Trying to Conceive? Part 2
Following on from Part 1; Trying to Conceive? Here's What You Need to Know, this blog will address what is needed and what to look for in prenatal supplementation, how your nervous system impacts conception and how to support yourself, and testing recommendations.
During preconception care (quick refresher – this is ideally 4 months or more as outlined in part 1!), your individual needs and nutrient requirements will be different to everyone around you. This is because you have different genetics, DNA, biochemistry, lifestyles, diets, environments, exercise routines, jobs, stress levels, I’m sure you get the point here, this list could go on and on!
However, there are some specific, vital nutrients required in preconception care, and I will cover those here. Some nutrients have general amounts listed, and some do not. Those numbers will change and fluctuate depending on your needs and your levels if you do testing (which I highly recommend – see the end of this blog for my suggestions).
What to Look for in a Preconception Supplement?
Folate
More specifically, activated folate. NOT folic acid. Activated folate will be listed as either methyltetraydrofolate (5-MTHF), methylfolate, folinic acid, calcium folinate, or levomefolic acid.
Folic acid is a synthetic version of folate. It is inactive in the human body until it is converted into the active, methylated form, 5-MTHF, which is then able to be used.
40% of women of reproductive age remain deficient in folate, despite the fortification of foods and use of supplementation. To reduce the risk of Neural Tube Defects, WHO recommends 400 micrograms of folate supplementation at least 1 month prior to conception.
I suggest 500 micrograms daily for activated folate in the preconception period – most good quality prenatal supplements will contain this amount from one or more sources of activated folate.
Iron
Your body uses iron to make haemoglobin, a protein found in our red blood cells, that carries oxygen from your lungs to the rest of your body – your brain, muscles, skin, liver, kidneys and everything else. During pregnancy, a woman’s iron needs double in the second and third trimester in order for enough haemoglobin to be made for mum and bub.
If iron stores are low (known as ferritin on a blood test) before falling pregnant or during pregnancy, you have a higher risk of developing iron deficiency anaemia.
The risks that can come with severe cases of anaemia during pregnancy are something that every mother will want to avoid. These can include:
- Increased risk of having a premature birth
- Increased risk of having a low birth weight baby
- Increased risk of postpartum depression
Not everyone will need a prenatal that contains iron, but many women will. This is where bio-individuality comes in, yet again! The same supplement will not work for everyone. Whether you need iron will depend on your intake, symptoms of low iron, and iron studies test.
Read more about the role of iron in the preconception period here.
Iodine
An often forgotten mineral, iodine is crucial in preconception and pregnancy care as deficiency impairs foetal development, increases miscarriage risk, affects thyroid function, and increases the risk of intellectual disability in the growing child.
Up to 50% of pregnant and breastfeeding women in Australia are deficient, with the WHO classifying Australia as a ‘mildly iodine deficient’ country.
Iodine is best tested via a urinary analysis, that your health care provider can give you a referral for. Important to do this test fasting, first void in the morning, with no iodine supplements taken for 1 week prior.
If a preconception client comes to me iodine deficient, I ask them to stop trying to conceive until we have correct the deficiency – it is simply not worth it. A good preconception supplement will contain from 220 – 300 micrograms of iodine. Additional will be necessary if correcting a deficiency.
B12
.Necessary for red blood cell production, Neural Tube Defect prevention, and necessary for replication and differentiation in early foetal cells. This nutrient has a particularly complex absorption and assimilation pathway versus other nutrients. Therefore deficiency is common in those with low intake, such as vegans and vegetarians, but also in those with digestive issues or disorders, such as Coeliac disease, or Inflammatory Bowel Disease (IBDs).
400 – 500 micrograms of activated B12 in a preconception supplement is optimal.
Vitamin D
Vitamin D is essential for foetal skeletal growth, tooth mineralisation, the regulation of calcium absorption and deposition in bones, and healthy immunity and T-cell function in the newborn.
90% of vitamin D is synthesised through the skin via sunlight, with the reminder through dietary nutrients, particularly oily fish (sardines, herring, salmon), egg yolks, and mushrooms that have been exposed to sunlight.
Test your Vitamin D levels – Vitamin D deficiency or sub-optimal status is ubiquitous in Australia – so that you can increase safe sun exposure and supplement according to your individual needs.
Additional Necessary Nutrients
Essential Fatty Acids (EPA/DHA)
EPA and DHA which have been shown to influence the constriction of blood vessels, hence the benefits in reducing the risk of high blood pressure and pre-eclampsia during pregnancy.
It is postulated that this same mechanism is why supplementation may delay labour and thus potentially increase the length of pregnancy and increase birth weight, by preventing the production of prostaglandins that encourage the cervix to ‘ripen’.
In pre-conception care, omega-3 fatty acid supplementation reduces the risk of:
- Preterm birth < 37 weeks
- Early preterm birth < 34 weeks
- Low birth weight babies (LBW)
- Perinatal death
- Neonatal care admissions
- Low birthweight babies (LBW)
- Pre-eclampsia and hypertension
- Peri-natal depression
Additionally, omega-3 fatty acid supplementation improves foetal brain and retina development, reduces the risk of cerebral palsy, and reduces the risk of post-partum depression (now commonly known as post-natal depletion) in the mother.
I like to see levels of EPA around 300 - 500mg/1g, and DHA around 200mg/1g of fish oil. 1 capsule usually equates to about 1g, so each capsule should contain this. Depending on the needs of the individual, anywhere form 2 – 4 capsules daily is what I would prescribe for pre-conception and pregnancy care.
Read more detail about EPA/DHA and benefits in preconception care and pregnancy in my blog here.
Also...
Other important nutrients to look for in a prenatal include zinc, selenium, choline, and antioxidant support. There are specific probiotic strains – Lactobacillus rhamnosus (LGG) is an important and well researched one – indicated for optimal microbiome health in mum, which we now know gets passed along to bub. Probiotics can assist with maternal health and wellbeing as well as baby’s immune and nervous system health.
A prescription must be personalised according to the individual, with all nutrient deficiencies corrected. They may also be increased requirements for calcium, choline, zinc, selenium, copper, amongst other nutrients.
Self-Care and Nervous System Health
High stress levels are associated with an increased time to conception. Please take a moment to read that again! Clients of mine will already know how much I harp on about stress-management tools and techniques and WHY they are important in my sessions. I don’t harp without good reason! If it is my job to assist your conception journey, and stress is hindering the process, all of the fabulous nutrients and supplements in the world won’t be able to outdo your high stress life (real or perceived, or both).
What I see work for my clients:
- Meditation, using an app
- Yin yoga
- Napping
- Talk therapy
- Technology-free time
- Actually exercising!
- Changing your perspective - instead of 'I have to' shift to 'I get to'
- Daily gratitude lists
- Journaling
- Saying no to things that do not serve you
- Having healthy work boundaries
I have written a blog all about stress, and how to address it here, as well as some fabulous ideas on how to rest and relax here.
What blood tests to do?
It is worth doing extensive blood work prior to starting your preconception journey so that nutrient deficiencies or excesses can be corrected, and your protocol can be tailored specifically to your needs. I suggest the following:
- Full blood count (FBC), this includes RBCs and WCC
- Liver function tests (LFT) and kidney function tests
- Full iron studies (not just ferritin please!)
- Thyroid panel – TSH, T3, T4
- Vitamin D
- B12, active and inactive
- Folate
- Urinary iodine
- ‘Day 21’/one week post-ovulation progesterone
- Fasting glucose and insulin
- Blood pressure
- Infection screen
Additionally, there are some investigations that may be required based of a person’s presentation and healthy history. These include:
- MTHFR gene mutations
- Thyroid antibodies
- Reverse T3 (rT3)
- Autoimmune markers – CRP, ANA, ESR
- Coeliac serology/gluten antibodies
- Additional hormones as required
- Zinc/copper
- A pelvic ultrasound
Between part 1 and part 2 of this series, I truly hope you have learnt valuable information about how to optimise and individualise your preconception journey, and feel you now have the tools to start supporting yourself of this beautiful and incredibly special process.
If you are looking for individualised support for your preconception or pregnancy journey, please get in touch by booking in a session here.
Jaclyn is a qualified Naturopath with a focus on hormonal complaints, cycle health, reproductive and fertility care, skin issues, and adrenal health.
Author
Jaclyn Cave
BHSc (Nat), BComm (Soc)
Masters Womens Health Med (UNSW - completing)
References:
https://www.who.int/maternal_child_adolescent/documents/preconception_care_policy_brief.pdf
https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
https://pubmed.ncbi.nlm.nih.gov/17022907/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/
https://pubmed.ncbi.nlm.nih.gov/22108279/