Why is it preconception health so important as an active woman?


To put it bluntly preconception health is a key determinant of pregnancy success and next generation health: the long-term health of your child depends on both partners’ health at conception. Continuing to be active into pregnancy has multiple benefits for you and baby but adds a further dimension to your nutrient demands. Preconception health is much more than taking a pregnancy supplement.

But it’s not all about baby - your strength and health going into pregnancy will determine the speed of your recovery post-partum. Pregnancy takes a lot out of you, you are after all, growing a whole new life, and a whole new organ (the placenta). A healthy and timely recovery from this life changing process takes focus and intention. Requirements for macro and micronutrients increase during pregnancy to support you and baby’s development, but sadly around 20% to 30% of pregnant women worldwide suffer from some vitamin deficiency (1). Starting from any place of depletion will make it hard to both start or continue an active lifestyle during pregnancy.

Bet let’s get back to baby. The three-month period either side of conception is critical  for optimising egg, follicle and sperm function, as well as placental development. Seeing as the placenta needs to nourish both baby and you for the duration you want it as healthy and robust as possible.


Key Nutrients


Here are some key nutrients you want to ensure are at optimal levels at this time.


Folic Acid


Folic acid is probably the most well-known (but not the only one by far). Folate is vitamin B9 and is essential for making healthy DNA and for proper cell multiplication, making it particularly important during the earliest stages of pregnancy where there is rapid cell division (2).  Because the neural tube (what will eventually be baby’s brain and spinal cord) develops in the first four weeks of pregnancy, the protective effects of folic acid supplements are limited to this window when you might not even realise you are pregnant! (3). Hence the need for a focus on preconception health.

Folate is an essential B-vitamin for multiple processes across your lifespan and can be easily depleted due to its many functions around the body and due to a prevalent gene mutation, that reduces its effectiveness. For this reason, many foods have been “fortified” with folic acid [FA], which is the synthetic form of folate used in supplementation. Folic acid is not an active form of the vitamin and requires an enzymatic conversion into active folate that the body can use. Sadly, the conversion capacity of this enzyme is limited, meaning high levels of blood folic acid may not reflect usable folate. In fact, FA can actively block the uptake of folate from wholefood sources - synthetic nutrients are never as well absorbed or efficiently utilised as the real thing from food. Therefore, when choosing a pre-conception/pregnancy supplement look for those containing folate not folic acid (this is usually in a whole-food/food sourced supplement).


A total intake of ~600μg/day is recommended for the 3 months leading up to conception and throughout pregnancy. This can be obtained through a wholefood supplement plus daily intake of folate rich foods such as organ meats and green leafy veg.

Iron


Moving on to iron, another essential nutrient that is in danger of being low in active women due to menstruation and its central role in how we make energy. Iron deficiency remains the leading single-nutrient deficiency worldwide, affecting over two billion people including ≥30% of pregnant women in the industrialised world (4). 

Optimal iron levels also fit a critical window of opportunity because Iron deficiency can impact the structural development of baby’s brain in the earliest stages of pregnancy, so correcting a deficiency after a certain time point won’t have an effect. Again, the time to be optimal is before you get pregnant.


Iron needs during pregnancy can actually exceed what you can physically absorb, hence the danger of anaemia during pregnancy (even without increased activity demands). 30-60mg iron per day is recommended – and once again, wholefood sources of haem-iron from foods such as meat (including organ meat) and fish (especially oysters) are easiest for us to absorb and use, making them the best source of this essential nutrient (5,6).

Zinc


On the subject of oysters, they are also a rich source of zinc which is central to sex hormone synthesis (maybe this is why they are known as an aphrodisiac?!). Preconception zinc deficiency compromises both baby’s growth and placental growth as well as neural tube closure. Zinc deficiency in pregnancy has also been associated with impaired immunity for mum, which is not great when trying to stay active. Zinc is an essential component of over 200 enzymatic reactions throughout the body, particularly immunity and, as mentioned, hormone synthesis, so is at risk of being depleted due to increased demands from these systems in active women. Deficiency is predominantly a reflection of poor diet, and it is estimated that 82% of pregnant women are zinc inadequate. Aim for 11mg zinc/day and (I may sound like a broken record here), but higher levels can be found in meat, seafood, and milk. Interestingly, diets high in fibre and grains can actually reduce the absorption of zinc because the phytates in vegetables, grains, nuts and legumes bind to zinc and increase its excretion in urine, which is the case with most minerals.

Vitamins A, D, E & K2


Further nutrients that are in danger of being low are the fat-soluble vitamins, A, D, E and K2. These are frequently low among all populations now, potentially due to the harmful misinformation surrounding meat and animal fat consumption. As fat-soluble vitamins, they are abundant in animal fats, fatty fish and dairy such as butter but are low or missing completely from plant-based fats like vegetable/seed oils, olive oil or margarine. So aim to include plenty of full fat dairy (if you tolerate dairy), and predominantly cook with animal fats like tallow or butter with coconut fat being the next best choice and dress your salad or veg in extra virgin olive oil or melted butter.

I am going to focus on vitamin A because much pregnancy literature still insists that expectant mothers can gain all the vitamin A they need from plant sources like yellow and orange fruits and vegetables. However, this is once again an inactive precursor form called carotene, which needs converting into retinol, the active form of vitamin A. In a large proportion of women this conversion is highly inefficient, meaning daily intake of carotene from fruit and veg like carrots and pumpkin will not reflect active levels of retinol within the body.

So, once more animal-based sources of retinol are the most bioavailable. Worries about excess vitamin A and birth defects are based solely on one old and seriously flawed study (7), which is in conflict with much of the other evidence that suggests that whole-food sources up to 20,000IU/day actually decreases the risk of birth defects, (8,9)

My favourite fact about Vitamin A is that it appears to hold the key to what scientists call the “holy grail” puzzle of developmental biology – the mechanism that ensures that the external of our bodies develop symmetrically, whilst the internal organs are arranged asymmetrically. Vitamin A buffers against asymmetric cues in baby’s earliest stages of development, allowing the body to develop symmetrically; fun fact - a smaller right eye, or a right side shorter than the left is evidence of a mild vitamin A deficiency in utero!

Liver is one of the richest sources of vitamin A, followed by fish, eggs and dairy. One 90g serving of beef liver provides around 11000IU of bioavailable vitamin A, in concert with a host of other essential nutrients.


Cholesterol


One more nutrient that gets a very bad rap in the current diet paradigm is cholesterol. Cholesterol is an essential nutrient in the human diet as it is the backbone of all hormone synthesis, is critical for making vitamin D (technically a steroid hormone) and plays a pivotal role in immune function. As active women, the hormonal necessity for cholesterol should in itself make us mindful of ensuring that we are getting good dietary sources of this wonderful stuff, but in terms of baby’s health it is central to the development of their brain, nervous system and intestinal tract. A cholesterol rich diet is a Must both preconception and throughout pregnancy.


DID YOU KNOW?

In pregnancy, baby relies completely on maternal vitamin D stores for its development.


One of the best sources of cholesterol is egg yolks, so eat at least one egg plus extra egg yolks (2-3) every day. Egg yolks are a powerhouse of nutrition for expectant mothers, being a great source of choline (essential for brain development), the fat-soluble nutrients A, D E and K, already mentioned, as well as folate, iron, zinc and selenium (a key antioxidant nutrient). In this case, quality really does matter as pasture raised free roaming hens produce eggs with 200 times higher folate than caged hens.



Eat egg yolks liberally – the future intellectual ability of your child may depend on it!

You might have noticed that alongside eggs, liver and organ meat contain all of the key nutrients I have discussed. Now, I understand many of us are not used to eating and including organ meats in our diets, but they are the most nutrient dense foods available to humans. Liver is known as natures multi-vitamin. It is so powerful you needn’t be eating it every day but including 60-90g 2-3 times per week will significantly improve the quality of your diet, helping you keep optimal levels of key preconception and pregnancy nutrients. If you love chicken liver pate, get making it! Other ways to increase your intake of organs is to buy “fortified mince” which is mince that has a blend of liver and kidney with it – or just do it yourself. Take a couple of ounces of liver and a couple of kidneys, zap them in a blender then combine this with normal mince to make into burgers or meatballs. Including chopped kidneys or heart in a slow cooked stew is another great way to increase your intake of these nutrient dense and cheap cuts of meat. If you still can’t face it there are a couple of great companies that provide desiccated organs in supplement form.

I hope this gives a snapshot of the central role that a nutrient dense diet plays in an active, healthy and successful pregnancy. Traditional cultures would often practice a period of special feeding for men and women before conception that would include the most prized and nutrient dense foods such as liver, eggs, and raw milk. I want us all to return to this ancestral wisdom and produce robust babies from strong active mothers.


About The Writer


“I am a strong, active woman who is also a strong active mother. I am passionate about using nutrition to empower other women to take control of their own bodies throughout this process whilst loving, and keeping a sense of themselves.”


Henrietta is a registered Nutritional Therapist and former international athlete for both Scotland and Great Britain. She came to Nutritional therapy after a major sporting injury, from which she was told she would not recover. However, after some fundamental nutritional changes Henrietta competed for Scotland at her 2nd Commonwealth Games which inspired her to go on to complete her MSc in Personalised Nutrition with CNELM.




This experience gives Henrietta a deep understanding of the huge potential good nutrition holds to make life changing differences in health and performance.


Henrietta is still very involved with the sport she loves and works closely with a number of national and international athletes using an integrated sports nutrition model. Having now had 2 children of her own she has become acutely aware of the inadequate

mainstream advice on nutrition for fertility, pregnancy, breast feeding and weaning and has further specialised in nutrition for fertility and pregnancy.



References

1. Baker H. et al., 2002. Vitamin profile of 563 gravidas during trimesters of pregnancy. J. Am. Coll. Nutr. 21, pp.33–37

2.  De-Regil L.M., et al. 2015. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst. Rev.

3.  Williamson C.S. 2006. Nutrition in pregnancy. Nutr. Bull. 31, pp.28–59.

4. Beard J.L. 2000. Effectiveness and strategies of iron supplementation during pregnancy. Am. J. Clin. Nutr. pp.71

5. Cairo G., Bernuzzi F., Recalcati S. 2006. A precious metal: Iron, an essential nutrient for all cells. Genes Nutr. 1, pp. 25–39

6. Milman N. Iron and pregnancy—A delicate balance. 2006 Ann. Hematol. pp. 85:559. 

7. Rothman, K. J., et al. 1995. Teratogenicity of high vitamin A intake. New England J Med. 333, pp. 1369-73

8. Shaw, G. M. et al., 1996. High maternal vitamin A intake an risk of anomalies of structures with a cranial neural crest cell contribution. Lancet, 347, pp. 899-900

9. Mills, J. L. et al., 1997. Vitamin A and birth defects. Am J Obstet Gynecol. 177(1), pp. 31-6.

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