During pre-conception, pregnancy and breastfeeding your nutrient requirements change, and dietary supplementation is recommended for certain important nutrients. Folate, iron and calcium are the top three essential nutrients needed to maintain a healthy environment for conception, a healthy pregnancy and to optimise your chances of growing a healthy baby. Supplementation in conjunction with good food sources may be necessary to maintain optimum levels of these three nutrients.
In addition, protein, magnesium, zinc, selenium, iodine, copper, essential fatty acids, vitamins A, C, D, E and several other B vitamins are all required in optimum amounts for the health of mother and child. Dietary fibre is also important to ensure good elimination for the natural detoxification process and extra hormones that pregnancy produces. Your daily food intake is the primary source and adequate levels of many required nutrients can be maintained through eating a high quality balanced range of nutrient dense foods. For some supplementation is recommended.
Women who eat a vegan diet or need to restrict their diet due to food intolerances, significantly underweight women and pregnant teenagers who are still growing themselves are all at risk of nutritional deficiencies at every stage from pre-conception through pregnancy and breastfeeding.
During pregnancy the baby has priority on nutrient uptake, so in order to keep yourself functioning in optimum health right through to the birth and into the breastfeeding stage you will need a higher nutrient intake than normal.
Your protein needs increase during pregnancy as the baby grows, requiring amino acids as the raw materials for cell formation and growth. About 70 gm per day is the recommended protein intake during pregnancy.Spirulina, chia seeds, bee pollen, royal jelly, organic free range eggs, organic raw milk, spinach, beans and other legumes (combined with grains for complete protein) are all good sources of protein for non-meat eaters.
Royal Jelly is secreted from the glands of worker bees and fed to the newly developing queen bee – it is this nutrient dense modified form of bee pollen that causes the differentiation in cells that transforms her into the queen bee, capable of procreation. Protein rich royal jelly is also fed to the immature bee larvae to promote growth and optimise health.
Besides its value as a rich source of protein, studies have established royal jelly as a fertility enhancing food, in humans as well as bees. Being rich in folic acid and other B vitamins, vitamins C, D and E, iron, calcium, amino acids and enzymes it offers a potent mix beneficial to both male and female pre conception health. It helps balance hormones, normalise the menstrual cycle and improve sperm production.
FOLATE and Folic Acid – a complex topic!
Folate is the naturally occurring form of the water soluble vitamin B9, found in high amounts in leafy green vegetables, beetroot, citrus fruits, legumes and liver. Most fruits and vegetables contain good levels of natural folate while bread, cereals and yeast extracts are generally fortified with folic acid.
Folic acid is the name for the synthetic form produced for use in the food industry and in dietary supplements. The body must convert folic acid through several steps to the bioactive folate form in the liver, and much of the ingested folic acid remains unused. Due to the high proportion of fortified processed foods eaten by much of the population, ingested folic acid levels can be excessive with potentially harmful health outcomes.
Folates are vital nutrients for the biosynthesis of DNA and RNA, and building blood cells and tissue. Because of their key role in cell division and cell formation as the baby develops, low levels can cause neural tube defects (NTDs) from incomplete brain and spinal cord development in early pregnancy. Spina bifida, hydrocephalus and anencephaly are the main forms.
The importance of adequate folate levels during the pre-conception period in reducing NTDs is well established. Although the risk of having a child with such serious birth defects is low, your need for folates is higher during pregnancy and taking a supplement from the preconception stage onwards is accepted best practice. Its protective action may also help to prevent miscarriage.
Now the complexities start – I’ll try to help you navigate through them.
While most B vitamin supplements contain folic acid, the better ones contain the bioactive folate forms, 5-formyl tetrahydrofolate (folinic acid) or 5-methyltetrahydrofolate (5-MTHF). Although official dietary recommendations refer to folic acid supplements, be aware of the potential difference to your health of taking this synthetic non-active form rather than the bioactive forms. Emerging research is linking unprocessed folic acid in the bloodstream with increasing incidence of food allergies, neurological disorders and other conditions. Particularly for people with the relatively common C677T MTHFR gene mutation, the folic acid form of supplement is contraindicated.
Official standardising of folate absorption rates using DFEs
Absorption rates among the natural folate forms and synthetic folic acid vary. Government and medical authorities still tend to recommend ‘folic acid’ supplements rather than naming the reduced forms. Official US science authorities advise that folic acid has double the bioavailability of food folate when taken on an empty stomach, and taken with food is 1.7 times as available. To give parity, they established dietary folate equivalents (DFEs), which have been used in NZ since 2006. 1 mcg DFE = 1 mcg food folate = 0.5 mcg folic acid on an empty stomach = 0.6 mcg folic acid with meals or as fortified foods.
How much folate do you need?
Studies indicate that the average Kiwi gets only 250 mcg folates per day from dietary sources, and folic acid dosage sufficient to reduce the risk of NTDs has been officially established at 400 mcg (0.4mg) per day starting at least one month prior to conception. This supplementary dosage is considered by NZ MoH guidelines as sufficient to reduce the risk of NTDs. Low levels of zinc and vitamin C will negatively affect dietary folate absorption and its biochemical activity.
Some medical drugs are folate antagonists and are known to increase the risk of NTDs; these include anti-epileptics, anti-convulsants, fertility drugs, insulin, acne medications and some anti-tumour drugs.
A blood test will determine your folate levels and indicate the supplement level you need. Supplementation of any individual B vitamin needs to be accompanied by a B complex containing other B vitamins in appropriate ratios. In particular, vitamin B12 supplementation is recommended if more than 1000 mcg folic acid per day is supplemented, since B12 deficiency tests can be masked by folic acid, resulting in nerve damage.
Why are Ministry of Health dosage guidelines confusingly high?
NZ Ministry of Health guidelines recommend one 800mcg (0.8 mg) folic acid tablet daily for at least 4 weeks before and 12 weeks after conception, as well as a dietary intake of 600 mcg DFEs from eating folate rich foods and foods fortified with folic acid. For women at increased risk of NTDs the MoH recommends supplementing 5000mcg (5mg) of folic acid daily for the same period. These recommendations are based on the size of the only folic acid tablets currently available as registered medicines in New Zealand, which come in the 800mcg (0.8 mg) or 5000mcg (5mg) sizes and are only available from pharmacies.
Conversely, the government’s Dietary Supplements Amendment Regulations 2010 restricts dietary supplements of folate or folic acid that are not registered as medicines to a maximum daily dosage of 500 mcg if they comply with the government’s therapeutic goods code and 300 mcg if they don’t.
In summary, government guidelines favour pharmacy-only medicines over dietary supplements in their allowable dosages, and their recommendations are based on pharmacy-available tablet size instead of clinical research outcomes!
Australian health authorities recommend 400 – 500 mcg folic acid supplement daily during preconception and the first trimester, combined with food sources, to achieve consistent folate levels in line with research outcomes.
The USA RDA for folate is 400 mcg per day for adults, 600 mcg per day for pregnant women, and 500 mcg for breastfeeding women. Up to 1,000-2,000 mcg per day may be prescribed as a therapeutic dosage.
Conclusion: Bioactive folates (from food or supplements) are better for you and your developing baby than folic acid. If you are taking a daily dietary supplement of 300 mcg folate per tablet you can either focus on increasing your food intake of folates, or take two tablets per day and still be well within the safe range of folate intake. In this way you can meet your important pre-conception and pregnancy folate requirements.
Iron is the most common micronutrient found to be deficient in pregnant women. Your iron requirements vary throughout each stage of pre-conception, pregnancy and breastfeeding. Studies show that around 40% of New Zealand women of childbearing age are iron deficient.
Beginning with preconception care, fertility increases when iron levels are adequate because ovulation health is compromised by iron deficiency. It’s also important to have enough iron at the start of the pregnancy because once conception happens the needs of the growing foetus and the mother’s increased blood volume create an ongoing requirement. If your iron level is low the needs of the foetus will override maternal needs and you risk developing iron anaemia. For all these reasons low body reserves of iron are difficult to restore once you become pregnant.
Iron-deficient mothers are more likely to produce infants who are susceptible to iron deficiency. Being iron deficient during pregnancy can have long term consequences on your children’s health throughout life, affecting cognitive ability, behaviour, motor skills and physical performance.
During the first trimester there is no increased iron requirement as other checks and balances are operating: your absorption of dietary vegetable iron increases and you save iron by not menstruating. As the baby grows into the second trimester more iron is needed and by the third trimester your baby is storing iron so your requirements increase accordingly.
During breastfeeding your iron requirements drop below what you needed prior to pregnancy. Breastfeeding helps restore your iron levels and delays menstruation so keeping up your pre-pregnancy iron intake will maintain your stores adequately. Research shows women who don’t breastfeed tend to have lower iron levels than those who do.
Your full term baby will be born with enough supply of iron to last the first 4 to 6 months of life. Babies absorb iron well from breast milk, whereas less than 12% is absorbed from infant formula and even less from cow’s milk. Avoid giving cow’s milk in the first 12 months and then only in moderate amounts. Beyond 6 months breast milk alone won’t meet your baby’s iron requirements and it’s important to introduce iron rich foods along with foods high in vitamin C to aid iron absorption.
Factors that increase iron deficiency risk
Your risk of iron deficiency increases if any of the following factors apply to you:
low iron levels during preconception; low vitamin C intake; heavy metal toxicity; eating a vegetarian or vegan diet; eating a diet high in cheese and milk; heavy tea or coffee drinkers; low socio-economic outcomes; adolescent mothers (a high-risk group); multiple pregnancy; post-partum anemia or haemorrhage; short gaps between pregnancies.
Measuring iron levels in the body
Your body regulates your iron absorption according to need, so someone who is either deficient or pregnant will be absorbing a higher percentage of iron from food sources. Those more at risk of being iron deficient are women menstruating heavily, athletes, vegetarians, vegans and teenagers experiencing a growth spurt.
Symptoms of iron anaemia include feeling cold, weak, dizzy, tired and irritable. Pale skin, a shiny smooth or burning tongue, brittle and spoon-shaped nails, dull thinning hair, low appetite, tinnitus, depression, frontal headaches, shortness of breath and a craving for non-food substances (e.g. dirt, chalk) can all indicate low iron levels. Your immune system, adrenal glands and thyroid are all more vulnerable when iron is low.
A blood test will establish your iron levels and indicate if supplementation is needed. There are several levels measured: iron saturation in the blood, indicating total body iron; haemoglobin – the amount of iron in your red blood cells; and serum ferritin, indicating how much excess iron is stored in the body. Normal iron saturation range is between 20 – 40% or 10 to 30 µmol/L (micromoles per litre). Normal haemoglobin is 115 to 160 g/L in females. Normal ferritin range is 20 to 160 mcg/L in females. If scores are low the cause needs to be identified and addressed.
Dietary sources of iron
There are two main forms of dietary iron: haem and non-haem. Haem iron comes from animal protein and is more absorbable. Best sources include organic pasture-fed beef and lamb, wild pork, free range chicken and eggs, fish and mussels. A weekly meal of liver or other organ meats is another concentrated source of dietary iron.
Non-haem iron describes plant-based sources of iron. Good sources include nettle tea, spinach and other green leafy vegetables, whole grains, breads and cereals, oatmeal, figs, beans, tofu, potatoes, dried fruit, nuts and seeds and hummus. A daily tablespoon of molasses is an excellent way to increase your iron level.
Iron absorption is inhibited by drinking black tea, coffee and soft drinks with the meal. Calcium, another important mineral in growing a healthy baby, inhibits iron absorption so it’s better to eat calcium-rich foods away from main meals when wanting to improve your dietary iron uptake. Zinc also inhibits iron absorption.
The absorption rate of plant derived iron is tripled when accompanied by animal protein. Vitamin C aids iron absorption so consuming sources of both nutrients at the same time is recommended.
In general it is best to take a multi-mineral complex with iron supplements, as other minerals are usually deficient when iron deficiency occurs. Taking individual minerals in isolation is not a good approach as minerals work synergistically in the body and are needed in combination and in natural ratio.
What is safe and adequate supplementation?
While maintaining adequate iron intake is very important, equally important is ensuring that your iron levels don’t become too high as this also can have serious health consequences. However, iron absorption is well regulated by our bodies according to need. Unless you have a condition called haemochromatosis, your body will naturally excrete any excess iron via the bowel.
The general recommended iron intake inNew Zealandis 18 mg per day for women from 19 to 50 years. Pregnant women need to increase their intake to 27 mg per day, reducing down to 9 mg per day during breastfeeding (or 10 mg per day for adolescent mums). If you are unable to maintain adequate iron levels from food sources, an iron supplement is indicated.
Are there any contraindications or adverse effects reported?
There are several different causes of anaemia so it is important to establish iron deficiency as the correct cause before taking supplements. Iron supplementation is contraindicated for people with haemochromatosis.
Ferrous sulphate is the common form of iron supplement prescribed by doctors, but this form tends to cause constipation and other gastric disturbances, and be less well absorbed than other forms. Ask for a supplement that doesn’t constipate.
A US source notes ferrous sulphate is a leading cause of accidental poisonings in young children, who find containers of iron supplements and swallow the contents. Ingestion of only 200 mg has been enough to cause death. Keep your supplements well out of reach of curious children.
Our bodies require more calcium than any other mineral. Our bones contain 98% of our calcium stores, our teeth 1% and the remaining 1% is a vital element in blood clotting, neurotransmission, regulating heartbeat and muscle contraction. It is an essential ‘macromineral’ – required in large quantities – and a critical nutrient during pre conception, pregnancy and breastfeeding.
Calcium intake in pregnancy is most important for teenage mums – because their bones are still growing they have a high need for calcium and so does the baby’s developing skeletal system. For those over 19 years if your calcium intake is already adequate it needn’t increase as your body will naturally absorb and retain more to meet the baby’s needs during pregnancy.
A US study of pregnant 17 year olds reported significantly less incidence of preterm delivery and low birth weight in those taking calcium supplements.
Studies indicate the risk of preeclampsia (high blood pressure onset after the 20th week of pregnancy accompanied by protein in the urine) is reduced by a significant 52% when prenatal calcium supplements are taken. There is also 20% lower risk of serious illness and death in pregnant women.
If your body doesn’t get enough calcium to provide for both your needs and the developing baby, the needs of the baby take precedence. Calcium will be leached from your bones to strengthen baby’s growing bones and teeth, heart, muscles and nervous system. Calcium deficiency during pregnancy can cause heart defects in the baby.
What is the recommended daily intake?
1000 mg per day is generally the minimum recommendation for total calcium intake for adult women up to menopause. Teenagers need a higher intake, 1300 mg being the recommended daily minimum.
Maximising calcium absorption
Efficient absorption is a key issue with calcium intake, and this depends on other minerals being present in the right ratios. The balance of magnesium to calcium is vital for healthy function and particularly to prevent calcification and calcium deposits forming everywhere from the microcellular level through to tissues and organs. A ratio of no more than 2:1 calcium to magnesium is needed by the body for optimal functioning.
Silica is also important because it enhances absorption of all other minerals in the body, particularly remineralisation of bones and all structural tissues in the case of calcium. As we age our silica levels decline. Good food sources of silica include raw oats, oatstraw tea, horsetail tea, beets and alfalfa. Women having babies at a later age may need to supplement silica as part of their nutrition plan.
Vitamin D regulates calcium absorption from the intestines, which is the body’s primary mechanism for increasing calcium levels during pregnancy. Research indicates that getting the calcium and vitamin D balance right can boost male fertility, an important factor in pre conception health. Recent studies reveal up to 40% of theNew Zealand population gets insufficient levels of vitamin D, indicating supplementation during pre conception and pregnancy may be required.
How do I know if my calcium levels are low?
A blood test doesn’t reliably measure your body’s calcium levels as most is stored in the bones. A bone density test using a special form of x-ray will identify any calcium depletion, however if you’re attempting to conceive or already pregnant, you won’t want to expose yourself to radiation.
A naturopath can assess your need for a calcium supplement along with the other nutrients needed for balanced biochemistry and optimum mineralisation.
Can I get enough calcium from my regular dietary intake?
Surveys indicate up to a third ofNew Zealandwomen have a low calcium intake and need to either improve their dietary sources or take a supplement.
If you need more calcium food is definitely your best source and the recommended way to increase your intake. The range of foods containing good bioavailable sources of calcium is not as limited as you might think.
Excellent calcium rich foods include
- bony fish
- figs, dates
- beans and other legumes
- nuts (esp. walnuts, pecans, hazelnuts, brazils, almonds)
- seeds (sesame, chia, sunflower)
- green leafy vegetables (kale, broccoli, bok choy, collards, mustard greens, watercress)
- organic non-GMO tofu
- brewer’s yeast
- blackstrap molasses
- tinned salmon or sardines
These are all recommended as part of your regular dietary intake. Many of these non-dairy sources contain the right proportion of magnesium needed by the body for optimal calcium absorption. Studies show tempeh (fermented soy) provides amounts of absorbable calcium comparable with cow’s milk.
Milk and milk products are rich sources, and some of us absorb roughly a third of the calcium they contain – but many others are deficient in the enzyme lactase, needed to digest the lactose in milk. Those who are lactose tolerant in early life often produce less lactase as they age, reducing their ability to tolerate much dairy product. This causes gastric disturbances which inhibits absorption of calcium (and other nutrients). For people who are lactose intolerant matured cheese and yoghurt may be tolerated.
Fortified cereals and breads supply extra calcium but the phytic acid they contain inhibits absorption, as does a high fibre diet or high caffeine consumption. Beans, nuts and seeds naturally have relatively high phytic acid content but traditional cooking preparation methods can mitigate its effect.
What is the best form of supplementation?
There’s a lot of debate and research into the form of calcium supplement that is best absorbed by the body. It’s important to remember that our bodies regulate calcium absorption according to need and influenced by any imbalance in our biochemistry – the ratio of nutrients in relationship to each other present in the body.
The best form of supplementation provides a balanced, bioavailable mineral formula, and focuses on enhancing our body’s absorption rate of calcium from food sources. It is not advisable to take a stand alone calcium supplement over the long term without professional guidance.
Are there any risks involved with calcium supplements?
There are health risks associated with elevated calcium levels, so it’s important not to over-supplement. Random self-prescribing of calcium supplements can lead to excess calcium precipitating out of solution and forming arthritic plaques, kidney and gallstones or bony spurs, or accumulating in heart valves and restricting blood flow.
Some calcium supplements may be sourced from raw material containing heavy metals and are best avoided. Healthpost recommends two high quality bioavailable calcium products: Lifestream Natural Calcium, a certified organic supplement made from a sea vegetable, and BioBalance Marine Coral Calcium & Magnesium, an organic formula sourced from fossilised Japanese coral harvested using an environmentally friendly method.
Many women are magnesium deficient. This is another macromineral required in relatively large quantities by our bodies, and we quickly deplete our magnesium reserves during times of stress. Indications for magnesium deficiency include muscle cramps, twitching or tics, anxiety and various types of pain. Oral contraceptives also cause magnesium depletion.
In conjunction with its important role in calcium metabolism, magnesium is necessary for healthy development of the baby’s nervous, circulatory and skeletal systems during pregnancy. Throughout pregnancy magnesium is needed to build, maintain and repair tissue in the mother. It will help the uterine muscles relax and reduce the risk of premature labour.
Conditions in which magnesium deficiency is implicated include toxaemia, hypertension, preeclampsia, gestational diabetes, low birth weight and infant mortality.
During breastfeeding you naturally increase your magnesium absorption rate so don’t need the higher intake you required while pregnant.
Leafy green vegetables, whole grains, seeds, nuts, beans, tofu, some fish and shellfish are all good dietary sources of magnesium.
The official recommended dietary intake (RDI) for adult pregnant women in NZ is 350-360 mg per day, and 400 mg per day for pregnant adolescents. This is based on minimum requirements and an optimal total daily intake is at least 500 mg, often more. Considering many people only obtain half that amount from food sources, a magnesium supplement (as part of a balanced mineral formula) is recommended.
Zinc has an important role in male reproduction and sperm health. At cellular level DNA synthesis and cell division are two of the many processes requiring zinc. It is an essential micronutrient for healthy conception and foetal development.
Ensuring you have adequate dietary zinc intake prior to conception reduces the risk of insufficiency during pregnancy as the high requirements of the developing foetus take precedence. Women who have taken the oral contraceptive pill for extended periods of time may have depleted zinc levels. Supplementing iron to the recommended levels for pregnancy may inhibit zinc absorption so this factor needs to be taken into account too.
Zinc rich foods include oysters, red meat and poultry, eggs, dairy foods, watermelon, sesame, pumpkin and sunflower seeds, cashew nuts, blackberries and a big range of organic vegetables and fruit.
High infant demands for zinc also mean more is required during breastfeeding, so that the mother’s stores aren’t depleted. Beyond the first 6 months breast milk doesn’t provide enough zinc for the growing baby and appropriate food sources need to be introduced. These could include meat, poultry and fish, tofu, beans and cereal grains. Zinc from animal sources may be more easily absorbed due to the inhibiting action of phytates in high fibre vegetable sources.
Selenium is an antioxidant and has roles in fertility, immunity, development of the foetus and the quality and amount of colostrum and breast milk produced. A 2003UKstudy found women with low levels of selenium were up to four times more at risk of preeclampsia.
In New Zealand our soils are often deficient in selenium, so it may be less available to us through our food. Seafood and Brazil nuts are reliable sources. During pregnancy and breast feeding supplementation of 25 to 50 mcg selenium per day is recommended.
Iodine is another trace mineral deficient in New Zealand soils, and food sources alone may not provide the iodine needed for extra thyroid hormone production demands in pregnancy. The baby’s brain and nervous system relies on these thyroid hormones for normal development. Consequently the Ministry of Health recommends women take a supplement of 150 mcg per day from preconception through pregnancy and breast feeding.
The best food source of iodine available to us is sea vegetables – various forms of seaweed which are also rich in all the other essential trace minerals. Adding a small quantity of seaweed to your daily diet is a good way to increase your supply of these vital nutrients.
Copper is an important nutrient in red blood cell formation, and since your blood supply needs to increase by 30-50% during pregnancy your copper levels need to increase. It’s also integral to formation of the baby’s heart and blood vessels, skeleton and nervous systems.
Pregnant women need 1 mg per day and this increases while breastfeeding to 1.3 mg per day. Your intake needs to average that amount over several days rather than be achieved on a daily basis.
Food sources of copper include seafood, nuts, seeds, dark leafy green vegetables, tempeh and many more.
Vitamin A is important for improving the father’s sperm production and maintaining the mother’s vision and resistance to infection throughout the pregnancy, and for repairing her tissues after the birth.
The growth of the embryo and healthy development of many of its vital organs and organ systems including early stage brain and nervous system development requires an adequate supply of vitamin A.
Animal sources such as liver, cod liver oil, dairy products and eggs are rich sources of retinol, the preformed vitamin A. The best sources of the plant form (provitamin A) carotenoids, of which beta-carotene is the most common, are the red and orange vegetables such as chilli, capsicum, tomatoes, carrots, kumara, pumpkin and apricots as well as various leafy greens.
Both retinol (the animal form) and beta-carotene (the plant-derived form) of vitamin A are used in supplements. Research shows excessive amounts of retinol are teratogenic (i.e. cause defects in the developing embryo). Studies show amounts less than 10,000 IU (international units) per day of beta-carotene are non-toxic, so it is considered the safer option for supplementation. Between 3500 and 5000 IU beta carotene per day is the recommended dosage during pregnancy.
Vitamin B complex
As mentioned above under Folates, all the B vitamins in the correct ratios are an important adjunct to folate supplementation. In particular, vitamins B1, B2, B6 and B12 are needed for a healthy pregnancy. The bioactive forms of these B vitamins are best, both for absorption rates and to effectively support the all-important methylation cycle. Take a comprehensive bioactive B complex formula to ensure your needs are met, especially if you are dealing with extra stress.
Sperm health is a function of the antioxidant vitamin C, which protects the genetic material during maturation and the sperm itself prior to fertilisation. Research also indicates that vitamin C helps protect foetal lungs from nicotine exposure.
The mother’s vitamin C needs increase during preconception and pregnancy, and the needs of both mother and baby increase with each successive trimester. However, it’s important to balance increased needs with moderation, as too much vitamin C supplementation during pregnancy can cause vitamin C dependency or ‘rebound scurvy’ in the newborn.
Eating a range of foods high in vitamin C and supplementing any deficiency with a maximum 2000 mg (2 grams) per day gives a safe and adequate intake according to research.
(link to vitamin C blog)
Already mentioned under Calcium, vitamin D is essential for proper absorption of this important mineral.
A study of pregnant women published in 2010 followed three treatment groups taking respectively 400, 2000 and 4000 IU per day. The most beneficial results regarding pregnancy, labour and birth outcomes were found in the group taking the highest dosage of 4000 IU per day. This finding indicates that the higher daily supplementation level of vitamin D is both safe and therapeutic. To achieve optimum vitamin D levels, supplementation in conjunction with exposure to sunlight is the recommended approach.
Most vitamin D supplements currently available have only 1000IU per capsule.
There are two forms of vitamin D supplement: D2 and D3. Vitamin D3 (Cholecalciferol) is the safest and most effective form of supplementation to take.
Vitamin E is an important nutrient in sperm health and fertilisation. Babies born prematurely usually have low levels of vitamin E, as do women with preeclampsia. Eating plenty of organic green leafy vegetables, nuts and good quality vegetable oils will provide natural sources of vitamin E. As a fat soluble vitamin, excess Vitamin E can be stored by your body.
Research findings show that natural vitamin E from food sources is much more readily absorbed by the developing baby via the placenta than is the synthetic form sometimes used in supplements.
Research outcomes vary regarding the effects of vitamin E supplementation during pregnancy, and more studies are needed to provide reliable evidence. Some sources recommend 100 to 200 IU (international units) naturally sourced vitamin E daily to maintain healthy levels and prevent toxaemia, and no more than 400 IU daily to prevent toxicity (occurring in rare cases).
On a cautionary note, high levels of vitamin E supplementation were linked to preeclampsia and stillbirth in a recent study, and the Blood Type Diet recommends supplementation for A blood type mothers but warns against it for O blood types.
ESSENTIAL FATTY ACIDS
Getting optimal amounts of Omega 3 essential fatty acids (especially DHAs) during the preconception stage will improve the conditions for brain development, eyesight and nervous system function in the early stages of the developing foetus from conception onwards. Learning potential, behavioural development and mood stability throughout life are all influenced by the quality of Omega 3s available in utero.
One study reported a lower rate of preterm births in the group supplemented with fish oils. Consequently time spent in the neonatal intensive care unit was significantly less, a factor likely to affect many other developmental and behavioural outcomes in the infant, and also, importantly, associated with incidence of maternal depression.
Fish oil supplements have been established as safe in pregnancy. Choosing a product made from fish sourced from uncontaminated oceans is an important qualifying factor in ensuring safety.
Links to Omega 3 EFA blog & Fish oil supplements in pregnancy blog
What is the recommended daily dosage?
The general recommendation is to eat a minimum of 2 to 3 Omega 3-rich fish portions per week to maintain healthy levels. If fish is not part of your regular diet then 1-2 grams of a good quality fish oil supplement per day will benefit you and your unborn child. A ratio of 5:1 DHAs to EPAs is recommended as optimal in pregnancy and breastfeeding. Up to 3 grams total fish oil per day is considered a safe intake during pregnancy.
Evening Primrose Oil
During preconception Evening Primrose oil (EPO) can be taken for the first half of the menstrual cycle through ovulation to enhance the cervical mucus, which increases the survival rate of sperm, thereby improving the chances of conception.
EPO is contraindicated throughout the pregnancy, as it may cause uterine contractions. Near the end (from the 36th week) it can be taken to help soften the cervix for delivery. It is then safe to resume taking EPO supplements (1500 mg to 3000 mg per day) orally, and an EPO capsule can be inserted vaginally or its contents massaged directly onto the perineum and cervix each evening.
During breastfeeding EPO is considered a safe supplement, as breast milk also contains linoleic acid and gamma linolenic acid.
http://www.bpac.org.nz/magazine/2008/december/pregnancy.asp research article
Proteins & royal jelly
http://mthfr.net/folic-acid-awareness-week-2014-want-awareness-here-you-go/2014/01/08/ NTD prevention with bioactive folate forms
http://www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/tabid/178/vw/1/ItemID/169/Haemochromatosis.aspx haemochromatosis iron disorder
http://www.truestarhealth.com/Notes/2870003.html research references
http://content.karger.com/produktedb/produkte.asp?doi=298781 prenatal calcium
http://www.ncbi.nlm.nih.gov/pubmed/2220915 research prematurity
http://www.ajcn.org/content/80/6/1740S.full vitamin D & calcium
http://www.nrv.gov.au/nutrients/calcium.htm NZ recommended intake calcium
http://www.ncbi.nlm.nih.gov/pubmed/19995131 milk vs tempeh
http://www.nrv.gov.au/nutrients/magnesium.htm magnesium RDI
http://www.aims.org.uk/Journal/Vol16No2/ResearchRoundup.htm selenium preeclampsia
Evening Primrose Oil
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