Pregnancy is a crucial time when your body goes through so many significant changes. Your body is adjusting and expanding to accommodate growing a little human, your hormones are experiencing ups and downs, and you’re likely feeling some emotional upheavals. During pregnancy, your body’s need for certain nutrients increases significantly to allow and assist in these changes.

Here are some key nutrients to look out for, some of which you might be surprised to learn are fairly limited in the average diet.

Vitamin D

While we call Vitamin D a vitamin, it’s actually a hormone! Most people associate Vitamin D with bone health and, while that’s absolutely true, it also plays an integral role in many other areas of the body. We are increasingly learning how important Vitamin D is to our overall health. Here are some areas in which Vitamin D works in our bodies:

• bone mineralization

• immune system response

• cell growth and differentiation

• reducing inflammation

• blood pressure regulation

• insulin secretion and blood sugar regulation

• cardiovascular health

• mental health

• neurodevelopment

You can probably pick out the areas that are especially vital during pregnancy: cell growth and differentiation, blood sugar regulation, neurodevelopment, and bone mineralization. These are all especially important during pregnancy and the reason I always talk about Vitamin D with my clients.

Low Vitamin D intake during pregnancy has been associated with a higher risk of preeclampsia, preterm birth, and gestational diabetes in the mother. In baby, low Vitamin D negatively impacts bone development in utero and may also have a lifelong influence on bone health. However, when we start to think about where we can get this crucial nutrient from, it gets a little trickier.

Vitamin D is found in fatty fish, organ meats, egg yolks (especially from chickens who are outdoors in sunlight), dairy products (from pastured cows or milk that is fortified with Vitamin D), and mushrooms (if grown under UVB light). However, the amount of Vitamin D in food varies widely and it is generally considered to be a poor source.

Instead, we receive about 90% of our Vitamin D from the sun. Under optimal conditions, our skin can form Vitamin D from exposure to UVB rays from the sun. However, this is influenced by a bunch of different factors:

• time of year and time of day

• latitude

• use of sunscreen and clothing

• skin color (melanin blocks UVB rays so melanated folks need to spend more time outside to form Vitamin D in the skin)

As you can see, it can start to get more complicated than just “spend time outside”. When you also look closer at latitude, anywhere above > 33 degrees North or South has pretty limited Vitamin D production in winter. That includes nearly all of North America except for most of Texas and the southernmost states.

As a result, I often recommend checking Vitamin D in my clients and we usually end up supplementing to some degree. The current RDA (Recommended Daily Allowance) for Vitamin D is 600 international units (IU) or 15 micrograms (mcg) per day in adults and pregnant individuals. However, you’ll find that different countries and organizations have different recommendations, some higher than others. In comparison, the Endocrine Society recommends 1,500-2,000 IU (37.5-50 mcg) per day in both adults and pregnant individuals. Recent research suggests that an intake of 2,000 - 4,0000 IU (50-100 mcg) per day is optimal and more may be required for individuals at higher risk for Vitamin D deficiency.

Key Takeaways

• The majority of individuals in North America don’t synthesize enough Vitamin D from the sun and likely need additional supplementation

• If you can have your Vitamin D levels checked, I highly recommend this. This can tell you if you would benefit from a higher dose of Vitamin D

• Look for a supplement that contains Vitamin D3 (cholecalciferol) which is the optimal form

• At minimum, look for a Vitamin D3 supplement that provides 2,000 - 4,000 IU per day (50 - 100 mcg per day)

Folate

Folate is the nutrient that is typically the most discussed when we talk about key nutrients for pregnancy. Research shows that inadequate folate intake has been associated with neural tube defects, low birth weight, and preterm birth. It’s especially important to ensure adequate folate stores pre-conception and in the first trimester of pregnancy. In addition to reducing risk of neural tube defects, folate plays a role in the body in the following ways:

• cell division

• production of neurotransmitters

• development of the midline (including the mouth)

• production of red blood cells

You’ve probably heard recommendations from physicians to take a prenatal supplement with folic acid (a synthetic form of folate). You may have also heard about something called a MTHFR gene variant and, along with that, some recommendations for taking 5-methyltetrahydrofolate (an active form of folate).

The current evidence supports taking folic acid to prevent birth defects (such as neural tube defects). There is ongoing research regarding 5-methyltetrahydrofolate (5-MTHF), however the evidence at this time is still growing. This is a conversation that is best had with your individual healthcare providers in terms of what form of folate is best for you and what will fit within your budget. To be clear, however, there is really no need to go get genetic testing done to determine your MTHFR gene status and there are many affordable supplement options that provide the folate your body needs during the early stages of pregnancy.

The good news is that your body can still absorb and use naturally occurring folate. So load up on these folate-rich foods! Folate can be found in higher amounts in spinach, turnip greens, lentils, asparagus, brussel sprouts, avocado, broccoli, beans, peas, and liver. Try to avoid boiling your vegetables since this will cause some loss of folate in the water! Instead, choose raw vegetables or cook by steaming or sautéing. Aim for at least 600 mcg folate per day (the RDA for folate during pregnancy).

Additionally, if you’ve struggled with miscarriages, it may be worth asking your OB to check your folate status (ask for RBC folate instead of serum folate).

Key Takeaways

• Talk to your healthcare providers to determine what form of folate is best for you. Common folate forms include folic acid, L-methylfolate, and 5-methyltetrahydrofolate

• Include folate-rich foods in your diet, especially preconception and during the first trimester

• Aim for a minimum of 600 mcg folate per day

Choline

This little-known nutrient is gaining a lot of traction in the prenatal world. We’re slowly learning how important choline is during pregnancy to brain health and neurodevelopment of the fetus.

Some ways in which choline plays a role during pregnancy:

• supports fetal brain development

• is a structural component of cell membranes

• formation of blood vessels in placenta

• supports nervous system development

• formation of neurotransmitters

• involved in gene expression

Can you see why we should be making sure we’re getting enough of this powerhouse nutrient?

According to the National Institutes of Health, an astounding 90-95% of pregnant women are not meeting their choline needs.

Most prenatal vitamins don’t even contain choline. Or they contain choline in an amount that doesn’t even begin to meet the needs of pregnant mamas.

The current RDA for pregnancy is 450 milligrams (mg) per day; however, research suggests that an intake closer to 930 mg per day is optimal to support baby’s brain development.

The richest food sources of choline include liver, egg yolks, red meat, and fish (liver having the most choline per serving). Vegetarian sources of choline include red potatoes, wheat germ, beans, and quinoa though at a considerably lower amount.

If you follow a vegan or vegetarian diet (and don’t consume eggs), you’ll want to pay extra attention to this nutrient. Additionally, if you have the MTHFR gene variant (discussed in the previous section on folate), your choline needs are actually higher than if you did not have this gene variant. If you fall into either of these categories, it might be worthwhile to look into supplementing with a separate choline supplement or making sure your prenatal vitamin contains a good amount of choline.

I do want to make a quick note about liver. You might have been told to avoid liver entirely in pregnancy due to its high Vitamin A content. However, that research was based on supplemental Vitamin A intake and not food-based Vitamin A. The general recommendation is that it is safe to include liver in moderation (limit to 1-2 times per week) and to be aware of other potential high Vitamin A sources if you do so.

Key Takeaways

• Include whole eggs and fish weekly in your diet

• If it appeals to you, you can include liver in moderation about 1-2 times per week (check with your OB and be conscious of other high-Vitamin A sources in your diet)

• Double-check that your prenatal vitamin provides some choline.

• If you follow a vegan or vegetarian diet, choose a prenatal supplement that contains a higher amount of choline. You may need to supplement additional on top of this depending on your diet

DHA

Also known as docosahexaenoic acid, DHA is an omega-3 fatty acid that is crucial for the development of the brain, eyes, and nervous system.

During pregnancy, your body needs even more DHA than usual to support your baby’s developing brain and eyes, especially in the third trimester.

However, it’s important to note that it’s not just any omega-3 that will do, but DHA specifically. Other types of omega-3 fats include ALA (alpha-linolenic acid) and EPA (eicosapentaenoic acid). ALA is the type of omega-3 fat found in nuts and seeds (walnuts, chia, and flax). While also an important nutrient, increasing your intake of nuts and seeds will not make up for a lack of DHA in your diet during pregnancy. There is some conversion from ALA to DHA, but it is quite small and inefficient. EPA on the other hand works synergistically with DHA and they are often found together in foods. EPA helps transfer DHA across the placenta and is therefore important to supplement alongside DHA.

DHA can be found in cold water, fatty fish (salmon, herring, sardines, mackerel, pollock, catfish), grass-fed meat, and pasture raised eggs. Fish is a significantly higher source of DHA than either meat or eggs, though keep an eye on the mercury level of fish as well. Those listed above have a higher ratio of omega-3 fats and lower mercury levels, salmon being the best balance of high omega-3 content and low mercury level.

Unless fish is a regular part of your weekly intake (2-3 times per week), you’re likely not getting enough of this key nutrient. Add to that the fact that fish is a commonly avoided food during pregnancy (due to food aversions, fear of mercury, etc.) and you can expect that the majority of pregnant individuals are likely deficient in DHA.

If this sounds familiar, consider adding a separate DHA + EPA supplement to your regimen.

Key Takeaways

• Consume 2-3 servings of cold water fish each week

• For most individuals (especially those who are vegan/vegetarian) I recommend supplementing with a separate DHA + EPA supplement

• Algae-based DHA supplements are a good alternative to fish-based DHA supplements (and more sustainable!)

• Aim for a minimum of 200 mg DHA per day

Iron

Iron is a mineral and key nutrient during pregnancy as it plays a significant role in cell growth and development.

Your body is producing more red blood cells and moving more oxygen around during pregnancy. Blood volume in pregnant individuals actually increases by 45% on average (though varies from individual to individual). In addition to supporting blood volume expansion, iron is also involved in several other supportive functions:

• thyroid health

• development of the placenta

• neurodevelopment

All of this contributes to iron needs increasing by 1.5x during pregnancy.

If possible, I always advocate trying to get as much iron as possible from food rather than supplements. Iron from supplements can be hard on the stomach and cause cramping, constipation, and just overall discomfort.

There are two main types of iron we can get from foods: heme iron and nonheme iron. These vary based on where they are found (animal vs plant foods) as well as their bioavailability.

Bioavailability: how well the body absorbs and is able to use a particular substance (i.e. nutrient). A higher bioavailability means that more of that nutrient is actually usable by your body

Heme Iron

• highest in animal proteins such as meat, seafood, and poultry

• more efficiently absorbed with ~30% bioavailability

Nonheme iron

• found in plant foods such as beans, chickpeas, seeds, lentils, spinach, and kale

• less efficiently absorbed with ~10% bioavailability

With a higher bioavailability, iron from animal sources will be better absorbed and used in the body. Including animal sources of iron can ensure your iron stores remain adequate during pregnancy. If you follow a vegan or vegetarian diet, you will need to closely follow your iron status and intake to ensure you’re meeting your higher iron needs during this time.

If you’re struggling to optimize your iron, there are several nutrient interactions to be aware. of. Calcium decreases iron absorption. Vitamin C (found in citrus fruits, peppers, tomatoes, strawberries, broccoli) increases iron absorption.

Signs of low iron include fatigue, weakness, pale skin, headaches, increased heart rate, shortness of breath, dizziness, and cold hands and feet. While checking iron is not always routine during pregnancy, if a client is at risk for iron deficiency (based on symptoms or usual diet), an iron panel is a helpful lab to obtain to guide diet recommendations and potential supplementation.

Iron supplementation is not always necessary during pregnancy and it’s best to adjust dosage based on the individual. I typically recommend a separate iron supplement as needed to ensure the dose can be tweaked based on labs and intake.

As I mentioned earlier, iron supplements can be hard on the digestive system so if we can boost up iron in foods, that’s ideal. If iron supplementation is warranted, commonly used iron forms (ferrous sulfate or ferrous fumarate) can tend to have more digestive concerns. Some brands are starting to transition to using iron bisglycinate (AKA ferrous bisglycinate) as a gentler, better tolerated and absorbed form of iron. This is the form I usually recommend to my clients.

If you’re trying to conceive (TTC) or thinking about becoming pregnant, I recommend trying to optimize your iron stores pre-pregnancy. It’s a lot easier to boost up those iron-rich foods or add an iron supplement (if warranted) before the common symptoms of the first trimester of pregnancy hit (i.e. nausea, vomiting, food aversions).

Key Takeaways

• Iron from animal sources is better absorbed than iron from plant-based sources

• Not all individuals require iron supplementation during pregnancy. This will depend on your current intake and iron status (labs are especially helpful here!)

• I typically recommend a separate iron supplement rather than taking a prenatal multivitamin with iron. This allows more flexibility in adjusting your iron dose and prevents any nutrient interactions with other vitamins in your prenatal multi.

• Some forms of iron in supplements are better absorbed and tolerated than others. Look for iron bisglycinate (also known as ferrous bisglycinate)

Post updated March 2024

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