This one is for all my expecting mamas out there. I am going to do a deep dive into what micronutrients are essential to be taking during pregnancy. For those of you who don't know, your health before, during, and after pregnancy has a huge impact on your baby's health as they develop and grow. While many factors impact maternal and baby health, I am going to focus specifically on nutrients of interest during pregnancy in this post. What to be taking, what food sources to get them from, and supplement recommendations to use when needed to complement your diet!
Unfortunately, the typical American diet leaves many expecting mothers nutrient deficient due to our high-calorie and low-nutritious food choices. Between fast food, processed food, and convenient food, most of us aren't eating the whole grains, fruits, and veggies our bodies need to get the proper nutrition for us, let alone our babies. Supplementation for vitamins is a great way to reduce risks associated with nutritional deficiencies, but of course, let's focus on food first!
Studies focused on supplemental recommendations during pregnancy are hard to come by as it wouldn't be ethical to restrict nutrients in this population. Therefore, research is limited, but I found this article that does a pretty good job summarizing all supplemental needs!
Fat-Soluble Vitamins: Let's begin by discussing the importance of fat-soluble vitamins during pregnancy. "Fat-soluble" simply means that these vitamins require dietary fat to be properly absorbed by the body. For example, eating an avocado with a carrot can enhance the absorption of vitamin A.
Vitamin A is a controversial supplement to take during pregnancy, and many prenatal vitamin formulas exclude it due to the risk of birth defects in the fetus. However, it is important to note that this vitamin also plays a crucial role in the development of the embryo. As a result, excessive or deficient amounts of vitamin A can result in developmental abnormalities. Vitamin A is essential to both the mother and fetus's immune function and overall health.
Recommendations: In Europe, the recommended intake is 540 ug per day while in the United States, it is 770 ug per day.
Food Sources: orange-colored fruits and vegetables (carrots, sweet potato, squash, peppers), tomatoes, beef liver, fish oils, milk, and eggs.
If you haven't already, check out my latest article on the link between vitamin D and depression in women, with a particularly strong correlation in pregnant women. Vitamin D deficiency has been associated with a range of other health issues including preeclampsia, gestational diabetes, emergency C-section, low birth weight, and small for gestational age (SGA). As a key component of the immune system, vitamin D has many other impacts worth considering.
Recommendations: In Europe and the United States at the minimum, the recommended intake is 600 IU per day with no reports of birth defects. But 1500 IU per day has been shown to improve blood levels of vitamin D, with an upper limit is 4,000 IU, which is considered safe. Before taking any supplements, I highly recommend having your blood levels checked by a professional to determine your vitamin D status and needs.
Food Sources: sunlight, fatty fish, fortified milk and juices, eggs, and yogurt. Also to improve vitamin D absorption, try pairing these sources with a calcium source, as calcium plays a significant role in vitamin D absorption.
Vitamin E has been identified as a safeguard against several pregnancy-related conditions, including preeclampsia, intrauterine growth restriction, and premature membrane rupture. It has also been shown to trigger the release of prostacyclin, a prostaglandin that serves as both an anticoagulant and vasodilator. During pregnancy, this can help to expand the cervix and trigger uterine contractions, leading to childbirth. As pregnancy progresses, vitamin E and prostacyclin levels increase. Low levels of vitamin E have been linked to a higher risk of SGA babies, preeclampsia, and gestational diabetes.
Recommendations: The recommended intake of vitamin E is 11 mg per day in Europe and 15 mg per day in the United States. Currently, the World Health Organization does not recommend taking vitamin E supplements to enhance pregnancy outcomes.
Food Sources: Although supplementation may not offer any benefits, it is not harmful to take them, and incorporating natural sources into your diet is a great way to start. Foods rich in vitamin E include nuts, seeds, avocados, spinach, and eggs.
Vitamin K plays an essential role in blood clotting and the formation of bones. It's important to note that maternal intake of vitamin K does not affect the newborn's need for it at birth to prevent hemolytic disease. Therefore, newborns are given a vitamin K shot after birth to prevent vitamin K deficiency, although research on this subject is limited.
Recommendations: In Europe is 70 ug per day and 90 ug per day in the United States.
Food Sources: dark leafy greens, broccoli, and brussel sprouts.
Water-Soluble Vitamins: Now let’s talk about water-soluble vitamins. These vitamins are a group of essential nutrients that are not stored in the body and need to be replenished regularly through diet or supplementation. Excess amounts of water-soluble vitamins are excreted in urine, making it important to consume them regularly to avoid deficiency. Now which ones are critical during pregnancy?
Vitamin B6 is crucial in supporting neural fetal development, particularly in the formation of neurotransmitters and metabolism. Studies indicate that supplementation may aid in alleviating mild nausea during pregnancy and can be helpful for women who are unresponsive to iron supplements and suffering from anemia.
Recommendations: The recommended intake for pregnant women is 1.8 mg per day in Europe and 1.9 mg per day in the United States.
Food Sources: Fish, meat, poultry, eggs, legumes, and nuts.
Folic acid is a crucial vitamin that helps prevent neural tube defects in unborn babies. It is widely known that women should supplement with folic acid even before getting pregnant.
Recommendations: The recommended daily intake in Europe is 600 ug and 400 ug per day in the United States, with an upper limit of 1 mg.
Food Sources: naturally in lentils, beans, leafy greens, broccoli, edamame, asparagus, and avocado.
Vitamin B12 and folic acid have a close relationship with each other, as B12 works to ensure that adequate folic acid is available in the body. When these vitamins are deficient, it can lead to a range of complications, including spontaneous abortions, low birth weight, and developmental anomalies (such as neural tube defects). Macrocytic anemia is a common symptom of B12 deficiency.
Recommendations: Pregnant women are recommended to consume 4.5 ug per day in Europe while the United States recommends a lower amount of 2.6 ug per day.
Food Sources: Natural sources are typically found in animal products such as meat, eggs, dairy, and fish. Plant-based sources include fortified soy milk, cereal, orange juice, and nutritional yeast.
Other Nutrients and Minerals
Calcium is essential for maintaining strong bones, which is common knowledge. However, it also plays a crucial role in fetal bone mineralization and maternal bone density, making adequate amounts vital during pregnancy. Calcium has also been linked to blood pressure regulation and the prevention of preeclampsia in high-risk groups.
Recommendations: In both Europe and the United States, pregnant women are advised to consume 1000 mg per day of calcium.
Food Sources: Dairy products, nuts, tofu, canned fish with bones, and dark greens are all excellent food sources of calcium. Keep in mind that vitamin D is necessary for calcium absorption, so make sure you're getting enough vitamin D to absorb the calcium you're consuming.
Iodine is an essential mineral for the production of thyroid hormone. An iodine deficiency can lead to reduced maternal thyroid function and may be linked to impaired neurodevelopment, cognitive development, behavior issues, and learning skills in the baby.
Recommendations: There is also a concern about over-supplementation. Therefore, the recommended daily intake of iodine is 200 ug per day in Europe and 220 ug per day in the United States.
Food Sources: To ensure adequate iodine levels, it is advised to consume natural sources such as eggs, freshwater fish, and iodized salt.
Iron is a critical mineral during pregnancy. An iron deficiency in the first two trimesters can increase the risk of low birth weight, preterm labor, and iron deficiency in infants. However, it's not recommended to supplement with iron routinely due to the negative impact of high levels on immunity.
Recommendations: The recommended daily intake is 16 mg per day in Europe and 27 mg per day in the United States.
Food Sources: Dietary options should always be your primary plan, and choose foods with heme iron, which is usually found in red meat since it has higher bioavailability, making it more readily absorbed. Plant sources of non-heme iron include nuts, dark green vegetables, legumes, and nuts. It's important to note that vitamin C increases the non-heme form of iron, so pairing plant sources of iron with vitamin C increases their ability to be absorbed. Even before getting pregnant, it's essential to have your iron levels checked by a doctor to determine your iron status.
Magnesium plays a crucial role in preventing preterm uterine contractions; therefore, a deficiency may increase the risk of preterm labor or birth. Additionally, lower levels of magnesium have been observed in women with high blood pressure disorders during pregnancy.
Recommendations: The recommended daily intake of magnesium during pregnancy is 300 mg per day in Europe and 350 mg per day in the US.
Food Sources: To increase magnesium intake, consider adding natural sources such as nuts, seeds, legumes, and whole grains to your diet.
Zinc deficiency can lead to an increased risk of infection and dermatitis, while also affecting early neonatal brain development. Alcohol consumption can interfere with zinc transport to the placenta, causing a deficiency that increases the risk of growth retardation. This is a key reason why alcohol is not recommended in any amount during pregnancy. Dietary phytate, which is present in plant-based foods, can hinder zinc absorption.
Recommendations: For those following a diet high in grains and legumes, the recommended zinc intake in Europe is 14.3 mg, while for those following a diet that is high in meat but low in legumes and grains, the recommended zinc intake is 9.1 mg. In the United States, the recommended intake is 11 mg per day, but for those following a vegan diet, it should be 50% higher.
Food Sources: Natural sources of zinc that are safe during pregnancy include red meat, cashews, poultry, and fortified cereals.
Omega-3 fatty acids are crucial for a healthy pregnancy. Adequate intake of these nutrients is associated with positive outcomes for both the mother and fetus. In particular, DHA – a type of omega-3 – is essential for developing cell membranes in the brain and retina, as well as fetal development. Low levels of maternal omega-3 may increase the risk of postpartum depression.
Recommendations: The European recommended daily intake of DHA is 250mg per day, with an additional 200mg recommended during pregnancy. By consuming adequate amounts of omega-3, expectant mothers can give their babies the best possible start in life.
Food Sources: To ensure a healthy pregnancy, it's important to consume foods that are rich in omega-3, such as fatty fish (e.g. salmon, herring, and trout). However, it's equally important to avoid fish that contain high levels of mercury or dioxin, such as swordfish, king mackerel, and tilefish.
Conclusion: Congratulations on making it this far! I know that was a lot of information to take in – perhaps more vitamins, minerals, and nutrients than you initially thought were important for pregnancy. Ideally, your primary goal should be to obtain all necessary nutrients from food, but this is not always the case. Therefore, taking a prenatal vitamin may be necessary to meet your micronutrient requirements. For optimal results, I highly recommend a prenatal vitamin that is third-party certified and contains similar amounts of vitamins and minerals as the recommendations above. If you are considering taking additional supplements with the prenatal, please consult your doctor first and consider having blood work done to determine exactly what you need.
I hope you found today's post helpful and please share it with someone who may benefit from reading it.
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-Samantha Runshaw, RD
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