A Prenatal through Postpartum Nutrition Guide

It is generally well-accepted that a woman's nutrient intake during pregnancy can affect the development of her baby.

However, there are many discrepancies between what conventional prenatal nutrition guidelines say and what both valid scientific data and the observation of traditional cultures show regarding a woman's nutrient needs during this critical time of growth and development.

During pregnancy, you are not simply "eating for two", as conventional rhetoric suggests---but are specifically eating to grow an entire baby from scratch. This includes muscles, bones, brain, and indeed, the entire complex human biological system.

You are also eating for yourself---to restructure and grow your tissues in order to accommodate for your baby during pregnancy and after birth---to provide yourself rest and recovery after birth, which can include additional factors, such as tears or cuts, either natural or induced as in the case of cesarean birth---to facilitate milk production, a process that will occur whether you breastfeed or not, as well as a host of other needs.

In pregnancy and birth, a woman becomes a vessel for the beautiful process of the continuation of human life. If you want to know more about what to eat in order to provide for all of the processes summarized above and more, then continue reading.

Conventional Nutrition vs Traditional Wisdom

Conventional prenatal nutrition is primarily based on the U.S. government's nutrition policies, from which are drawn generalized dietary advice for all Americans. There is no individual consideration.

Increased caloric intake, with little guidance on where those calories should come from, is recommended for the second, third, and "fourth" trimester. The "fourth" trimester is considered to be the postpartum period during which breastfeeding is suggested. Beyond this vague outline, a prenatal multivitamin is also typically suggested, intended to reduce the probability of birth defects and other complications common with nutrient deficiencies that can affect both mother and child.

These general set of guidelines have remained much the same now for several decades. You might recall the USDA Food Pyramid which has morphed modernly into the MyPlate recommendations. The advice to Americans in the newest iteration is to eat less meat, limit saturated fat, and eat more grains, in addition to limiting added sugars and salt. (1) Taken as a whole, however, very little in either model represents the best dietary science available.

Does traditional wisdom support these modern, general recommendations?

What does the research say?

During the difficult and demanding time that is pregnancy, a woman needs to receive and to be able to utilize the necessary nutrients she needs to grow her baby. In doing so, she also needs to be able to maintain her own health. This much is well established, and not up for debate, even according to less than desirable models.

While traditional cultures around the world vary in their practices in caring for pregnant women, they do hold some similarities, which are commonly ignored in modern discourse.

For example, in Traditional Chinese Medicine, an emphasis is placed upon certain foods for the postpartum period. (15) In other cultures, emphasis is placed upon other stages in the preconception and pregnancy phases, and interestingly the foods and practices recommended are similar across the board.

Of further interest, many of these practices align with current nutrition science. More modern studies posit consistent evidence to support the "Barker hypothesis" (2) which holds that the nutritional status of mothers even before pregnancy and factors such as in-utero stress can influence the baby's health even in such ways as intelligence, temperament, metabolism, and susceptibility to diseases that may extend beyond the first generation. (3, 4, 5)

There may be a lot of things that occur during pregnancy that are out of your control such as genetics, age, family history of diseases, etc. The things that are within your control, however, such as diet, exercise, sleep habits, stress management, exposure to toxins, and more---can have marked effects on your pregnancy. They may even leave a permanent imprint on your baby’s health, and quite possibly, their own children.

What does this mean for you?

There are plenty of resources out there for women who are looking to eat a healthier diet to help support their health throughout pregnancy and their baby's health.

I highly recommend Lily Nichols' book Real Food For Pregnancy as a valuable, scientifically-backed resource. (7) A healthy diet generally consists of minimally processed, properly prepared foods from all food groups, with special consideration to foods that are produced locally (for the increased nutrient content from reduced transit time), obtained in-season (ripeness generally indicates peak nutrient content), and prepared traditionally (processes such as soaking, sprouting, or fermenting).

What are the most important nutrients for pregnancy?

FOLATE

Folate (vitamin B-9) is known for its role in healthy cell growth and development, maintaining healthy brain function, and protecting us from certain cancers. It is important during the growth and development of a new human life.

Folate is needed to make new DNA during cell division and is most known for preventing neural tube defects in babies.

A woman's blood volume by the end of the third trimester has increased by almost 50%, which increases her need for both folate and iron. (8)

During pregnancy, women who test positive for MTHFR genetic mutation, which prevents folic acid from being broken down into the active and usable form of folate by the body, may have a higher risk for miscarriages, preeclampsia, and birth defects, such as spina bifida.

It is estimated that up to 25% of Hispanic women and up to 15% of Caucasian women have this gene. (9, 10) If you suspect you have the MTHFR gene mutation, it is important to test, but also to get enough folate from both food sources and supplements. Some supplements offer forms of folate that are easier for those with this gene mutation to absorb.

While liver has fallen out of popularity in the western world, it is a nutrient-rich food that is especially high in folate, and it continues to be used in traditional cultures from preconception to postpartum periods. Other foods that are high in folate are: soaked and sprouted beans like mung beans, lentils, and chickpeas; vegetables like spinach, cauliflower, and asparagus; fruits such as citrus and berries; and fermented foods such as kefir, kombucha, and sauerkraut. Sprouted and fermented foods have been shown to increase a food's nutrient content, especially the B vitamin content, such as folate. (10)

Most, but not all, wheat and maize flour began being fortified with folic acid around 1998 to reduce the risk of neural tube defects in pregnancies. The interesting thing is that when wheat flour is fermented such as in the process of making sourdough, the B vitamin content is raised considerably. So is the case with maize treated with lime in the process of nixtamalization.

Eating foods high in folate as part of a healthy diet will always be the best option, but as a precaution, the USDA recommends that all women of childbearing age supplement with folate before conception, as the first few weeks are the most important when it comes to preventing birth defects from folate deficiency. (11)

IRON

Iron is important for the production of red blood cells during pregnancy, but also because this vital mineral helps to oxygenate and provide energy to our babies' cells.

Iron is necessary for proper brain function, and iron deficiency is common in children and adults with symptoms of poor focus or inattention. Signs of deficiency include fatigue, muscle weakness with exertion, rapid heart rate, heart palpitations, and inability to keep warm upon exposure to cold. Even without pregnancy, up to 16% of black women are deficient in iron, 12% of Latina women, and 10% of women 12 to 49 years of age. Needless to say, the demand for iron increases during pregnancy.

According to a 2011 review in the American Journal of Clinical Nutrition, roughly 24% of Mexican-American women, 30% of non-Hispanic black women, and 14% of non-Hispanic white women are depleted in their iron stores during pregnancy.

Iron is found in two forms: heme and non-heme iron. Meat contains both of these forms of iron and plants and fortified foods contain only non-heme iron. Non-heme iron is absorbed less efficiently than heme iron, about 10% compared to 18%. Phytic acid, found in beans, lentils, rice, soy, and grains, also binds to non-heme iron, which further reduces its absorption. Soaking your grains and legumes can reduce this phytic acid content.

Eating your non-heme iron sources with vitamin C can also increase the absorption of this important mineral. Cooking soaked beans with chili peppers, a source of vitamin C, is a common, traditional practice in the Southwest.

Meat, shellfish, nuts, dried fruits, and fortified foods are also good sources of iron. Cooked spinach is also high in iron. Cooking your food in a cast-iron skillet is another way you can increase the iron in your food. (12)

While iron is important on its own, you must also have adequate vitamin A, vitamin B2, copper, and zinc for proper utilization of iron. On the other hand, too much iron can also be toxic to the body. A common genetic disorder in the U.S. is hemochromatosis, which causes iron to be absorbed and stored by the body at a higher rate. Treatment for this disorder requires draining a pint of blood every two to four months. Excess iron can cause several issues, including neurodegenerative disease, heart failure, diabetes, and cirrhosis of the liver. Do not take supplemental iron unless instructed by your healthcare provider.

VITAMIN B12

Folate and iron usually take the spotlight when it comes to prenatal requirements, but vitamin B12 is an important player when it comes to regulating the health of our brain and cells.

Vitamin B12 is essential for the formation of DNA. We need it for physical and mental energy and even emotional well-being. Vitamin B12 contributes to the production of the protective covering of our nerves, and deficiency has been connected to tingling and burning in the arms and legs. Along with B6 and folate, vitamin B12 is important for the production of the neurotransmitters serotonin, dopamine, and norepinephrine---the chemicals in our brains that regulate our mood and pleasure. Low levels of vitamin B12 during pregnancy can increase a woman's risk for postpartum depression. If you already suffer from depression, get your levels checked to ensure that nutritional deficiency is not part of the problem.

Pregnancy increases the requirements for vitamin B12, as it is necessary to ensure the healthy development of the baby. Along with other B vitamins, vitamin B12 is important for creating and maintaining DNA structure and helping the liver in detoxification, which is a process that happens daily.

In addition to folate, low levels of B12 can cause a buildup of the amino acid homocysteine, which can cause estrogens to accumulate in the body and cause systemic inflammation. These elevated homocysteine levels can increase a woman's risk for breast cancer, heart disease, and diabetes. (13) One study shows the harms that even modestly elevated blood sugars can cause in both mother and child both before and over a decade after birth. (14)

Vitamin B12 is found almost exclusively in animal foods like meat, seafood, and dairy. It is also found in fortified foods, nutritional yeast, algae, and seaweed. Unfortunately, by the time that signs and symptoms are apparent, deficiency of B12 has been present for some time. These symptoms can include pale skin, fatigue, dizziness, sore tongue, shortness of breath, and heart palpitations, along with neurological changes including tingling in hands and feet, weakness, depression, paranoia, and personality changes. Some neurological effects of B12 deficiency are irreversible. (12) Vegans are at high risk of B12 deficiency and should take a B12 supplement. Overall, about 18 million people in the US are B12 deficient.

CHOLINE

Choline is an essential nutrient that plays a role in the prevention of birth defects during pregnancy and fosters the healthy development of the brain and nervous system of young children.

It also supports cellular structure, heart health, and proper liver function. According to the NHANES study from 2007-2008, about 90% of Americans do not meet the adequate intake for choline. Choline is critical for the production of neurotransmitters that play a key role in memory, cognition, and muscle control. It has been suggested that choline can provide a child with lifelong protection against anxiety and extreme stress responses. A study of 274 pregnant women from Public Health Nutrition in 2014 found that 95 percent of pregnant women had a suboptimal intake of choline.

Pregnant and breastfeeding women should increase their consumption of choline-rich foods and find a prenatal multivitamin-mineral supplement that contains choline. Two major sources of choline are eggs and organ meats. For daily adequate intake, women need 425mg. Pregnant women need 450mg and breastfeeding women need 550mg. It's important to not exceed the upper limit of 3500mg per day.

I hope that this preliminary information has been helpful to you. If you are interested in more detailed data, and in receiving support for either your pregnancy or planned conception---consider booking a health consultation or email us at mars@endlesssea.org.

References

1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.

2. Edwards, M. (2022). The Barker Hypothesis. Retrieved 17 July 2022, from https://www.researchgate.net/publication/323794549_The_Barker_Hypothesis

3. Allegra, A., Giarratana, R. M., Scola, L., & Balistreri, C. R. (2021). The close link between the fetal programming imprinting and neurodegeneration in adulthood: The key role of “hemogenic endothelium” programming. Mechanisms of Ageing and Development, 195. https://doi.org/10.1016/j.mad.2021.111461

4. Rinaudo, P., & Wang, E. (2012). Fetal programming and metabolic syndrome. Annual review of physiology, 74, 107–130. https://doi.org/10.1146/annurev-physiol-020911-153245

5. Calkins, K., & Devaskar, S. U. (2011). Fetal Origins of Adult Disease. Current Problems in Pediatric and Adolescent Health Care, 41(6). https://doi.org/10.1016/j.cppeds.2011.01.001

6. (removed)

7. Nichols, L. (2021, July 26). Real Food for Pregnancy. Lily Nichols RDN. https://lilynicholsrdn.com/real-food-for-pregnancy/

8. Hytten F. (1985). Blood volume changes in normal pregnancy. Clinics in haematology, 14(3), 601–612.

9. Liberto, R. R. N. (2018, February 16). Can You Have a Successful Pregnancy with MTHFR? Healthline. https://www.healthline.com/health/pregnancy/mthfr#1

10. Folate and Folic Acid in Pregnancy. (2022, June 14). American Pregnancy Association. https://americanpregnancy.org/getting-pregnant/infertility/folate-vs-folic-acid/

11. Hundley, N. (2019, July 6). Food Sources of L-Methylfolate. Mindwhale. https://mindwhale.com/food-sources-of-l-methylfolate/

12. Low Dog, T. L., MD. (2016). Fortify Your Life: Your Guide to Vitamins, Minerals, and More. National Geographic.

13. Cho, N. H., Lim, S., Jang, H. C., Park, H. K., & Metzger, B. E. (2005). Elevated Homocysteine as a Risk Factor for the Development of Diabetes in Women With a Previous History of Gestational Diabetes Mellitus. Diabetes Care, 28(11). https://doi.org/10.2337/diacare.28.11.2750

14. Reinburg, S. (2018, September 11). Blood Sugar Spike in Pregnancy Bad for Mom & Baby. WebMD. https://www.webmd.com/baby/news/20180911/blood-sugar-spike-in-pregnancy-bad-for-mom-baby

15. Dennis, C., Fung, K., Grigoriadis, S., Robinson, G., Romans, S. E., & Ross, L. E. (2007). Traditional Postpartum Practices and Rituals: A Qualitative Systematic Review. Women’s Health, 3(4), 487–502. https://doi.org/10.2217/17455057.3.4.487