7 key nutrients your prenatal vitamins should include
Everything you need to know about PNV for TTC and pregnancy
In other articles, we covered the importance of;
- Folate vs folic acid in Prenatal Vitamins: Folate vs. Folic Acid and the MTFHR mutation.
- Prenatal vitamins and neural tube defects
- Prenatal screening and testing
Now, let’s talk about a few other vitamins and minerals that should be included in a prenatal vitamin and other important supplements:
- Iron
- Iodine
- Choline
- Omega-3 Fatty Acids, including DHA
- Calcium
- Vitamin D
- Coenzyme Q10
Iron, Iodine and Choline
IRON can be found in beans, lentils, enriched breakfast cereals, beef, turkey, and shrimp. You should also eat foods rich in vitamin C because they help your body absorb iron, including oranges, grapefruit, strawberries, broccoli, and peppers.
Iron is needed to produce hemoglobin, the protein in red blood cells that carries oxygen to tissues. A pregnant person’s blood volume increases significantly to supply oxygen to the growing fetus, which increases their need for iron.
Adequate iron intake helps prevent anemia, a condition where the blood doesn’t have enough healthy red blood cells, which can lead to fatigue, weakness, and complications such as preterm delivery or low birth weight.
A pregnant person typically needs about 27 milligrams of iron per day, according to the American College of Obstetricians and Gynaecologists (ACOG) to meet the increased needs during pregnancy.
IODINE can be found in Iodized table salt, dairy products, seafood, meat, some breads, and eggs.
Iodine is essential for producing maternal and fetal thyroid hormones that regulate the development of the fetal brain and nervous system. A person’s iodine requirements increase substantially during pregnancy to ensure adequate fetal supply.
The American Thyroid Association (ATA) recommends that women who are planning pregnancy, pregnant, or lactating take supplements containing 150 mcg of iodine per day.
CHOLINE is essential for fetal brain and nervous system development and may reduce the risk of neural tube defects. Choline may also reduce the risk of certain pregnancy complications, such as preeclampsia, and can improve placental function.
Choline is found in many foods like chicken, beef, eggs, milk, soy products, and peanuts. Choline is also found in plant sources, such as navy beans, brussels sprouts, broccoli, and spinach. Plant sources generally contain lower levels of choline and it is recommended that vegetarians and vegans seek out supplemental sources of choline.
Choline is not found in most prenatal vitamins, so it’s important to make sure you’re getting enough in your diet or consider adding a supplement. 450 mg of choline daily is recommended in pregnancy. The forms of choline in dietary supplements include choline bitartrate, phosphatidylcholine, and lecithin.
Omega 3 Fatty Acids (including DHA, EPA, ALA)
Omega-3 fatty acids are a group of polyunsaturated fats, among which EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the most beneficial for human health. These fats are vital for the functioning of every cell in the body and have widespread health benefits.
The best food sources for omega-3s are fish, fortified eggs, and flaxseed (ground or as oil). Other sources include broccoli, cantaloupe, kidney beans, spinach, cauliflower, and walnuts.
For those trying to conceive (TTC) and during pregnancy the recommended amount is 1000 – 1,500 mg per day. Omega-3s support brain and eye development in the fetus and may reduce the risk of preterm birth.
Omega-3s are not found in most prenatal vitamins, so pregnant women should ensure they are consuming it in their diet or taking it in supplement form. For vegans, there are vegan forms of omega-3 supplements.
You should aim to eat at least 2-3 servings of fish or shellfish per week before getting pregnant and while pregnant. A single serving of fish is 4 ounces. Some types of fish have higher levels of mercury than others, so it is important to be mindful of the types of fish as well.
Calcium
The best food sources for Calcium include milk and other dairy products, such as cheese and yogurt. You can also get calcium from broccoli, fortified foods (cereals, breads and juices), almonds and sesame seeds, sardines or anchovies (with the bones), and dark green leafy vegetables.
Calcium is important for fetal bone and teeth development and may reduce the risk of maternal preeclampsia.
The recommended dose of calcium in pregnancy is 1000 mg per day.
The typical amount of calcium in a prenatal vitamin is 200-300 mg so some people may require additional supplementation, depending on their dietary consumption.
Vitamin D
The best sources of vitamin D include sunlight, fortified milk and breakfast cereals, fatty fish such as salmon, sardines, mackerel, and egg yolks.
The recommended dose of vitamin D in pregnancy is 600 international units (IU) per day. The typical amount of vitamin D in a prenatal vitamin is 400 IU.
Supplements while trying to conceive, including Vitamin D, Omega-3s and, Coenzyme Q10
Vitamin D
Vitamin D, often referred to as the “sunshine vitamin,” is a fat-soluble vitamin essential for bone health, immune function, and cell growth. While it’s well-known for its role in maintaining bone health, emerging research suggests that Vitamin D also plays a significant role in reproductive health.
Vitamin D and women’s Fertility
Some studies have investigated the relationship between vitamin D levels and fertility in women.
A study by Ozkan et al. found that vitamin D levels are associated with pregnancy rates in patients undergoing IVF.
However, a study by Franasiak et al. looking at implantation of euploid embryos specifically did not show a correlation between vitamin D levels and implantation. Meaning, implantation rates were the same in women regardless of their vitamin D levels.
Because of conflicting evidence, there are no specific guidelines for vitamin D levels for people trying to conceive. As a matter of fact, vitamin D testing is not covered by OHIP and is often not covered by private insurance either.
How much vitamin D is necessary?
While there is no specific guidance for measuring vitamin D levels for fertility, we do know there is widespread vitamin D deficiency in countries like Canada that don’t get a lot of sun. The recommended daily allowance (RDA) for vitamin D in Canada is 400-1000 IU/ day for ALL individuals.
Omega-3 Fatty Acids and Fertility
Omega-3s and Women’s Health
1. Heart Health: Omega-3s are known to support heart health by reducing triglycerides, lowering blood pressure, and decreasing the risk of heart disease.
2. Anti-inflammatory Properties: They exhibit strong anti-inflammatory properties and may be beneficial in conditions like rheumatoid arthritis and reducing general inflammation in the body.
3. Mental Health: Studies have shown that omega-3s can improve mental health outcomes, reducing symptoms of depression and anxiety.
Omega-3s and Fertility
For women trying to conceive, omega-3 fatty acids are particularly important due to their role in reproductive health. While there is no specific recommended daily intake for omega-3s for fertility, a general guideline is to include two to three servings of fatty fish per week or to take a supplement of 1500 mg of omega-3 per day.
Let’s look at a study published by Stanhiser et al. in Human Reproduction in 2022. This study analyzed 900 women aged 30 to 44 comprising 2,510 menstrual cycles. Women taking omega-3 supplements had 1.83 times the probability of conceiving in a given menstrual cycle compared to women not taking omega-3 supplements.
Coenzyme Q10
Understanding Coenzyme Q10
Coenzyme Q10 is a naturally occurring substance in the body and it plays a crucial role in the process of energy production within cells. It’s also known for its antioxidant properties, protecting cells from oxidative stress and damage.
CoQ10 and Female Fertility
The interest in CoQ10 for fertility primarily stems from its potential impact on egg quality and ovarian reserve.
Egg Quality and Ovarian Reserve:
Research suggests that CoQ10 can improve egg quality by enhancing mitochondrial function. As women age, the energy production in their eggs diminishes, potentially affecting egg quality. CoQ10 supplementation has been shown to improve this energy production, thereby potentially enhancing egg quality.
Some studies have indicated that CoQ10 supplementation might improve the ovarian response in IVF treatments, leading to a higher number of retrieved eggs.
Coenzyme Q10 (CoQ10) supplementation and egg quality:
Impact of CoQ10 on Ovarian Response and Egg Quality in Older Women:
A 2023 study published in the journal ‘Human Fertility’ investigated the effects of CoQ10 on ovarian response and egg quality, particularly in older women undergoing in vitro fertilization (IVF). The research found that CoQ10 supplementation improved ovarian response and increased the number and quality of retrieved oocytes (eggs).
No studies (yet) have shown improvement in the ultimate outcome which is live birth rate. But, these studies are very hard to do and require massive resources. Given the low risk of CoQ10 supplementation and promising data for improving age-related egg quality decline, we recommend CoQ10 supplementation to anyone TTC after age 35. It is important to stop taking CoQ10 once pregnant, as CoQ10 has not been studied in pregnancy so its safety is unknown.
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