Nutritional and lifestyle factors at the time of conception are known to play a significant role in the pathogenesis and prevention of many reproductive failures, and are important determinants of embryonic and foetal growth. In addition, there is now accumulating evidence which suggests that inadequate levels of maternal nutrients during the critical pre-implantation period and the first few weeks of pregnancy, predisposes the developing foetus to chronic illness later in life. The quality of a woman’s diet throughout pregnancy also has an influence on foetal and maternal outcomes.
Encouraging healthy eating patterns forms the cornerstone of a naturopathic nutritional intervention during the pre-conceptional period, however additional support through supplementation may be required to meet the increased physiological demands of pregnancy.
Use of natal multivitamin supplements have been shown to have a number of benefits for both the mother and her offspring.
Use of multivitamins, which contain at least 400 micrograms of folic acid, have been shown to be protective against a number of paediatric cancers, and reduce the incidence of numerous birth defects including neural tube defects. Micronutrient supplements also reduce the incidence of low-birthweight babies and small-for-gestational-age babies, compared to pregnant women who received only iron with or without folic acid. Ovulatory infertility is also inversely associated with multivitamin use.
Current guidelines recommend that in addition to dietary intake, folate, in the form of folic acid, should be supplemented at a minimum of 400 micrograms per day prior to conception and up to 12 weeks of gestation, in order to maximally prevent neural tube defects (NTD’s). It is not known whether forms of folate, other than folic acid, are equally effective for NTD prevention.
For women with a history of the delivery of a baby with a NTD, have diabetes or are receiving anticonvulsant treatment, the recommended daily dose is 5000mcg of folic acid.
For women who have been diagnosed with MTHFR or other methylation problems, individualised assessment is called for to ensure they receive not only the correct daily doses but also the most beneficial forms of the B-vitamins.
Vitamin B12 is also required for prevention of NTD’s, with women with low B12 status having nearly a three-fold higher risk of having a child with a NTD. Vitamin B12 plays an essential role in homocysteine metabolism; hyperhomocysteinaemia is associated with adverse pregnancy outcomes including pre-term delivery, Small-for-Gestational-Age infants, and intrauterine growth retardation.
Iodine deficiency is increasingly common in the Australian population due to poor soil content. A deficiency can lead to foetal hypothyroidism, resulting in impaired thyroid-hormone-dependent neurodevelopment and in severe cases results in cretinism and mental retardation. Cretinism can be prevented by correcting maternal iodine deficiency before or during the first three months of pregnancy. An Australian study demonstrated that even mild iodine deficiency during pregnancy reduced the educational outcomes of offspring during the 9-year follow up period, despite ensuring iodine sufficiency during childhood. Iodine deficiency also increases the risk of miscarriage, stillbirth and neonatal mortality. Current guidelines suggests that at least 220 mcg/day is required during gestation for optimal outcomes.
Vitamin D plays an important role in egg implantation and regulation of local immunological embryo protection. Deficiency during pregnancy is also associated with adverse health problems in offspring including, impaired growth, skeletal problems, type 1 diabetes, asthma and schizophrenia.
A dose of 1000-5000 IU daily, dependent on baseline levels, is suggested to be optimal.
Iron is the most common nutrient deficiency among pregnant women and requirements are significantly increased during gestation. Supplementation reduces the risk of low-birthweight newborns and pre-term delivery. Iron deficiency anaemia in early development is linked with altered behavioural and neural development, as deficiency results in hypomyelination. Anaemia is associated with perinatal maternal and infant mortality and premature delivery. The RDI increases from 18 to 27mg/day in pregnancy and additional supplementation is often required achieve recommended intakes.
Ensuring the sufficiency of these key nutrients during the pre-conceptional period can have profound impacts on the health of the mother and developing foetus, extending beyond the gestational period.
For a comprehensive assessment of your nutritional needs, contact True Medicine on 5530 1863.