Pre, During, and Post-Pregnancy Health An Expert Series on Women’s Health, Part II

Many women and their healthcare providers underestimate the nutritional demands of pregnancy and the importance of nutrition throughout the pregnancy journey, including the periods before and after pregnancy itself. Consequently, many patients do not consume an adequate amount or array of nutrients prior to conception, during pregnancy, and postpartum, throughout breastfeeding, and nutritional deficiencies are common. 

All healthcare professionals who care for reproductive-aged women need to understand the composition of a healthy diet that supports pregnant people and their babies. A high-quality diet consists of a wide variety of nutrient-dense, preferably organic, minimally processed foods, including lean meats, poultry, eggs, whole grains, fruits, vegetables, beans, lentils, nuts, and seeds, with a focus on including adequate protein, fiber, and healthy fats. Minimizing or avoiding ultra-processed foods, fatty red meats, and beverages sweetened with high fructose corn syrup or artificial sweeteners is also essential. ¹ 

Nutrition through diet is the best approach to maternal and fetal health. However, adhering to a nutrient-dense, minimally processed diet in our modern world can be extremely difficult, so even patients who eat a well-balanced diet may experience nutritional deficiencies.² 

For most patients, nutritional supplementation is a highly beneficial adjunct to food consumed. Nutritional supplementation is crucial for maternal and fetal health. A good prenatal vitamin should include folic acid, vitamin d, iodine, iron, calcium, and omega-3 fatty acids, particularly DHA, and supplementation should start at least several months before conception and continue for several months after delivery, and until the end of breastfeeding in patients who do so.³ 

Three supplements of particular importance are: 

1) Folic Acid 

Supplementation with folic acid, and/or its other form, folate, beginning at least one month prior to conception and continuing for at least the first three months of the pregnancy, as support for healthy fetal neural development. Folate is also a major contributor to maternal tissue growth and is known to support maternal mood.⁴ 

2) Omega-3 Fatty Acids 

An adequate consumption of the omega-3 fatty acid, docosahexaenoic acid (DHA), plays a significant role in the proper development of the fetal heart, brain, and nervous system, including the proper development of the eyes, both in utero and during breastfeeding. Data has linked maternal DHA supplementation with improved focus and attention in the offspring.⁵ 

3) Iron 

A large percentage of reproductive-aged women are iron deficient. Iron plays a critical role in many essential functions, including the production of hemoglobin, the oxygen carrying component of red blood cells. Iron is essential for energy production and individuals with iron deficiency will experience occasional fatigue and low energy status. Low iron in pregnancy is linked with maternal health issues such as breathing difficulties, sleep problems, palpitations, and fainting. Low iron also increases the risk of fetal complications such as growth restriction and low birthweight.⁶ 

Nutritional status is a critical component of maternal and fetal wellbeing, and it is an essential area that every healthcare professional needs to address during the preconception, pregnancy, and postpartum phases. Personalized supplementation can fill in dietary gaps to support nutritional status of certain nutrients. Optimal nutrition is not optional for supporting the best maternal and fetal outcomes.  

Ask the Expert  

What diet is best for supporting maternal and fetal health? 

Diet is an essential component of maternal health because no amount of supplementation can match the diversity of nutrients gained from a high-quality diet. Pregnant people should consume lean protein with Every meal (such as chicken, turkey, fish, eggs etc.) and then focus on eating a wide array of minimally processed, plant-based foods. “Eat the Rainbow” is a simple approach that encourages a diet of diverse, nutrient-rich fruits and vegetables. Extra attention should be given to beans, nuts, seeds, and legumes, which provide high-quality protein, fats, and fiber. Pregnant people should limit highly processed foods to minimize intake of sugars, artificial food additives, microplastics, and preservatives. Eating organic as much as possible will also help minimize exposure to pesticides and other toxic chemicals. 

What are the key supplements for preconception, pregnancy, and postpartum health? 

The supplements that are most likely to support maternal and infant health include prenatal vitamins, vitamin D, iodine, folic acid, iron, calcium, and omega-3 fatty acids, especially DHA. A well-formulated prenatal vitamin should contain most, if not all, of these ingredients anyway at efficient and tolerable levels. Particular attention should be given to folic acid, omega-3s, and iron.  

What supplements should be avoided during pregnancy? 

Women should avoid high levels of vitamin A and vitamin E and most herbal supplements, including CBD and hemp. If women were using herbals to aid preconception weight loss, they should stop those as well. Additionally, if women are taking a prenatal vitamin plus additional supplements, they should be careful not to “double up” on iron, vitamin A, iodine, and other nutrients such that they exceed daily recommended values. And women should be counseled to carefully read the labels of nutritional shakes and other food products that may be fortified with herbals, vitamins, and minerals that are not safe during pregnancy. 

Meet Our Expert  

Felice Gersh, M.D. is a multi-award-winning physician with dual board certifications in OB-GYN and Integrative Medicine, with degrees from Princeton University, University of Southern California School of Medicine, and University of Arizona School of Medicine.

She is the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive health care for women by combining the best evidence-based therapies from conventional, naturopathic, and holistic medicine. For many years, she taught obstetrics and gynecology at Keck USC School of Medicine as an Assistant Clinical Professor. She now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine through the University of Arizona School of Medicine.  

Dr. Gersh is a prolific writer and lecturer who speaks globally on women’s health and regularly publishes in peer-reviewed medical journals. She has been featured in multiple medical documentaries, including the Real Skinny on Fat, Fasting, and The Business of Birth Control. She is the bestselling author of the PCOS SOS series and Menopause: 50 Things You Need to Know.   

+Our Medical Consultants are retained advisors to Pure Encapsulations.   

REFERENCES 

1. Stephenson J et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health, The Lancet. 2018; 391(10132):1830-1841.  

    

2. Purnell PM et al. The importance of nutrition and lactation: lifelong consequences, American Journal of Obstetrics and Gynecology, 2022; 6 (5):607-6322. 

    

3. Mousa A et al. Macronutrient and micronutrient intake during pregnancy: an overview of recent evidence, Nutrients, 2019; (2):443. 

    

4. Argyridis S. Folic Acid in Pregnancy, Obstetrics, Gynaecology, & Reproductive Medicine, 2019; 29(4):118-120. 

    

5. Middleton P et al. Omega 3 fatty acid addition during pregnancy, Cochrane Database, 2018; 11:CD003402. 

    

6. Pena-Rosas et al. Daily oral iron supplementation during pregnancy, Cochrane database of systematic reviews. 2015; 7:CD004736.