Micronutrients - Beyond the Prenatal
We discussed that the idea of “eating for two” is kind of a pregnancy myth. Growing babies doesn’t take nearly as many calories as you might think, and certainly not enough to justify an extra burger, milkshake, and a side of tacos (or at least not every day...). BUT, when it comes to vitamins and minerals, the idea of “eating for two” isn’t so far-fetched. While your calorie needs really don’t change much, your micronutrient needs change drastically during pregnancy (and postpartum!). While not quite double, thinking of it that way can help you focus on getting adequate amounts to support you and your growing babe.
Micro-what?
Micronutrients are non-caloric compounds in the foods we eat that provide health benefits to the body and keep our systems working smoothly. They include vitamins and minerals. These compounds are necessary for all different enzymatic reactions in the body, DNA synthesis, blood cell production and health, hormones, neurotransmitters, immune health, and more. While they contribute no calories to our bodies, they are absolutely essential to good health and an optimal pregnancy. Deficiencies not only cause problems for mom’s general health, but can also increase the risk of poor pregnancy outcomes and compromise baby’s health.
Before jumping into some examples, I want to touch on another frequent misconception. So many women I talk and work with think that their prenatal is sufficient, they don’t need to stress about getting extra micronutrients. Here’s the problem, well, there are actually several. First, many prenatals are actually quite low in several super essential micronutrients (like choline). Second, many women are getting low-quality supplements, like CVS-brand or “One-A-Day” prenatals; not only are these unlikely to have sufficient amounts of several nutrients (if they have them at all), but low quality supplements are often made with such poor ingredients that they either pass mostly unabsorbed through the digestive tract, or they can’t be absorbed well by the body at all because of a really inaccessible form of the vitamin or mineral. Poor quality vitamins and minerals tend to also be cheaper to use, so the cost of the supplement itself is lower. You know the saying: you get what you pay for. The other issue is that even if the prenatal says it contains 100% or some high amount of the RDA (Recommended Dietary Allowance), these numbers are based on quite out-dated and often non-pregnancy specific data.
For example, a recent study found that there’s about a 17 year lag between research discoveries and ACTUAL policy or recommendation changes. That’s nearly TWO DECADES! In other words, the discoveries today won’t become actual recommendations until the baby in your belly is getting ready to graduate from high school. This means the standards for the recommended amounts of vitamins and minerals is way behind. That, in and of itself, is super problematic, but it gets worse. The majority of recommendations for pregnancy are based on research done in NON-pregnancy women, or....MEN. That’s right. Research is done with men, then those finding are taken and someone (mostly more men) extrapolates from that data and decides on a value that they “think” will work for pregnant women. (I can’t insert a big enough eye roll here).
LET’S GET REAL
So, how far off are the recommendations? Well, studies (that won’t be put into policy for another decade or more) suggest the recommended intake for choline during pregnancy is likely to be more than DOUBLE the current RDA. The current value was based off of men and “adjusted” for pregnancy. B12 may actually be TRIPLE the RDA, while vitamin D has a current recommendation of just 600 IU, but optimal intake appears to be around 4,000+ IU based on current randomized control trials. Meanwhile, when we talk about vitamin A, the form of the vitamin A (beta-carotene vs preformed vitamin A) isn’t even considered. Why does this matter? Well, beta-carotene is a vitamin A precursor. That means the body has to convert beta-carotene into active vitamin A before it can be used. The problem? Research suggests up to 60% of people have mutations that dramatically impede this conversion. Similarly, no distinction is typically made between folate and folic acid, the latter being a synthetic form never found in nature. Again, many individuals have gene mutations that inhibit the use of folic acid by the body, making fortified foods (foods that have folic acid added) and folic acid supplements essentially useless. There are certainly more examples, but I hope this drives the point home that relying on supplements is a precarious gamble at best.
Food is vastly superior to supplements, as it comes in a readily bioavailable (easy to absorb) form, tends to be in foods that contain other compounds to compliment the micronutrients available (like vitamin D in milk alongside calcium and with fat, since it’s fat soluble, or vitamin E in nuts and seeds so that it has the proper fat for absorption), and also prevents toxicity. Some vitamins and minerals can be dangerous in too high of amounts. However, research shows that this is almost ALWAYS only an issue with supplemental forms, not food forms! Preformed vitamin A was recently called out for being potentially toxic during pregnancy, but the studies showed that this was the case only when taken as a supplement. Women eating high quality, real foods that happened to be high in vitamin A had no issues! And depending on your diet, your needs may be even high for some of these things.
For example, while many doctors and sources like to say vegan and vegetarian diets are fine and adequate during pregnancy, I, myself, and many of my colleagues would strongly disagree, especially without some very, very significant supplementation. Iron, choline, B12, DHA, and preformed vitamin A are just a few of the nutrients likely to be low or entirely absent from these diets. That’s not to say all omnivore diets are adequate; far from it! Whether you eat a plant-based diet or a meat-based one makes little difference if the quality of either is poor. But, if you’re vegan or vegetarian, I highly recommend working with a skilled registered nutritionist to ensure you and baby are getting what you need to be safe, health, and thrive.
FOOD FIRST
Remember, during pregnancy, you need to get significantly more micronutrients WITHOUT significantly more calories. That means your focus must be on super nutrient-dense foods, ensuring you get the biggest “bang for your buck”. And a super high quality prenatal will help bridge any potential gaps. But a prenatal should serve as a safety net, not as your first line of defense.