Chances are, you’ve heard about some of the recommended dietary changes for women who are pregnant: limit caffeine, stay away from raw shellfish, and limit alcohol, among others. We’ll dive into nutrition DURING pregnancy in our next blog post later this month (get excited!) but did you know that there are also evidence-based dietary recommendations for women BEFORE conception?
Why are some dietary changes important before pregnancy though? Can’t you just adjust once you know you’re pregnant? The reality is that some critical periods of development can take place in an embryo before a woman may even know she’s pregnant (1). In fact, the majority of these developments take place within the first eight weeks after conception and establish the foundation for important structures like the neural tube, heart, eyes, and limbs, among others (1).
For these critical developments to occur as they should, the expecting mother must have an adequate amount of the right nutrients available in her body. This is where the preconception dietary recommendations come into play. Don’t worry though, while these recommendations are important to help mama and baby have a healthy pregnancy from day one, most of them likely won’t overhaul the way you eat right now, they’ll just be little tweaks!
Let’s start by looking at folate: having enough folate before conception can help reduce the risk of neural tube defects (which can cause serious and life-threatening complications for a baby) and can also lower the risk of delivering a baby that is small for gestational age (2). So where can you get some folate in your diet? It can be found in green leafy vegetables like spinach and Brussels sprouts, avocados, legumes, and many other foods (3,4). You may also hear that folic acid, the synthetic form of folate that is used in supplements and fortified in refined grains in the United States, is a way to make sure you're getting enough folate before pregnancy (3).
It's not that simple though, and here's why: folate needs to undergo a series of chemical reactions before your body can use it (5). There's a critical enzyme that helps you convert folate into a useable form and it's known as MTHFR (5,6). If you have a specific polymorphism in the gene that codes for this MTHFR enzyme, you may not be able to properly use the folate or folic acid you consume (5,6). It's actually quite common to have a polymorphism in the gene that codes for this enzyme. In fact, 30-45% of the population may have a polymorphism that prevents MTHFR from converting folate to a form that your body can use (5). Have no fear though, that doesn't mean you're out of luck, it just means you most likely need to supplement with methylfolate, a form that your body can directly use (5). As with all supplements though, it’s important to talk to your doctor and your registered dietitian before starting anything new because we all have different needs and not all supplements are created equal.
While you want to be sure you’re getting enough folate, you also want to make sure you aren’t overdoing it on Vitamin A. Don’t get me wrong, you still need an adequate amount of Vitamin A for a healthy pregnancy so don't go cutting out foods with this nutrient. However, the main concern in developed countries is an excessive intake of Vitamin A (7). If a woman has too much Vitamin A stored in her body once she conceives, it can increase the risk of facial and heart abnormalities within the fetus (2). To avoid having too high of Vitamin A levels, it is recommended that women consume less than 10,000 IU per day (7). Consuming more than 10,000 IU of vitamin A per day is only a concern when a woman is taking in high amounts of vitamin A in supplement form.
In addition to getting the right balance of folate and vitamin A, iodine is also an important nutrient to consider. Adequate iodine intake can help reduce the risk of hypothyroidism in both the mother and the fetus/neonate (7). To make sure you're getting enough for you and your baby, a daily intake of 220 mcg is recommended during pregnancy (7). While iodized salt used to take care of meeting our daily iodine needs, Americans are using different salts more frequently than in the past (think sea salt, Himalayan salt, etc. (7). No worries, you don’t have to switch back to iodized salt just to meet your iodine needs. Plus, getting your nutrients through food is often best! You can incorporate eggs, seafood like shrimp and oysters, seaweed, fish such as cod, and nonfat milk to help you get your iodine (8,4).
While folate, Vitamin A, and iodine are some of the big hitters, this is by no means an exhaustive list. Pregnancy comes with a lot of changes and that means some preparation can pay off in the long run. Additionally, don’t forget that you, and everyone else for that matter, are unique in your nutritional needs! That means your pre-pregnancy needs may differ from someone else’s. If you're in the pregnancy-planning stages and are wondering how you can best adjust your nutrition for you and your future baby, reach out to a registered dietitian to help you create the best individualized path forward!
References:
1.) Hill, M.A. (2020, October 13) Embryology Human-critical periods of development.jpg. Retrieved from https://embryology.med.unsw.edu.au/ embryology/index.php/File:Human-critical_periods_of_development.jpg
2.) Learning, C. (2018). Nutrition Through the Life Cycle Chapter 2: Preconception Nutrition Periconceptional Folate Status: Cengage Learning.
3.) Supplements, N. I. o. H. O. o. D. (2020). Folate Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/#h3
4.) Nichols, L. (2018, August 2018). Basics of Real Food Prenatal Nutrition. Paper presented at the Women’s Health Nutrition Academy.
5.) Romm, A. MTHFR: What the Bleep is It? Retrieved from https://avivaromm.com/mthfr-what-the-bleep/
6.) Upendra Yadav, P. K., Sushil Kumar Yadav, Om Prakash Mishra, Vandana Rai. (2014). Polymorphisms in folate metabolism genes as maternal risk factor for neural tube defects: an updated meta-analysis. Metabolic Brain Disease, 7-24. doi:10.1007/s11011-014-9575-7
7.) Garner, C. D. (2020). Nutrition in Pregnancy. UpToDate Retrieved 10/1/2020, from UpToDate
8.) Supplements, N. I. o. H. O. o. D. (2020). Iodine Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/#h3