Calcium. Calcium—and large amounts of it—are absorbed by the fetus during pregnancy: One 2017 review article published in the Journal of Obstetrics & Gynaecology of India noted that “fetal calcium levels suggest that ionized calcium is transferred from the mother to the fetus at a rate of 50mg/day at 20 weeks of gestation, to a maximum of 330mg/day at 35 weeks of gestation.” To this end, the National Institutes of Health (NIH) suggests that everyone 19-50 years old—whether not pregnant, pregnant, or lactating—take 1,000mg/day, while those 14-18 should take 1,300mg/day, but in doses of around 500mg or less.
Another perk of calcium is that it can help reduce risk of pre-eclampsia, according to the World Health Organization (WHO). Pre-eclampsia is a hypertensive disorder that can cause maternal death and preterm birth. Normally, WHO says, blood pressure falls during early pregnancy, and then slowly rises until the end of the pregnancy, but factors including diabetes, twin or teenage pregnancies, and low calcium consumption can alter this pattern, and increase the risk of developing pre-eclampsia. Calcium supplementation can help, in populations with low dietary calcium intake.
Choline. Choline is rising in awareness, as we have come to understand that “all plant and animal cells need choline to preserve their structural integrity,” according to the NIH. Why? Choline is required to synthesize phosphatidylcholine and sphingomyelin, two phospholipids vital for cell membranes. Choline is also required to produce acetylcholine, a neurotransmitter necessary for memory, mood, muscle control, and other brain and nervous system functions. On top of all that, choline plays important roles in modulating gene expression, cell membrane signaling, lipid transport and metabolism, and early brain development.
While humans can produce some choline in the liver, the amount the body synthesizes is not enough to meet an individual’s needs, let alone the needs of an individual and a fetus. A 19+ year-old adult needs 425-550mg/day, depending on gender. The NIH notes that pregnant people require 450mg/day, and lactating people require 550mg/day.
Choline is found mostly in animal sources—liver is far and away the richest source at 356mg/serving, with egg yolks coming in second at 147mg per egg and Soybeans coming in fourth at 107mg/serving. Chicken breast, beef, fish, potatoes, and cruciferous veggies all contain choline, albeit at much smaller amounts. A supplement would be the best way to ensure that both the pregnant person and the child get adequate amounts of choline.
Fatty Acids. Fatty acids are moving into the limelight for adults, and when it comes to prenatal care, it’s time to put fatty acids in the spotlight there, too. A 2008 article published in Reviews in Obstetrics & Gynecology notes that two specific polyunsaturated fatty acids (PUFAs) are vital here: The omega-6 arachidonic acid (AA) and the omega-3 docosahexaenoic acid (DHA) are “critical” to fetal and infant central nervous system growth and development, according to the researchers. AA is embedded in cell membranes, and is involved in cell signaling pathways and cell division; DHA is highly concentrated in retinal and brain membrane phospholipids, and it is involved in visual and neural function and neurotransmitter metabolism. During the last trimester, the baby takes in about 50-70mg per day of DHA (and, actually, they continue to accrue DHA in the central nervous system until about 18 months of age, according to the researchers).
While most Americans take in plenty of omega-6 fatty acids, including AA—and, in fact, take in too much—omega-3 intake is low. The researchers suggest that pregnant people should, on a daily basis, take in 1.4g of omega-3 fatty acids from vegetable oils such as flaxseed oil, canola oil, or soybean oil, and take a 650mg omega-3 supplement, wherein 300mg are DHA. On a weekly basis, the researchers suggest two servings of low-mercury seafood, such as shrimp, salmon, or pollock.
Worth noting: While the two-serving rule with regards to fish is due to concerns regarding mercury, new opinions on the matter are emerging. At the Naturally Informed event Mental Wellness: Mastering the Market, Alex Richardson, DPhil (Oxon), PGCE, FRSA, discussed the importance of DHA, explaining that prenatal DHA deficiency can result in everything from a lowered IQ to behavioral challenges. While the session can be viewed on-demand at www.naturallyinformed.net, the roundtables are not available—but in her roundtable, she stated that mercury levels in the fish aren’t high enough to be a problem. She added that, at worst, mercury will drop the child’s IQ by half a point—in comparison to DHA deficiency, which can cause a drop of five points. Your customers who particularly enjoy fish may want to discuss a higher intake with their healthcare provider, to work through the risks and benefits.
DysgeusiaWhile nausea during pregnancy is expected, pregnant people may be surprised by a metallic taste in their mouths. However, according to a small 2009 study published in Acta Oto-Laryngologica, changes in taste—known as dysgeusia—may happen in up to 92.8% of pregnant women. And pregnant patients often complain that their mouth tastes foul, rancid, salty, or burnt, according to Kecia Gaither, MD, MPH, FACOG, who is board-certified in both obstetrics/gynecology and maternal-fetal medicine. Dr. Gaither serves as Director of Perinatal Services at NYC Health + Hospitals/Lincoln.
In an interview with Verywell Family, Dr. Gaither explained that hormonal changes can cause this issue, as can a changing sense of smell or an existing medical condition like diabetes, dry mouth, gingivitis, or taking certain medications. Elisa Cinelli, author of the article, pointed to interviews with individuals who experienced a metallic taste, noting that the taste may happen all the time, only when eating, only when eating certain foods, or for one pregnancy but not another, and the dysgeusia can last until the end of the first trimester or throughout the entire pregnancy.
Jill Purdie, MD, OB/GYN of North Women’s Specialists in Atlanta, GA, also offered advice in the interview: drink citrus juices or lemonade, chew gum, suck on mints, or consider changing prenatal vitamins. Dr. Purdie also advises patients suffering from dysgeusia to use a toothpaste that contains baking soda, and to scrape the tongue after brushing their teeth.
Offer all-natural lemonade and sugar-free chewing gum and mints, and consider putting a sign to this effect by your prenatal vitamins. And, as always, advise your customers to speak to their healthcare provider about dysgeusia, so that the doctor can keep track of the changes and ensure that the issue is harmless. Folic Acid. Folic acid is so important that the CDC suggests that all people capable of giving birth take 400mcg of folic acid daily, in addition to consuming folate through the diet, to ensure that even unplanned pregnancies get off to a good start—folic acid helps form the neural tube very early during pregnancy, and adequate amounts of it can help prevent anecephaly (a birth defect of the baby’s brain) and spina bifida (a birth defect of the spine). The CDC notes that around half of U.S. pregnancies are unplanned, and these major birth defects occur three to four weeks after conception, before a person would know that they are pregnant.
Many foods are enriched with folic acid, for precisely the purpose of preventing birth defects. The CDC allows that the 400mcg daily can come from supplements, fortified foods, or a mixture of the two, in addition to foods containing natural folate, a list that includes legumes, asparagus, and leafy greens—Healthline notes that while one cup of cooked lentils contains 90% of the daily value (DV) of folate, most foods have much smaller amounts, with a 3oz serving of beef liver containing 54% of the DV, one cup of cooked kidney beans coming at 33% of the DV, a half-cup of asparagus bringing in 34% of the DV, spinach dropping to 15% of the DV—citrus fruits, Brussels sprouts, and broccoli contain about the same amount.
Iron. Pregnant people are at an increased risk of iron deficiency anemia. Experts at the Mayo Clinic explain that the body uses iron to make hemoglobin, a protein that carries oxygen to the tissues. During pregnancy, the body uses iron to make more blood in order to supply oxygen to the baby, too—such that pregnant people need double the amount of iron that nonpregnant people do. Severe anemia can increase risk of premature birth and postpartum depression, and can put the baby at risk of being born at a low birth rate. People are at particular risk for this if they:
- Have two closely spaced pregnancies;
- Are pregnant with more than one baby;
- Had a heavy pre-pregnancy menstrual flow;
- Have a history of anemia, pre-pregnancy;
- Are vomiting frequently due to morning sickness;
- Don’t consume enough iron.
When it comes to maintaining healthy iron levels, pregnant people need 27mg of iron per day. Iron, of course, is found in animal products, where it is most easily absorbed; it can also be found in supplements and fortified foods. To enhance absorption of iron in plant sources and supplements, Mayo Clinic recommends pairing it with food or drink high in vitamin C, such as orange juice, tomato juice, or strawberries—and avoid taking calcium at the same time, whether in supplement form or in calcium-fortified orange juice, because calcium can decrease iron absorption. (And to get more information on iron supplementation without side effects, check out WholeFoods’ February article on the topic.)
Vitamin D. Vitamin D is important, in large part, due to its use in calcium absorption—without vitamin D, that 1,000mg/day of calcium won’t be absorbed very well. And in cases wherein the pregnant person is severely deficient, the baby can be born with congenital rickets, disordered skeletal homeostasis, and fractures, although that’s rare enough that The American College of Obstetricians and Gynecologists doesn’t recommend that vitamin D screening be a broad recommendation.
However, a 2015 study published in Women’s Health notes “a striking difference… in vitamin D metabolism during pregnancy and fetal development compared with nonpregnant and nonfetal states.” The study explains that, typically, vitamin D is converted into 25(OH)D, and then into an active hormonal form known as calcitrol, which acts to maintain calcium homeostasis. In nonpregnant people, the study notes, circulating 25(OH)D levels below 20 ng/ml represent deficiency—but based on a randomized controlled trial the researchers had previously performed, optimization of calcitrol does not occur until total circulating 25(OH)D levels have reached 40 ng/ml. Specifically, the experts explained, the conversion of 25(OH)D to calcitrol during pregnancy is “unique and unparalleled during life.” By 12 weeks of gestation, calcitrol levels “are more than twice that of a nonpregnant adult, and continue to rise two- to threefold from the nonpregnant baseline” until the pregnant person attains levels that would be toxic to a nonpregnant individual.
Interestingly, the study states that this rise in calcitrol is not related to the needs for extra calcium, suggesting that vitamin D serves an important purpose beyond just facilitating calcium absorption. One of the leading theories, the researchers state, is that calcitrol is important for the pregnant person’s “tolerance to the foreign fetus whose DNA is only half that of the mother’s,” although there is no answer yet.
The researchers also note that a breastfeeding person’s vitamin D status becomes the infant’s vitamin D status, making it vital for the parent to be vitamin D sufficient.
Regarding supplementation, the researchers contend that a vitamin D intake during pregnancy of 400 IU/day is “grossly inadequate, especially with ethnic minorities,” and suggest supplements of 1000 IU/day in pregnant people, as per findings from the researchers’ two randomized clinical trials involving vitamin D supplementation in pregnant people.
Most parents—and parents-to-be—likely won’t need encouragement to keep nutrition in mind. Rather, what they’ll need is reassurance that the food they’re eating and the products they’re taking are safe, nutritious, and effective. Provide that reassurance, and you may end up with a new tiny regular. WF