• Preconception Nutrition and Health

    by Renee Cotter, MD
    on Sep 24th, 2015

Only three weeks after conception, an embryo begins the formation of organs and the structure that eventually develops into its brain and spinal cord. Three weeks after conception, most women are still unaware that they are pregnant. So, if you are planning to have a baby soon, it’s important to make sure your body is already in tip top shape. By the time you miss a period, the first sign of pregnancy for many women, you are already two to three weeks into your pregnancy. Four weeks after fertilization, a baby has already closed its neural tube (structure that forms the brain and spinal cord) and its heart has begun to pump fluid. 



Your body works with what it’s got to begin building a brand new human. Nutrition, body composition, and exercise are all important components on preparing your body for the demanding nature of pregnancy. What’s even more shocking is that your lifestyle can actually alter your developing baby’s genes. In other words, even though their genes are normal, certain factors cause their genes to either work on over-drive or not really work at all! Healthy preconception is all about balance; finding that amount of nutrients that’s just right for your body. Undernourishment and overnourishment both lead to health complications for you and your offspring. This week, we will discuss, in detail, the importance of preconception nutrition as well as other factors that affect your health and your baby’s health, early into pregnancy.

Risks of poor nutrition and health on your developing baby:

Risks of poor nutrition and health on you:

 

Lifestyle for Two

Because you are and your partner are planning to become pregnant, it is important to optimize your health so that when you do become pregnant, you are confident your baby has all the tools in your body to thrive and begin building right away.

Immediately after fertilization, cells begin to form and divide. Just three weeks after fertilization, your embryo begins to develop its organs. Cells get a set of instructions that tell them what type of tissue to turn into and then begin multiplying, this is called ‘differentiation’. This time of development and differentiation is the most important and sensitive time for your baby and most birth defects occur during this period. Without the proper nutrients or with exposure to other harmful stimuli, your baby is at risk of permanent damage. For this reason, it is important to prepare in advance for pregnancy. Begin by treating your body as though you are already pregnant because once you do realize you’re pregnant, many organs and tissues have already begun developing or are finished developing. Just 10 weeks after you conceive, your baby’s organs are almost completely developed.

Three weeks after fertilization:

Four weeks after fertilization

 

DNA and Epigenetics

DNA is the base of all existing life forms, including humans. DNA is like a blueprint. It contains all the information and instructions necessary to build a unique human. DNA is inside every cell and every cell uses its DNA to accomplish tasks. For example, a pancreatic cell has DNA inside it that tells it how to make the hormone, insulin. When sperm and egg unite at conception, a baby’s DNA is instantly formed and every one of the millions of cells within that baby contains that same exact DNA. For a long time, it was thought that DNA could never be altered. Now, it is known that the information contained in the DNA itself cannot be changed, but it can be modified.

Epigenetics refers to the way environment modifies how DNA works. Because a baby develops within your body, your body is an environment for your baby. Food, chemicals, stress, and bacteria are some of the components of the environment you create for your baby. All these components can then cause certain parts of your DNA to be “turned on” or “turned off”. Imagine DNA as instructions on a paper.

You can use White Out to cover up some lines of instruction or a Highlighter to make other lines of instruction more noticeable. The instructions themselves are not actually changed; just covered up or highlighted.This is basically how “turning off” or “turning on” DNA works. The environment of your body uses vitamins, minerals, sugar, fat, stress, and so much more to make similar modifications to your baby’s DNA.

This is how the food you eat during pregnancy plays an important role in the health of your future offspring, especially in those first few weeks. Some changes that occur during pregnancy are permanent, while others are reversible. Maintaining a balanced diet with the appropriate amount of vitamins and minerals to meet pregnancy needs is essential for the overall health and livelihood of your baby as it grows and enters adulthood. This new understanding of health before, during, and shortly after pregnancy and its permanent effects on the baby will hopefully cause a movement of preconception and perinatal nutrition.

 

Nutrition

Nutrition in preparation for and during pregnancy is very complicated and constantly changing depending on the state of pregnancy. Vitamins and minerals are tiny compounds that naturally interact with each other in the body and are one of the reasons why nutrition around pregnancy is complicated yet important. If you think about the new human growing inside of you, it’s not hard to imagine the millions of intricate and tiny processes that occur and require an increase in nutrients. All the nutrients you ingest create the building blocks your baby will use as it develops. By eating a well-balanced diet, and supplementing when necessary, you can create the perfect foundation for an optimally healthy baby! The power is truly in your hands.

Nutrition can be broken down into two major components:

  1. Macronutrients
  2. Micronutrients

 

Macronutrients

Macronutrients refer to the three components of your diet you need in large amounts. The three macronutrients are carbohydrates, protein, and fat. A good balance of these macronutrients is important throughout your life, but especially when you are planning on becoming pregnant. By maintaining a healthy and consistent spread of carbs, protein, and fat, you are laying the foundation for a healthy pregnancy. Water is another important component of a healthy diet, especially during pregnancy because your blood volume increases and women need extra water to be able to keep up with this demand.

Carbohydrates

Carbohydrates include starches, grains, vegetables, fruits, and dairy. Together, they should compose 50% of your calories. More important than getting 50% of your calories from carbs is the quality of the carbs consumed. Choose carbs low in added sugar, salt, and fat and high in fiber and natural nutrients. For example, choose a whole-wheat bread with 5 grams of fiber over a white bread with less than 1 gram of fiber. Fiber prevents sugar from being quickly absorbed into your blood and also helps keep cholesterol levels normal. When choosing a vegetable or fruit, go for colorful, dense options over pale, watery options like a carrot versus a potato. 

It’s important to limit consumption of added sugars as these have been shown to negatively, epigenetically modify your developing baby.

Fats

Fats should compose 30% of your daily calories. There are three types of fat: unsaturated, saturated, and trans. Unsaturated fat should compose 20% of calories while saturated fat should compose the remaining 10% of calories. Trans fats should always be avoided.

Unsaturated fats:

Saturated fats:

Omega 3s

Omega-3 fats are another type of fat. It is found in flax seeds, chia seeds, fatty fish, walnuts, and fortified food items. Omega-3 fats are important for the development of your baby’s brain and part of its eye tissue. It also helps prevent perinatal depression and determine gestational length. Pregnant women should consume 200 mg Omega 3 fats each day or 1200 mg each week. This can be achieved by consuming salmon, mackerel, or trout 1-2 times per week or by consuming 1 tablespoon of flax seed/flax seed oil per day.

Protein

Protein should compose at least 20% of daily calories and is a very important component of a body preparing for pregnancy. Proteins include meats, poultry, fish, tofu, beans/legumes, eggs, and high protein yogurt like greek yogurt. It is important to get enough protein as protein is used to build fetal tissues and the placenta early in pregnancy. Women should consume more protein if they live a very active lifestyle or exercise frequently. Protein malnutrition during pregnancy can also cause epigenetic modifications that cause the offspring to store more fat through their life. This means that the offspring is more prone to obesity and therefore other health complications due to a low protein diet in pregnancy.

Micronutrients

Micronutrients refer to the many components of your diet that are still essential for your body’s function, but that you need in smaller amounts. For example, you don’t think about slicing up a loaf of pure calcium, but you do know that by drinking a glass of milk, you will be getting some of the calcium your body needs. The two main categories of micronutrients are vitamins and minerals.

Vitamins:

*Discussed below

Minerals:

All discussed below

Vitamins

Vitamin A: 20% increase 

Vitamin A is an important vitamin early in pregnancy because it is used in the development of the embryo’s heart, eyes, ears, and limbs. It also plays an important at week three after conception when cells get their assigned function and begin to multiply. Vitamin A is also important in the mother as it improves iron deficiency anemia and immune function.

Though Vitamin A is very important, it is also associated with birth defects when it is over consumed in the supplemental form. (Vitamin A found naturally in foods is not related to birth defects). Women should get no more than 3,000 IU of supplemental Vitamin A per day. Because many foods contain added Vitamin A, is is important to check your food labels for hidden Vitamin A fortification in food. For this reason, if you decide to take a Vitamin A supplement, make sure it is at a dose less than 1,500 IU. Skin products are also a hidden source of Vitamin A. Any skin treatments that contain Retinoid or Retinol should be avoided during pregnancy and discontinued several months before planning to become pregnant.

Vitamin A is high in orange and red foods such as carrots, sweet potato, mango, and peaches. It is also high in dark leafy greens such as spinach and broccoli.

Folic Acid: 147% increase 

Folate and Folic Acid are used interchangeably. It is one of the most important vitamins because of its role in forming the neural tube. Because the neural tube closes just four weeks after conception, it is very important to begin supplementation with folic acid if you are planning to become pregnant. Folic acid is heavily used by your body at 20 days after conception so being replete as this time is essential.

Inadequate folic acid is associated with neural tube defects such as spina bifida and anencephaly. It is also linked to cleft lip, cleft palate, limb defects, and heart defects.

Folic acid for pregnancy preparation is best taken in a supplemental form at 800 mcg per day. Natural forms of folate are not absorbed well by the body.

Biotin: unclear increase

Biotin is used for the large amount of rapid cell division in the fetus and is broken down more rapidly and levels decline throughout pregnancy. Low levels of Biotin early in pregnancy may lead to several birth defects or abnormal development of the baby known as teratogenesis. Because Biotin deficiency is not always clear and may not cause any symptoms, a woman may not know if she is deficient. Therefore, it is safe to supplement Biotin at 30 mcg per day. Many multivitamin supplements do not contain Biotin so it is important to always check the label.

Biotin is naturally found in liver, egg yolks, chocolate, nuts, and some vegetables. Liver is the best source of biotin with smaller amounts contained in other forms.

 

Vitamin B12: 40% increase

Vitamin B12 is essential in early pregnancy. It is one of the most important components in permanent epigenetic modification in the baby, so adequate levels of this vitamin are necessary. Vitamin B12 deficiency is also associated with other birth defects including neural tube defects, low birth weight infants, and more.

Folate and Vitamin B12 have an interesting relationship. Folate supplementation can mask a B12 deficiency and prevent a woman from showing any signs or symptom of deficiency. Because Folate is also important during pregnancy and most women take supplements, it is easy to hide a Vitamin B12 deficiency.

Vitamin B12 is only found naturally in animal products so it is important that vegans and vegetarians take a supplement. Other people may also have issues with B12 absorption like those who have had a gastric bypass or gastric sleeve type surgery. Some experts recommend a supplement with 6-30 mcg Vitamin B12 or a diet that contains a daily grain or cereal fortified with the vitamin. This would ensure adequate absorption for the prevention of birth defects and proper epigenetic modification.

Vitamin C & Vitamin E: 67% increase and 25% increase

Vitamins C and E are both powerful antioxidants. They are not essential to supplement if you have a well balanced and healthy diet full of lots of colorful fruits and vegetables. Their needs are only mildly increased. If you smoke, however, Vitamin C and E play important roles in both you and your baby. Smokers should make efforts to stop smoking and begin supplementation with Vitamin C and E.

 

Vitamin D: 300% increase

Vitamin D, also known as a hormone, may play an important role in your developing baby’s brain, lungs, motor development, and more. Because the vitamin is actually a hormone in nature, it has a wide array of interactions. Vitamin D is known to interact with Calcium for absorption, but studies are also showing that it may work with Vitamin A during fetal development. Other roles Vitamin D has been associated with are decreased miscarriage in the first trimester, maternal depression, pre-eclampsia and so much more. Many experts have come to think of it as “the miracle vitamin”.

Vitamin D is fat-soluble which means that your body can’t just pee out the extra Vitamin that you don’t use. This is why it’s important to make sure you are not over supplementing yourself. It is safe to supplement 2000 IU of Vitamin D before pregnancy to prepare your body. Deficiency is very common and doesn’t cause symptoms. Around half of all pregnant women were shown to be deficient in Vitamin D.

Food is a very poor source of Vitamin D with its top source being cod liver oil. Most other foods, unless fortified, have little to no Vitamin D. As it is a hormone, your body can actually make Vitamin D itself with exposure to the sun. This is different for women depending on their skin color, use of sunscreen, geographical location, season, and much more. Therefore, if you are not frequently exposed to sunlight for more than 10-15 minutes a day, taking a Vitamin D supplement before pregnancy is recommended.

 

Minerals

Calcium: 122-167% increase

Though calcium needs increase in pregnancy, supplementation before or during pregnancy is unnecessary. Some studies have shown a reduction in hypertension and preeclampsia, however in the preconceptional period, supplementation with calcium is not needed. Extra Calcium is not used by the developing embryo or fetus. A diet rich in dairy products or dairy substitutes fortified with calcium should provide adequate calcium needs.

Iron: 150-180% increase

Iron is an especially important nutrient during pregnancy. It is responsible for transporting oxygen throughout your body, and during pregnancy it transports oxygen to the developing fetus as well. Without adequate iron, the fetus will not be able to grow and develop properly. Iron is also an important epigenetic modifier and low levels of iron cause the DNA to be improperly modified.

Nearly half of all pregnant women around the world are iron deficient during pregnancy. Needs increase from 15-18 mg to 27 mg per day. The national average of iron intake in pregnant women is only 15 mg, nearly half of the daily recommendation for the mineral. 

"Nearly half of all pregnant women around the world are iron deficient during pregnancy."

Iron supplementation is crucial late in pregnancy, but making sure your levels are adequate before conception is also important due to the mineral’s role in growth and development. Beef is a good source of iron with an average of 3 mg of iron per one 3 ounce serving. Chicken, fish, and poultry are much lower at about 1 mg iron per 3 ounce serving. Beans and lentils are relatively high in iron at around 5 mg per serving, however this number may be higher or lower depending on the type of bean. Iron is always contained on the back of a food label, so it’s easy to tell if your foods contain iron. Because iron needs in pregnancy are 27 mg per day, getting enough iron from food alone may be difficult. For example, you’d need two servings of spinach, three servings of beans, one serving of beef, two servings of chicken, and two servings of fortified bread just to get one day’s worth of iron.

This is why an iron supplement of 30 mg is recommended. It will meet increased needs for during pregnancy as well as make sure your current iron stores are adequate for conception. An important part to note about iron supplementation is that it interferes with Zinc absorption. Therefore, if iron supplements are taken, it’s also important to supplement with Zinc.

Zinc: 44% increase

Zinc is important in the prevention of birth defects early in pregnancy and for cell division and multiplication close to conception. Pregnant women need 11-12 mg Zinc per day whereas non pregnant women need 8 mg. 82% of women do not consume enough Zinc in their diet.

Food sources of zinc include beef at 8 mg per 3 ounce serving. Other animal products contain Zinc but at much lower quantities. This lack of food sources with Zinc makes it clear why most women do not consume enough of the mineral. Furthermore, as stated above, Iron supplements interfere with Zinc absorption. So, if you are one of the many women who choose to take an Iron supplement during pregnancy, you should include a Zinc supplement in your diet as well.

Copper: unclear increase

Copper is important to follow after Zinc as high Zinc levels can cause a Copper deficiency. Copper deficiency from lack of dietary sources alone is rare, thus the main cause is interactions between other vitamins. Copper is considered a trace element. This means that it is only needed in very tiny amounts by your body. However, without copper, several health problems may arise. For your developing infant, copper is used in early development and has been associated with the growth several organs and tissues including the neural tube. Thus, Copper deficiency is associated with birth defects and low birthweight babies.

If Iron and Zinc supplements are used, it is also important to add a Copper supplement, or to choose a prenatal vitamin that contains Copper.

Magnesium: 12% increase

Magnesium plays a role in embryonic development at the early stages of pregnancy and aids in neural tube closure. Deficiency in Magnesium was also related to a higher number of birth defects. These are some of the reasons why this mineral is important in the very early stages of pregnancy.

Magnesium needs increase by 40 mg during pregnancy and women should consume 350-360 mg Magnesium per day. Luckily, magnesium is found in a wide array of foods including nuts, spinach, soy milk, beans, and cereals as top Magnesium containing foods. If you consume a well balanced diet of vegetables, fruits, nuts, and beans/legumes, you may be getting enough Magnesium. However, 56% of adults do not meet the daily recommendations for the mineral. If your diet is not rich in these foods, a Magnesium supplement is recommended.

Iodine: 45% increase

Iodine is massively important in the early development of the embryo and iodine deficiency is considered the most common cause of preventable mental retardation in the world. Iodine plays a large role in thyroid hormone production and the development of your baby’s brain and spinal cord. It also helps create the structures that allow for quick communication between the brain and the rest of the body. Without iodine, infants are at a much greater risk of cognitive deficits, birth defects, and hypothyroidism. This hypothyroidism and cognitive deficits are linked. Iodine is necessary for thyroid hormone production in the mother. Thyroid hormone is used by the fetus to produce the structures that allow for quick communication between the body and the brain. Thus, low thyroid hormone causes slow brain and body function. This is referred to as Cretinism and it is the biggest reason why Iodine is essential before conception and during pregnancy.

Non-pregnant women should consume 150 mcg per day, while pregnant women should consume 220 mcg per day. It is recommended that women consume a 150 mcg supplement of iodine to ensure that the complete daily recommendation of iodine is met. The primary source of iodine is in iodized salt. Thus, if you regularly consume sea salt or kosher salt, you may not be getting enough iodine in your diet. Other main sources of Iodine include cod and other seafood, seaweed, dairy products (if the animals are fed iodized foods), eggs, and fortified grains. For example, to get enough Iodine in your diet without salt you’d need to consume one 3 ounce serving of cod, 1 cup of yogurt, and two eggs.

You should begin supplementation if you are planning a pregnancy since iodine is largely used in fetal development before the mother is even aware that she is pregnant. It’s important to understand that most prenatal vitamins do not contain Iodine. So, again, always check the label on your prenatal vitamins before purchasing.

Choline: unclear increase

Choline is important in early development of a fetus’s brain and women should get 450 mg per day. It is also an important nutrient for organ development, cell division and multiplication, and cell differentiation in the early stages of pregnancy.

Women who have adequate Choline may have infants with better cognitive functioning. Animal studies showed rats born to mothers with high Choline levels had better memory and spatial awareness.

Choline is found in many foods including wheat germ, eggs, and pork. Because liver is abnormally high in many vitamins and minerals, it should be avoided during pregnancy.

 

Brief Nutrition Wrap Up

As you can see, vitamins and minerals are a complicated yet essential part of healthy fetal development. Without the proper balance of these nutrients, there is an increased risk of birth defects, miscarriage, or other problems in the health of the mother. Though some of the importance of vitamins and minerals have been covered above, it is important to note that not every vitamin, mineral, and trace element has been discussed. Only the most essential and commonly deficient nutrients have been outlined.

Basically, it can be seen here that pregnancy puts a large demand on both your body and the developing baby’s. Before you are even aware of pregnancy, your fetus may have already formed many of its organs and tissues, using what was available to it at the time. A balanced - and supplemented when necessary - diet is essential for your baby’s health as it develops and even as it grows to become an adult. It’s a large pressure to understand that another human’s ability to thrive is completely reliant on you, but hopefully it is an enjoyable responsibility.

 

Other Healthful Preparations

Body Composition

Body composition also plays a role in the development of your baby. Women who are overweight may have problems with Vitamin and Mineral absorption and storage. An overweight or obese body may also epigenetically modify an infant to be more likely obese as an adult. Women who are underweight are more likely to have low birth weight infants or not meet the nutritional needs of their growing fetus.

Before you become pregnant, all women should do their best to achieve a normal body weight. You can calculate your BMI with an online calculator and it should be in the normal or healthy range. BMI takes into account your weight for height ratio but other factors such as high muscle mass may generate a higher than normal BMI.

Exercise

Pregnancy puts a large physical demand on your body. Preparing for pregnancy with regular physical exercise that includes strength training and weight bearing activities is important. Building strength and stretching to promote mobility help to reduce the stress that carrying around a small human places on your body.

Genetic Testing and Health Screen

Genetic testing and health screenings are also important parts of preparing for a pregnancy. If you have a family history that indicates a genetic anomaly, your doctor may recommend a genetic panel. Women with Jewish ancestry may be especially recommended for genetic testing.

Some other health screenings that are important before becoming pregnant are blood type, thyroid hormone levels, CBC for anemia, and Rubella (German measles). If you are at risk for STIs including HIV, Hepatitis B, and Syphilis, it is important to request screening. These STIs can be transmitted from mother to child and may cause problems during development so it is very important that you have a blood test to screen for these before pregnancy.

Avoid These:

Conclusion

The time before you become pregnant and shortly after conception are very important for both you and your growing baby. By preparing in advance for your pregnancy, you can be positive that your baby will have the perfect environment for growing; full of all the vitamins, minerals, proteins, and carbs it needs.

During pregnancy, your need for many nutrients, vitamins, and minerals increases. Many of these nutrients are needed early in pregnancy, before you may even be aware of your pregnancy. Choosing a prenatal vitamin is a simple choice to make sure that you are getting all the nutrients that your body needs; however a very well rounded diet may provide some of those nutrients in proper amounts.

Folic acid is one of hte most important vitamins to supplement and is recommended for all women who plan to become pregnant. The interplay between Iron, Zinc, and Copper is also important. Supplementation of iron is important since needs of the mineral are much higher during pregnancy, however, with supplementation of iron comes the need for Zinc and therefore Copper. Be aware of extra supplemented Vitamin A in foods and skin products as it is associated with birth defects. Vitamin A found naturally in foods does not pose the same risk and is very important in the diet of a woman who plans to become pregnant. Many of the other vitamins and minerals that are essential in the diet are outlined above so please read carefully so you are best informed.

Nutrition is complicated in itself, but when it’s in preparation for pregnancy, it suddenly becomes even more complicated. When the food you eat can actually modify the DNA of your baby, the situation becomes instantly more serious as these are often permanent changes. That said, eating responsibly before your pregnancy can be a difficult, but enjoyable adventure. Optimizing your health is the first step. Afterall, a healthy baby starts with a healthy mother.

 

References:
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Keen, C.L. et al. Effect of copper deficiency on prenatal development and pregnancy outcome. Am 
    J Clin Nutr. 1998;67:1003S-11S.
NHS. Vitamins and nutrition in pregnancy. NHS Choices. 2015.
ACOG. Nutrition During Pregnancy. ACOG FAQ. 2015.
CDC. Planning for Pregnancy. Preconception Health and Health Care. 2015.
Brown, H.L. Conception and Prenatal Development. MSD Manual. 2013.
Coletta, J.M., Bell, S.J., Roman, A.S. Omega-3 Fatty Acids and Pregnancy. Rev Obstet Gynecol. 
    2010;3(4):163-171.
OSU. Micronutrient needs during Pregnancy and lactation. Linus Pauling Institute. 2011.
Ladipo, O.A. Nutrition in pregnancy; mineral and vitamin supplements. American J Clin Nutr. 
    2000;72(1):280s-290s.
Buppasiri, P. et al. Calcium supplementation (other than for preventing or treating hypertension) 
    for improving pregnancy and infant outcomes. Cochrane Database Syst Rev. 2015;2:CD007079.
Hobel, C.J. Vitamin D supplementation should be routine in pregnancy: FOR: Recent research 
    supports routine Vitamin D supplementation in pregnancy. BJOG. 2015;122(7):1021.
NIH Office of Dietary Supplements. Fact Sheets for Health Professionals.
Louis, G.M.B., Cooney, M.A., Lynch, C.D., Handal, A. Periconception Window: Advising the 
    pregnancy planning couple. Fertil Steril 2008;89(2 Suppl):e119-e121.

Author Renee Cotter, MD

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Renee Cotter, MD
7320 Woodlake Ave, Suit 160
San Fernando Valley

West Hills, CA 91307
Phone: 818-208-4280
Fax: 818-887-5577
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818-208-4280

Renee Cotter, MD
7320 Woodlake Ave
Suit 160
West Hills, CA 91307