Every calorie you eat needs to be nutrient-rich to nourish both you and your baby. No time is more important for optimum nutrition than while you’re pregnant. Even if your diet was adequate before you conceived, you can’t assume it will continue to meet your (and your baby’s) needs for the next nine months. In fact, most people who think they eat a ‘well-balanced diet’ fail to meet even the basic RDA level of nutrients.
Every survey conducted in Britain since the 1980s shows that even those who said that they ate a balanced diet fail to eat anything like the European or American recommended daily allowances (RDAs) of vitamins and minerals. These RDAs aren’t even designed to ensure optimal health, rather to prevent severe nutritional deficiency diseases such as scurvy.
You will most likely have been told to supplement folic acid. But why not any other essential nutrients for which there is equally good evidence of a shortfall, and an additional benefit during pregnancy? Most doctors aren't aware why folic acid is important. The answer is that it is one of six nutrients (the others being vitamin B2, B6, B12, zinc and TMG) required for healthy methylation. Methylation is total critical for cell replication and DNA repair and, if faulty, risk for birth defects and pregnancy complications goes up exponentially. That is why I recommend all women intending to get pregnant to first check their homocysteine level, which is the blood test that determines healthy methylation.
There is a straight line and very strong correlation showing that the lower a woman's homocysteine level the lower is their risk of pregnancy complications. A significant number of women are not short of folic acid (actually the vitamin is folate) but of B12. This is more likely in vegans but some women unknowingly are poor absorbers of vitamin B12. Also, some women cannot make use of folic acid, but require the more biologically active form called Tetra-Hydra-Folate (THF). Having a homocysteine test is an easy way to rule out these unseen issues what can affect a pregnancy.
In my book written with Susannah Lawson, Optimum Nutrition Before, During and After Pregnancy we encourage you to eat nutrient-rich and preferably organic food. But it’s still necessary to supplement with extra vitamins and minerals to guarantee you get optimum levels to help both you and your developing baby achieve the best health possible.
Supplements do have to guarantee what they contain. Foods don’t. Supplementation is especially important in pregnancy as your nutrient needs are even greater than usual – your requirements for folic acid and other B vitamins, vitamin C, calcium, zinc and magnesium, for example, increase by 30 to 100 per cent.
Vitamins fall into two categories – water soluble or fat soluble. The water-soluble ones are the B vitamins (of which there are eight main types), vitamin C and vitamin K – levels of these need replenishing daily. Vitamins A, D and E are fat soluble and are stored in your body fat, so although you need to maintain a good intake, it’s not so essential to ensure this on a daily basis. For most nutrients, you will see that as well as eating plenty of the right food sources, you also need to supplement to reach the levels you need.
Vitamin A is especially essential in pregnancy for the healthy development of your baby’s eyes, heart and reproductive system, and studies have shown that women who supplement their diets with
multivitamins including vitamin A have a lower incidence of birth defects. So it’s key to get the right amount but not too much. As there are two kinds of vitamin A – retinol, which is derived from animal sources such as liver and cod liver oil, and betacarotene from vegetables such as carrots and sweet potatoes – this can be confusing. But it’s retinol rather than betacarotene that has the potential to be toxic at high levels, so it’s unwise for women of childbearing age to supplement any more than 3,300mcgs ( 10,000IUs11) daily unless directed by their doctor or nutritional therapist. As cod liver oil is also a rich source of retinol, check the label for exact quantities if you’re taking this – a high strength formula rarely supplies more than 800mcg 1(2640IUs) of retinol, so in practical terms, take no more than four cod liver oil capsules a day just before and during pregnancy. I recommend supplementing 1,500mcg a day during pregnancy.
Vitamin D is also a pregnancy essential as low levels are, again, a known risk of complications and frequently found. The current RDA of 200iu/5mcg is hopelessly inadequate in ensuring pregnant women have an adequate blood level of at least 75nmol/l. They are likely to need at least 1,000iu/25mcg. That is achievable by eating oily fish three times a week, eggs six times a week, and having sun exposure for 20 minutes a day, as well as supplementing 15mcg, which is what I recommend in any multivitamin for anyone.
Just as important as vitamins, and perhaps even more frequently deficient, are minerals. These are mainly used to regulate and balance our body chemistry, with the exception of calcium, phosphorus and magnesium, which are the major constituents of bone. These three, plus sodium and potassium – which control the water balance in the body – are called ‘macro minerals’ because we need relatively large amounts each day (300mg to 3,000mg). The remaining elements are called ‘trace minerals’ because we need only traces (30mcg to 30mg). For instance, you need around 1,200mg of calcium a day when you are pregnant, but only 40mcg of chromium (0.04mg). Yet chromium is no less important.
We do include an A-Z of essential nutrients and a guide to find the optimum level of each essential vitamin and mineral you should be getting every day in the resource section of Optimum Nutrition Before, During and After Pregnancy. An alternative is to try one of the many nutrient formulas which do the hard work for you by combining all the necessary vitamins and minerals into a few single supplements. Although it would be ideal to seek expert help to formulate your individual supplementary needs preconceptually and during pregnancy, there are also plenty of ready-made supplements designed specifically for pregnant women if you decide not to do this.
The other no brainer to supplement is a fish oil capsule containing omega-3 fats. These provide both EPA and DHA which literally build the brain. The level of omega-3 found in the umbilical chord at birth predicts the speed of a child's thinking at age 8 - that is how critical an optimal supplement of omega-3 fats are.
The brain is made out of both omega-3 fats and phospholipids, found in eggs and lecithin, as well as fish. I strongly recommend supplementing these as well for optimising the ability to build a baby's healthy brain.
I get so many women telling me of their super bright baby, which they put down to an optimal diet plus supplements during pregnancy. Here's one from a Dad:
"I recently had a child, and the mother was committed and disciplined throughout
the pregnancy to your books on healthy eating and optimum nutrition. Now, I know about as much regarding this stuff as I do about the history of Indonesia, but I let her get on with it, as it kept her happy.
Our baby is a remarkable little girl, has such perfect skin, is ridiculously beautiful, and a very happy young thing.
Now, I don’t know how much is down to nutrition and my girlfriend’s care not to
drink while pregnant, but I thought I’d just drop you a line to say thank you
for your dedication to such a noble pursuit.
I can’t get over what a gorgeous and (usually) content little thing she is, and
so if your advice had any role in the formation of such a fine child, we both
thank you deeply for your efforts." Nick
Here's another from a Mum:
“We decided to try for a baby but we were having difficulty
due to 'sub-fertility'. Anyway, I read my first P. Holford book and a few
months later, my son was conceived. We had made the necessary dietary changes
and were amazed how effective they were. I was hooked! I followed all the
advice during my pregnancy and have been very vigilant about providing the
right nutrients for my young son as he is growing up. He is super smart (can
spell his name, Austin, at 20 months!). I credit a lot of this to the
information I read and implemented from Mr. Holford’s books over the years." Pauline
To cover all the basics, our recommendation is to take three supplements:
- An optimum nutrition or pregnancy multivitamin and mineral formula (good ones normally say ‘take two a day’ you can’t get enough in one tablet).
- 1,000-2,000mg of extra vitamin C
- An essential fat formula providing 400mg EPA, 200mg of DHA and 200 mg of GLA. These are essential fats that have a direct effect on your child’s IQ.
- A combined calcium and magnesium supplement if you can’t find a multivitamin/mineral that includes adequate levels. Aim to get two parts calcium to one part magnesium. For example 400 mg of calcium and 200 mg of magnesium.
- An antioxidant if you are an older mother (over 30 years), live in a polluted environment, are at risk of developing pre-eclampsia or are under a lot of stress. A good formula should provide extra betacarotene, vitamin E, selenium and zinc, and other beneficial antioxidants such as reduced glutathione, N-acetyl, Cysteine, co-enzyme Q10 and alpha-lipoic acid.
For a full list of essential vitamins and minerals and the correct amounts to take see our book, Optimum Nutrition before, During and After Pregnancy which also provides a list of good supplement suppliers and how to find a nutritional therapist.