Pregnancy nutrition begins well before conception takes place and it involves far more than looking at trimester specific energy requirements, despite the age old, and now largely understood, myth that pregnant women are 'eating for two'. Pregnancy nutrition actually begins in the 6 - 12 months prior to conceiving and there are many micronutrient and macronutrient specific considerations to be accounted for.
Appropriate pregnancy nutrition is ultimately about:
Supporting the mother's quality of life while pregnant and postpartum.
Increasing the chances of conception taking place and reducing risk of miscarriage.
Optimising the health of the newborn baby.
Pretty important, wouldn't you say?
To create a personalised and therefore safe and efficacious preconception and pregnancy nutrition and supplement plan I recommend getting started with a few key tests in the 6 - 12months prior to trying to conceive (TTC). This window of time allows a couple the opportunity to rectify any less than optimal outcomes before even trying to conceive. It could mean for less heart ache and a much smoother journey ahead!
Key tests to request include:
Urine iodine: iodine supports healthy thyroid hormone production and aids foetal neurodevelopment.
Vitamin D: in a study of 1,684 pregnant women done in 2015, vitamin D deficiency (<50 nmol/L) was associated with a two-fold increase in miscarriage in the first trimester.
TSH: untreated thyroid conditions during pregnancy are linked to serious problems so, it’s best to get a baseline reading to work from and monitor in pregnancy.
Iron studies, CRP and Full Blood Examination (FBE): a 2017 study demonstrated that as much as 12% of women are iron deficient going into pregnancy (worse in some populations), which is concerning given the significant demand for iron during pregnancy. Speaking from clinical experience, it becomes a much easier & less stressful pregnancy if you can enter it iron replete.
Folate (B9): it’s no secret the role folate plays in preventing neutral tube defects. Testing preconception allows for a tailored approach to folate supplementation.
Active B12 (holotrasncobalamin): it’s essential for healthy neonatal neurodevelopment and although the plant-based community are at greater risk of B12 inadequacy, if you’ve never been tested then don’t presume your levels to be adequate.
Zinc: also crucial to neurological development and again, the plant-based are at greater risk of deficiency, but they’re certainly not alone.
HbA1c: it can be used as a screening tool for gestational diabetes (not to be mistaken for a diagnostic tool). Being aware of levels preconception allows for monitoring throughout pregnancy.
Depending on where you are in the world these tests could be arranged via your primary care Dr or privately via your Nutritionist or Naturopath. In Australia, most of these tests can be arranged via a GP and are covered my Medicare, but not always. In speaking with a GP I recommend you address your request by saying something along the lines of:
"I would like to begin TTC naturally and in addition to the standard tests would you be open to supporting me with some more extensive blood testing so that I can tailor my preconception nutrition and supplements for my needs?". Here you would also highlight any dietary preferences (such as vegetarian and vegan) or history of nutrient deficiency that may further influence the need for testing. "I intend on working with a <insert your chosen practitioner e.g. Nutritionist> who can assist me with treating the result if required".
It's crucial that you consult someone trained in Nutrition on your results as 'Dr Google' and/or over the counter supplements won't cut it. I’m taking new clients in the clinic and virtually so please reach out if you'd like my support. Book a Complimentary 15-minute Discovery Call to get started.
References
Skeaff SA. Iodine deficiency in pregnancy: the effect on neurodevelopment in the child. Nutrients. 2011;3(2):265-273. doi:10.3390/nu3020265
Andersen LB, Jørgensen JS, Jensen TK, et al. Vitamin D insufficiency is associated with increased risk of first-trimester miscarriage in the Odense Child Cohort. Am J Clin Nutr. 2015;102(3):633-638. doi:10.3945/ajcn.114.103655
Alemu A, Terefe B, Abebe M, Biadgo B. Thyroid hormone dysfunction during pregnancy: A review. Int J Reprod Biomed. 2016;14(11):677-686. PMCID: PMC5153572
Fisher AL, Nemeth E. Iron homeostasis during pregnancy. Am J Clin Nutr. 2017;106(Suppl 6):1567S-1574S. doi:10.3945/ajcn.117.155812
De-Regil LM, Peña-Rosas JP, Fernández-Gaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2015;2015(12):CD007950. Published 2015 Dec 14. doi:10.1002/14651858.CD007950.pub3
Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev. 2008;66(5):250-255. doi:10.1111/j.1753-4887.2008.00031.x
Mathur NB, Agarwal DK. Zinc Supplementation in Preterm Neonates and Neurological Development, A Randomized Controlled Trial. Indian Pediatr. 2015;52(11):951-955. doi:10.1007/s13312-015-0751-6