Without adequate supply of certain essential nutrients, your body cannot sustain a pregnancy. Vital micronutrients are crucial to supporting the healthy growth and development of a new life. Deficiency of essential micronutrients, are associated with significant reproductive risks ranging from infertility to impaired fetal development and long term disease predisposition in the infant.
Our health and nutrient status prior to conception plays a significant role in our ability to fall pregnant and to maintain a healthy pregnancy. Our preconception health also greatly impact fetal development including congenital abnormalities, disrupted fetal growth, premature birth as well as pregnancy complications in the mother.
Below are the most important nutrients to help improve fertility and the progression of a healthy pregnancy and healthy baby.
Folate, also known as vitamin B9, is necessary to maintain healthy hormone balance and ovarian function. It also plays a critical in the development of DNA and is therefore essential to embryo development. Having sufficient folate in our system is vital to support conception the healthy growth and development of your baby. Without sufficient folate, you cannot sustain a pregnancy. Women with low folate levels are at increased risk of miscarriage and birth defects. Folate is an essential nutrient, which means we are totally reliant on dietary sources for adequate supply.
Folate supports development of the neural tube, which connects the brain and the spinal chord. This chord enables the brain to communicate with the rest of the body. Complete development and closure of this neural tube occurs in the first 5 weeks of pregnancy, before you may even be aware you’re pregnant. So it’s vital to boost your folate intake before you conceive. Failure of the neural tube to properly develop can lead to miscarriage or birth defects.
Folate also helps to reduce homocysteine levels. Homocysteine is a marker of inflammation in the body and can impact fertility and pregnancy. High homocysteine levels are common in people with high stress, high cholesterol or other disease states. High homocysteine levels are also more common in women with Polycystic Ovarian Syndrome (PCOS).
Some women with PCOS may be prescribed insulin sensitizers such as Metformin, to help improve ovulation function. This can be effective in many women, however these drugs also deplete folate levels, therefore a high folate diet and supplementation is essential for these women particularly. This is also the case for women losing weight. Although weight loss (to reach a healthy BMI) is highly beneficial to fertility and conception, homocysteine levels rise during this period and an adequate supply of folate becomes even more important.
Women taking folate supplements have been found to have higher quality eggs and a higher level of maturity in their eggs than women who don’t supplement. Folate is also vital for early embryo development. The amount of folate present in the egg and sperm at the time of fertilisation, impacts the development of the embryo.
Asparagus, brusel sprouts, romaine lettuce, beans, soy beans, lentils, peas, sweet potato, broccoli, great leafy vegetables, sprouts, oranges, oatmeal, wheat germ
Should I supplement?
Unfortunately folate is a very unstable nutrient, which means it is easily lost during cooking and processing, therefore it is difficult to know exactly how much folate your food is providing. For this reason it’s best to eat high folate foods as fresh and raw as possible and during the crucial time of preconception and pregnancy, supplementation is highly recommended.
The common supplemental form of folate is folic acid. Many people use terms folate and folic acid interchangeably, however folate is the natural nutrient used by the body and folic acid is a synthetic supplemental source of folate.
Whilst folic acid is still the most commonly recommended form of folate, its important to not that a common genetic polymorphism, found in up to 50% of women, impairs the body’s ability to convert synthetic folic acid into natural folate. This polymorphism can significantly impact folate levels, which subsequently affects hormone function, ovarian function, ovulation, embryo development as well as risk of miscarriage, birth defects and your ability to conceive.
Calcium folinate/folinic acid is a supplemental form of folate, which bypasses many of the metabolic steps to folate for more efficient folate uptake.
Calcium folinate/folinic acid has been shown to raise plasma folate levels more effectively than folic acid and so may be beneficial for those who may have metabolic difficulties.
A supplement providing both folic acid and folinic acid can help optimise folate uptake.
Recommended therapeutic dose for preconception – minimum 500mcg of folate
Choline is an essential nutrient involved in the development, structure and function of every cell in our body. You cannot sustain life without choline.
During pregnancy it is particularly essential alongside folate for the development of the neural tube, which occurs within the first 5 weeks of pregnancy, before you may even be aware you’re pregnant. So boosting choline prior to conception is recommended.
Choline also helps support healthy brain development, supports healthy growth of the placenta as well as reducing the risk of miscarriage.
“The importance of choline cannot be overstated as we continue to unravel the role it plays in human health and development” Gerald Weissmann MD, Editori-in-Chief FASEB Journal
Choline levels in the Mother have been shown to affect the longer term health of the infant including improved learning and memory and reduced stress and anxiety levels.
‘Choline in the diet of the pregnant mother and infant is directly related to permanent changes in brain function. Without enough choline during the critical time of brain growth and development, intelligence, memory and possibly mood regulation will be damaged permanently. We may not be able to measure the exact impact on IQ or other brain functions, but we do know enough at this point to start preaching the choline message’. A review in the Journal of Pediatrics concluded
lecithin granules, eggs, beef, salmon, chicken, baked beans, kidney beans, lentils, brussel sprouts, broccoli, spinach, cauliflower, wheatgerm, oats and milk.
Should I supplement?
Research shows that 90% of women aren’t reaching their recommended adequate intake of this important nutrient so supplementation during the preconception period is highly recommended. Choline is one of the ‘newer’ nutrients, only added to the list of required human nutrients in 1998. It was previously believed that our bodies produced enough choline from other nutrients however recent data shows that dietary intake is essential to meet the body’s demand, especially during the important months of conception, pregnancy and breastfeeding. Ideally look for a good quality prenatal supplement which includes choline.
Choline is commonly available in the form of
- choline chloride
- choline bitatrate
Choline chloride and bitatrate provide a higher dose of measurable choline however phoshytidylcholine is a more natural source as found in foods such as lecithin. All are fine choices to help boost choline levels.
Recommended therapeutic dose for preconception – 400mg – 500mg of choline per day
Vitamin B12 works alongside folate and iron in the synthesis of DNA, which is vital for growth and development. Vitamin B12 deficiency is linked to sub-fertility and infertility. Low levers are linked to a reduced ability to fall pregnancy as well as increased risk of miscarriage. Lack of this critical nutrient during pregnancy can also impact the long-term health of the child.
Vitamin B12 helps support regular ovulation and aids in the healthy development of the endometrium lining to enable successful fertilization. Vitamin B12 also works alongside folate and B6 in the reduction of homocysteine, high levels of which can impair fertility.
The good thing about vitamin B12 is that deficiency can be quickly and easily rectified through a healthy intake of vitamin 12 rich foods and supplementation. When supplementing either folate or vitamin B12, it’s best to take these important nutrients together. This is not only due to their unique combined action but also because high folate levels can mask vitamin B12 deficiency. A good prenatal multivitamin should provide healthy doses of both these important nutrients.
The source of Vitamin B12 should be the same in all supplement brands. For those with very low vitamin B12 and digestive issues, some supplements come in sublingual form which are dissolved directly through the mouth which may help speed metabolism.
Beef, crab, clams, oysters, lamb, tuna, trout, salmon, sardines, veal, milk, yoghurt, cheese, eggs
Recommended therapeutic dose for preconception – 100 – 500mg per day
Vitamin B6 is required for hormone production and regulation. Therapeutic doses of vitamin B6 are commonly used in the treatment of hormonal conditions including PMT, PMS, menstrual regulation and morning sickness of pregnancy.
Women are more likely to be deficient in vitamin B6 than men. Although the reason for this is unknown it may be due to its role in hormone regulation. Vitamin B6 is also more common in women taking the Pill with research showing that up to 40% of women using this form of contraception, have biochemical evidence of deficiency.
Due to its hormone balancing properties, research shows that vitamin B6 may have a positive impact on fertility and the progression of a healthy pregnancy.
There is a direct link between a high processed diet and vitamin B6 deficiency. Those following a whole food diet are significantly less likely to be deficient in B6. However even healthy diets struggle to reach a therapeutic level of vitamin B6, therefore supplementation can be beneficial if indicated.
Fish, chicken, veal, pork, beef, eggs, lentils, split peas, kidney beans, peanuts, walnuts, sunflower seeds, avocado, bananas, brussel sprouts, sweet potato, carrots, peas, whole grains
Vitamin B6 comes in an ‘activated’ and regular ‘non-activated’ form. Activated forms can be beneficial for those with metabolic issues however these should only be taken on the recommendation of your Health Care Professional. Non-activated B6 is the best option for general use. Your prenatal multivitamin should provide sufficient B6.
Recommended therapeutic dose for preconception – 50 – 100mg per day (more may be prescribed by your Health Care Professional however this does should not be exceeded unless under medical supervision)
Vitamin D has such diverse and widespread activity in the body that researchers are actually calling it a pro-hormone rather than just a simple vitamin.
Vitamin D plays a vital role in fertility due to its role in the production and regulation of sex hormones. Vitamin D deficiency is extremely common affecting around 80% of women and has been found to be more common in women visiting fertility clinics. In a study from Yale University School of Medicine it was found that only 7% of infertile women, had normal levels of vitamin D.
Vitamin D is vital for healthy fertility. Research shows that women with healthy vitamin D levels are twice as likely to successfully fall pregnant than those with low levels. Women with healthy vitamin D levels are also likely to have better quality embryos and a greater chance of an embryo implanting in the uterus.
A recent review of current data relating to the impact of vitamin D deficiency on fertility showed that healthy vitamin D levels improve fertility and ability to conceive and carry a healthy pregnancy. Healthy vitamin D levels are associated with higher rates of successful pregnancy in those undergoing IVF treatment. Studies suggest that this may be due to a role in improving implantation and immune balance to support acceptance of the embryo. Supplementation was also found to be effective in improving fertility issues associated with Polycystic Ovarian Syndrome (PCOS). Another study showed that women with PCOS have been found to have lower levels of vitamin D than healthy, fertile women.
There are limited food sources of vitamin D, these include
Milk, butter, salmon, tuna, cod liver oil, herring liver oil, prawns, egg yolk
The most potent natural source is sun exposure.
Vitamin D is widely available in tablet form, there are also newer sprays available which report a possible higher absorption for those who may struggle to metabolise through the gut. Look for a prenatal supplement which provides 1000iu of vitamin D.
Recommended therapeutic dose for preconception – 1000IU per day
Iron works in combination with folate and vitamin B12 in the development of DNA and is therefore essential to healthy fetal development. Severe iron deficiency is associated with reduced fertility and conception rates and negatively impacts the progression of a healthy pregnancy.
However, it is important to remember that iron is a heavy metal. It is stored in our fat reserves and our body has no means by which to excrete excess. Therefore, supplementation should be monitored and never exceed the recommended dose unless under medical supervision.
Australian, New Zealand, US and Canadian guidelines recommend an intake of 18mg prior to conception increasing to 27mg during pregnancy, with an upper safe limit of 45mg. Varying standards exist across the globe with the World Health Organization recommending maximal supplementation of 60mg for a maximum 6 months of pregnancy only whereas the UK don’t recommend to supplement unless anaemia has been diagnosed and intake both prior to and during pregnancy is recommended to be 14.8mg per day. Either way, high dose supplementation should not to self prescribed.
There are 2 different forms of iron, heme iron from meat sources and non-heme iron from vegetarian sources. Heme sources are more quickly and easily absorbed than non-heme sources, however metabolism of non-heme sources increases when iron levels are low. Therefore vegetarians can get enough iron from their diet so long as the include plenty of vegetarian iron sources.
Oysters, Beef, Turkey, Chicken, Pork, Fish
Soybeans, lentils, kidney beans, molasses, spinach, tofu, leafy greens
There are varying forms of iron supplements, the most common being
- ferrous sulphate
- ferrous fumarate
- iron amino acid chelate.
Ferrous sulphate is the cheapest form of iron but also the least well absorbed and most likely to cause gastric disturbance and constipation. Ferrous fumarate is a more natural source with slightly better absorption and potentially reduced side effects. The best form of iron supplement to look for within your prenatal supplement is an iron amino acid chelate. Chelated minerals are more easily absorbed by the body resulting in a better uptake into cells and greatly reduced incidence of side effects.
Recommended therapeutic dose for preconception – 8 – 24mg per day
Iodine is used by the body to produce the thyroid hormones triiodothyronine (T3) and thyroxine (T4). Healthy thyroid function is essential for fertility, conception and healthy fetal development. If the thyroid does not have sufficient iodine to produce adequate thyroid hormones this can cause ovulatory problems and inability to ovulate, which can result in infertility.
Iodine during pregnancy is vital for healthy brain and nervous system development. Lack of iodine during pregnancy is the most common cause of preventable mental retardation worldwide. In severe cases, deficiency of this essential nutrient can cause cretinism; symptoms include severely stunted physical and mental growth.
Iodine deficiency is a common worldwide health problem. The average western diet is very low in iodine and therefore the World Health Organisation recommend supplementation during pregnancy. Most of the world’s iodine in found in the ocean, this is why seaweed is one of your best sources of dietary iodine. Women who are currently taking thyroid medication or who have a pre-existing condition should consult their Health Care Professional before taking iodine supplements.
Seaweed and other sea vegetables, fish, shellfish, yoghurt, cow’s milk, eggs, strawberries, mozzarella cheese
Potassium iodide is the most common form of iodine found in prenatal supplements. Iodine can also be supplemented as kelp tablets.
Recommended therapeutic dose for preconception – 150 – 250mcg per day
Zinc is vital for healthy ovulation. As the egg reaches maturation and prepares for release at ovulation, major biochemical changes take place to prepare the egg for potential fertilization. This process is critically dependent on zinc. Zinc levels within the egg have been shown to increase by 30 – 50% during this time.
Overall zinc levels within the body have a significant effect on the egg maturation process impacting fertilization and embryo development. Acute zinc deficiency has been found to cause profound defects during this period, which can prevent ovulation and fertilization. A clinical trial showed that a zinc deficient diet 3 – 5 days before ovulation dramatically disrupted the maturation process. Ovulation rates remained similar in the acutely zinc deficient group however the zinc deficient diet significantly reduced fertilization rate by almost 50% and in those eggs that were fertilised the embryos were less competent. If pregnancy does occur, continued zinc deficiency can lead to significant developmental issues in the fetus.
Zinc also supports the absorption of folate, which is vital for conception and early prenatal development.
Oysters, shellfish, canned fish, red meat, pork, hard cheese, nuts, pulses, wholegrain
Recommended therapeutic dose for preconception – 15 – 40mg per day
Antioxidants help protect the body, and in the case of fertility the precious developing egg, from free radical damage.
Free radicals are basically damaged cells, which are described as ‘free’ because they are missing a critical molecule which spurs them to seek out other molecules to pair with. Unfortunately when these free radicals pair with another healthy cell, they can damage that cell, often injuring the DNA, which can lead to development of disease or simply accelerate the aging process.
The simple process of living creates a small amount of free radicals, which increases as we age. Factors such as smoking, alcohol, exposure to toxins, stress and poor diet increase the amount of free radicals our body produces.
Antioxidants assist by pairing with these free radicals and deeming them harmless. This stops them from pairing with, and damaging, other healthy cells.
As a general rule the more colourful the food, the greater the antioxidant content. For example, blueberries, strawberries, tomatoes, cherries, gogi berries, ………………..
There are may supplementary sources of antioxidants, some good ones include
- Vitamin C
- Vitamin E
- Co enzyme Q10
- Lipoic acid