc levels can be tested in the blood plasma and an optimal level is 15 or more.
Magnesium supplementation reduces the risk of low birth weight, Intrauterine growth restriction, Preterm birth, hospitalisation in pregnancy, Intrapartum haemorrhage (Makrides 2010). Magnesium can also be useful for restless legs and sleep. Magnesium rich foods include spinach, pumpkin and squash seeds, fish, beans, lentils, brown rice, avocado and dark chocolate. Magnesium supplementation can be beneficial if diet is not optimal.
So this may all be a bit overwhelming, but in short, trying to sneak in some whole food as much as possible, get your nutrient levels checked as early as you can (pre-conception is an ideal time – in a perfect world), and supporting your body further with some supplements is a good idea. If your iron and vitamin D levels are adequate, then the first three to aim for on a daily basis are:
- A good quality prenatal vitamin/mineral complex- ideally with activated vitamins
- A good quality fish oil that has low peroxide, heavy metals, PCB and dioxins
- A good quality broad spectrum probiotic with a high count
Further to this is looking at zinc and magnesium supplementation if diet or absorption isn’t optimal.
Dr Catherine Collins
Integrative GP and Founder of ejuno.