Optimal nutrition support for our client begins before she even conceives. Birth control pills make it difficult for women to absorb some nutrients that are essential for healthy pregnancy. Ideally, women who were previously on birth control pills will replete those nutrients before conception.
Nutrients that are not well absorbed while women are on birth control pills include folate, vitamins B2, B6, and B12, vitamins C and E, coenzyme Q10, magnesium, selenium, and zinc (Palmery, Saraceno, Vaiarelli, & Carlomagno, 2013) (Palan, Strube, Letko, Sadikovic, & Mikhail, 2010).
Antidepressants, which are commonly prescribed to women of childbearing age also deplete folate.
Non-steroidal antiinflammatory drugs (NSAIDs), including ibuprophen, can irritate the intestinal lining increasing the requirement for zinc and amino acids, and they can suppress ovulation in the short term (Duffy, 2015). Thus, a women who has been on these medications prior to trying to conceive needs to focus on optimizing her nutrient intake.
Taking a high quality prenatal vitamin is an important step.
Additionally, taking prenatal vitamins has well established benefits for babies regardless of the specific ingredients or quality of the prenatal supplement, including…
- Lowering the risk for leukemia (Leung et al., 2013).
- Lowering the risk for pediatric brain tumors (Leung et al., 2013)
- Lowering the risk for neuroblastoma (Leung et al., 2013).
- And, lowering the risk for a number of congenital anomalies cardiovascular defects, limb defects, urinary tract anomalies, cleft palate, and neural tube defects (Leung et al., 2013).
In other studies, specific benefits have been found for specific nutrients being at optimal levels for baby’s development and childhood health, and for maternal health during and after pregnancy.
Mothers of children with early childhood dental cavities had significantly lower vitamin D levels, measured by 25(OH)D levels (Schroth et al., 2014). Those mothers with an average of 40nmol/L vitamin D level vs. those with an average of 52nmol/L vitamin D level had babies with more cavities (Schroth et al., 2014).
Nearly half of pregnant women have deficient (less than 30 nmol/L), or insufficient (30-49 nmol/L) vitamin D status at mid-pregnancy, and 82% are deficient or insufficient at birth (Ozias et al., 2014). Typical supplementation of vitamin D from average prenatal vitamins (approximately 334 IU/day) is not enough to restore adequate vitamin D status in pregnant women. The variables that are important are the 25(OH)D level in mid-pregnancy and the season of birth. Women who delivered in summer and fall had a 1.5-fold greater plasma 25(OH)D concentration than women who delivered in winter in spring (41.1 +/- 23.1 and 40.7 +/- 20.5 nmol/L summer and fall, respectively, versus 27.7 +/- 17.9 and 29.3 +/- 21.4 nmol/L in winter and spring, respectively).
Adequate vitamin D supplementation prior to pregnancy or at least by mid-pregnancy is essential. Higher levels of maternal vitamin D correlate with birth weight, infant calcium levels, and infant bone mass (Harvey et al., 2014).
I recommend that women have their 25(OH)D levels assessed prior to pregnancy and/or in early pregnancy. Adequate vitamin D levels are rare in women of childbearing age who spend much of their time indoors or wearing sunscreen. Vitamin D is necessary throughout pregnancy and for nursing mothers, but it’s nearly impossible for nursing mothers to have enough vitamin D to pass along through their breast milk unless they are supplementing in the range of 5,000 – 6,000 IU/day (Creighton University, 2014).
Omega-3 Fatty Acids
Women who took omega-3 fatty acid supplements (fish oil) showed decreased risk of postpartum depression on the Edinburgh Postnatal Depression Scale (EPDS) (Leung et al., 2013). At least 200mg-300mg per day of omega-3 fatty acid intake is ideal for pregnant women for other reasons as well, such as increasing gestation length, reducing the risk of preterm birth, and improving fetal brain development including infant cognitive and visual performance and even reversing some of the neurological effects of fetal alcohol syndrome (Jordan, 2010) (Patten, Sickmann, Dyer, Innis, & Christie, 2013).
Vitamins C and E
Vitamins C and E are essential antioxidants for pregnant women and their babies. Supplementing with vitamins C and E is associated with a reduction in placental abruption and preterm birth among mothers who smoke (Abramovici et al., 2014). Obviously, I don’t recommend smoking during pregnancy, but for this high-risk population and others with antioxidant depletion, such as mothers who were previously on birth control, I recommend supplementing with antioxidants, including vitamins C and E to potentially reduce the risks of preterm birth and placental abruption.
Additionally, adequate vitamin C levels can protect fetal brains from the increase in oxidative stress that occurs during pregnancy (Ahn, Kim, Park, Park, & Lee, 2007) (Paidi, Schjoldager, Lykkesfeldt, & Tveden-Nyborg, 2014).
Vitamin B6 is a vitamin that is often low in high-risk populations of prenatal women, including those with previous birth control use. Women who were given B6 supplementation reported less nausea, improved appetite, less headache, and less depression as compared with controls (Var, Keller, Tung, Freeland, & Bazzano, 2014).
Folate (Vitamin B9)
In addition to reducing the risk for neural tube defects and other congenital anomalies, healthy maternal folate levels in mid-pregnancy is associated with a decreased risk of lower respiratory tract infections and atopic dermatitis in early childhood (Kim et al., 2015). However, folic acid supplementation may not be as safe as supplementing with the active form of vitamin B9, 5-methyltetrahydrofolate. Synthetic folic acid has been linked to leaving circulating residues in the maternal blood and in fetal cord blood (Choi, Yates, Veysey, Heo, & Lucock, 2014), which can increase colon cancer risk.. Synthetic folic acid is more difficult to metabolize than the active form, 5-methyltetrahydrofolate.
Fetal memory can be negatively affected by maternal iron deficiency. Supplementing with iron and choline can prevent or improve the memory deficits (Kennedy et al., 2014). Prenatal iron is ideally supplemented based on maternal levels. Levels at or below 70 μg/L require some degree of supplementation (Millman, 2011).
Women who took selenium supplements showed decreased risk of postpartum depression on the Edinburgh Postnatal Depression Scale (EPDS) (Leung et al., 2013). Additionally, women who were thyroid peroxidase antibody positive who were given 200 mg/ day of selenium supplements had significantly lower rates of hypothyroidism postpartum as compared with the control group who received a placebo (28.6 vs. 48.6%, P<0.01; and 11.7 vs. 20.3%, P<0.01) (Negro et al., 2007).
Adding 15 mg of zinc to prenatal vitamins, improved zinc status both for mothers and their infants, but in most it was still lower than recommended values for well-nourished populations (Caulfield, Zavaleta, & Figueroa, 1999).
So… What do I recommend?
The winner is… Designs for Health Prenatal Pro Essential Packets.
While there are many high quality brands of prenatal supplements available for women who are pregnant or planning to conceive, I recommend Designs for Health Prenatal Pro Essential Packets because this supplement is truly evidence based for what women need prior to conception and during pregnancy, postpartum and nursing, it comes in an easy packet that includes the additional minerals and fish oil that most pregnant women need, plus it includes…
This list is for two packets daily. Depending on nutrition needs, collaborate with your nutrition professional to decide on the optimal dosage for you. Generally women will benefit from 1-2 packets per day with food – one at breakfast and one at dinner.
- 1300 IU of vitamin D3 daily.
- Vitamin E in the form of mixed tocopherols, which is healthier for maternal heart health as compared with alpha tocopherol only – the form found in most supplements.
- 50 mg of vitamin B6 to prevent maternal side effects like nausea.
- Folate and B12 in their natural forms, which are better absorbed without leaving residue in the maternal and cord blood circulation.
- Calcium and magnesium for mother and baby’s bone health, but in heart-healthy ratios.
- 200 mg of selenium, which is recommended to prevent postnatal hypothyroidism.
- 30 mg of Iron in a form that is less likely to cause constipation.
- 100 mcg of Choline for optimal fetal brain health and memory.
- Anti-inflammatory grape seed extract.
- 500 mg of vitamin C, an important anti-oxidant.
- 1200 mg of High quality, highly available fish oil in a pleasant lemon flavor. Some women will need a higher dose of omega-3 fatty acids if they are not also regularly consuming low toxin fish as a part of their nutrition plan.
Runners up: Some other quality options for prenatal supplements include…
- Nutrience – I like their highly absorbable powder form. Jayson and Mira at Calton Nutrition are true experts in anti-competition technology which allow the nutrients in their supplement to be among the best absorbed on the market. I especially like the vitamin D3, K2, and active forms of B vitamins including folate and B12 in this supplement. I would recommend the unsweetened version since there is some very old research that does suggest a possibility of miscarriage from stevia. However, there is no iron in their supplement which may be a negative for many pregnant women who are iron deficient. And, you would need an additional omega-3 fatty acid (fish oil) supplement.
- Thorne Research Basic Prenatal – Similar to Designs for Health, but with less selenium, vitamin E in only the alpha tocopherol form, and like Nutrience you’ll need an additional fish oil supplement.
- Wellness Essentials Pregnancy by Metagenics – very similar to Designs for Health, but with only the alpha tocopherol form of vitamin E, and a bit less B6 for women who struggle with prenatal nausea.
Remember that it is impossible for your clients to supplement their way out of a bad diet. For women who are trying to conceive or who are pregnant, supplements are a necessary part of their nutrition program. But, they are not enough.
In addition to prenatal supplementation, all pregnant women and those trying to conceive need to have at least a basic foundation of healthy nutrition.
Click here to download the complimentary IWHI Preconception Detoxification and Preparation Guide for a complete nutrition program and recipe guide for pregnant women and women who are trying to conceive.
- Abramovici, A., Gandley, R., Clifton, R., Leveno, K., Myatt, L., Wapner, R., . . . the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units, N. (2014). Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis. BJOG. doi: 10.1111/1471-0528.13201
- Ahn, Y. M., Kim, Y. J., Park, H., Park, B., & Lee, H. (2007). Prenatal vitamin C status is associated with placental apoptosis in normal-term human pregnancies. Placenta, 28(1), 31-38. doi: 10.1016/j.placenta.2006.01.018
- Caulfield, L. E., Zavaleta, N., & Figueroa, A. (1999). Adding zinc to prenatal iron and folate supplements improves maternal and neonatal zinc status in a Peruvian population. Am J Clin Nutr, 69(6), 1257-1263.
- Choi, J. H., Yates, Z., Veysey, M., Heo, Y. R., & Lucock, M. (2014). Contemporary issues surrounding folic Acid fortification initiatives. Prev Nutr Food Sci, 19(4), 247-260. doi: 10.3746/pnf.2014.19.4.247
- Creighton University. (2014, June 6). Vitamin D and the nursing mother. ScienceDaily. Retrieved February 26, 2015 from www.sciencedaily.com/releases/2014/06/140606184845.htm
Duffy, D.M. (2015) Novel contraceptive targets to inhibit ovulation: the prostaglandin E2 pathway. Hum Reprod Update, 21(5), 652-70. doi: 10.1093/humupd/dmv026. Epub 2015 May 29. Review.
Harvey, N. C., Holroyd, C., Ntani, G., Javaid, K., Cooper, P., Moon, R., . . . Cooper, C. (2014). Vitamin D supplementation in pregnancy: a systematic review. Health Technol Assess, 18(45), 1-190. doi: 10.3310/hta18450
Jordan, R. G. (2010). Prenatal omega-3 fatty acids: review and recommendations. J Midwifery Womens Health, 55(6), 520-528. doi: 10.1016/j.jmwh.2010.02.018
Kennedy, B. C., Dimova, J. G., Siddappa, A. J., Tran, P. V., Gewirtz, J. C., & Georgieff, M. K. (2014). Prenatal choline supplementation ameliorates the long-term neurobehavioral effects of fetal-neonatal iron deficiency in rats. J Nutr, 144(11), 1858-1865. doi: 10.3945/jn.114.198739
- Kim, J. H., Jeong, K. S., Ha, E. H., Park, H., Ha, M., Hong, Y. C., . . . Chang, N. (2015). Relationship between prenatal and postnatal exposures to folate and risks of allergic and respiratory diseases in early childhood. Pediatr Pulmonol, 50(2), 155-163. doi: 10.1002/ppul.23025
- Leung, B. M., Kaplan, B. J., Field, C. J., Tough, S., Eliasziw, M., Gomez, M. F., . . . Team, A. P. S. (2013). Prenatal micronutrient supplementation and postpartum depressive symptoms in a pregnancy cohort. BMC Pregnancy Childbirth, 13, 2. doi: 10.1186/1471-2393-13-2
- Millman, N. (2011) Iron in pregnancy: How do we secure an appropriate iron status in the mother and child? Ann Nutr Metab. 2011;59(1):50-4.
- Negro, R., Greco, G., Mangieri, T., Pezzarossa, A., Dazzi, D., & Hassan, H. (2007). The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. J Clin Endocrinol Metab, 92(4), 1263-1268. doi: 10.1210/jc.2006-1821
- Ozias, M. K., Kerling, E. H., Christifano, D. N., Scholtz, S. A., Colombo, J., & Carlson, S. E. (2014). Typical prenatal vitamin D supplement intake does not prevent decrease of plasma 25-hydroxyvitamin D at birth. J Am Coll Nutr, 33(5), 394-399. doi: 10.1080/07315724.2013.879843
- Paidi, M. D., Schjoldager, J. G., Lykkesfeldt, J., & Tveden-Nyborg, P. (2014). Prenatal vitamin C deficiency results in differential levels of oxidative stress during late gestation in foetal guinea pig brains. Redox Biol, 2, 361-367. doi: 10.1016/j.redox.2014.01.009
- Palan, P. R., Strube, F., Letko, J., Sadikovic, A., & Mikhail, M. S. (2010). Effects of oral, vaginal, and transdermal hormonal contraception on serum levels of coenzyme q(10), vitamin e, and total antioxidant activity. Obstet Gynecol Int, 2010. doi: 10.1155/2010/925635
- Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci, 17(13), 1804-1813.
- Patten, A. R., Sickmann, H. M., Dyer, R. A., Innis, S. M., & Christie, B. R. (2013). Omega-3 fatty acids can reverse the long-term deficits in hippocampal synaptic plasticity caused by prenatal ethanol exposure. Neurosci Lett, 551, 7-11. doi: 10.1016/j.neulet.2013.05.051
- Schroth, R. J., Lavelle, C., Tate, R., Bruce, S., Billings, R. J., & Moffatt, M. E. (2014). Prenatal vitamin D and dental caries in infants. Pediatrics, 133(5), e1277-1284. doi: 10.1542/peds.2013-2215
- Var, C., Keller, S., Tung, R., Freeland, D., & Bazzano, A. N. (2014). Supplementation with vitamin B6 reduces side effects in cambodian women using oral contraception. Nutrients, 6(9), 3353-3362. doi: 10.3390/nu6093353