I Have a Great Diet, Do I Really Need to Take a Prenatal Supplement?
One of the questions I get asked in clinic on a reasonably regular basis is do I really need a prenatal vitamin supplement? I work in an area where people are (overall) pretty health conscious, diet and healthy lifestyles are prioritised, and many couples feel that their healthy living should be sufficient for optimising fertility and growing a healthy baby. But despite all that I still suggest everyone takes a prenatal supplement, and sometimes even several supplements if they are on a fertility journey. Preconception health really does matter.
My personal take is that one of the best things you can do for your health at any stage of life is to eat well. However, there are a few reasons why, even when you have a great diet, some supplements may be beneficial for your fertility, pregnancy and the postnatal period.
First, the age couples are starting a family is now a bit older than it was even a decade ago, and there may be additional reasons why they are struggling to conceive that can be assisted by increased nutrition. As we age we do become less efficient at absorbing nutrients, so increasing the amount we get in means that even if we don’t absorb as much we are still get an adequate amount for optimal function. Age also leads to lower production of many antioxidants which offer protective benefits to many cells including sperm and ovum, so we can support this functional decline by having additional antioxidants. Some conditions that can impede fertility, such as endometriosis, thyroid conditions or mthfr and other gene mutations can mean that some people have higher requirements for antioxidants and other nutrients. Generally in these cases you would need more than a basic prenatal, but that is a good start. In these instances working with a practitioner will also help you to identify more individual nutritional requirements that you may have.
We are also living in a time and place where the nutritional content of our food is lower than it used to be. Conventional, mass produced, monocultural farming practices have depleted our soils – the food grown in those soils can not contain good levels of the nutrients they are deficient in. Zinc, magnesium, selenium, iodine and others are all depleted along the eastern sea-board and they are all important for good hormone regulation and fertility. We now have a variety of vegetables available all year unlike in previous generations, but the practice of growing them and storage for months in supermarket cold rooms may mean they do not carry the same nutritional value they did when grown seasonally, in well cared for soils and consumed soon after harvesting.
Our diets have also changed over time and may not be as rich in some of the nutrients that were once prized for fertility. Foods like offal, bone marrow and liver are extremely nutrient dense and were once eaten more frequently than they are today. These foods are fantastic, and I highly recommend including them in your diet, but if that doesn’t happen as often as you’d like, then a prenatal can help provide some of the nutrients.
Supporting fertility is only one benefit of taking a good prenatal supplement. Taking a good quality prenatal can also help support a healthy pregnancy, a healthy baby and women’s postnatal health. Most women are aware that taking folate prior to conception prevents neural tubal defects like spina bifida. Unfortunately the recommendation of many in western medicine fertility practice is to take large doses of synthetic folic acid. However, good quality active folate (folinic acid or methyl folate) in a prenatal that provides a full complex of all the B’s will be far more beneficial as B’s are best taken together to support each other, and active forms of B’s tend to be far easier for many to utilise. Taking high amounts of synthetic folate can be quite detrimental for some people, and folate taken alone will leave many depleted in b12 which is also essential for good health and fertility. This is only one example of how nutrition can support healthy embyronic development, there are many, many other instances. For example, we now have evidence that zinc deficiency during pregnancy is not only associated with preterm labour and low birth weight, it has also been found to lead to a greater risk of high blood pressure for the offspring in later life. These are just a couple of examples of how maternal nutritional deficiencies before and during pregnancy can have a lasting impact on the health of your child. We are now discovering more and more about the role of nutrition and sperm in foetal health. A recent study in mice found that males on a poor quality diet at the time of conception resulted in offspring with compromised metabolic health. Given that male fertility is in absolute freefall, and at least half of all fertility problems, including miscarriage, have a male factor, taking a few months of a quality supplement to ensure your swimmers are up to the task is a worthwhile investment. Male fertility support multi’s have the basic building blocks of healthy sperm to support a good diet and lifestyle. If you have had a semen analysis that shows a fertility problem then you will require more than a good male multi, but again, this serves as a good start for improving sperm health.
Taking a prenatal supplement can also help a woman and her baby in the post natal period. Many women are unaware that their nutritional requirements are even greater in the first months of breastfeeding than they were during pregnancy. Being the sole source of nutrition for a tiny, rapidly growing human is pretty energy & nutrition intensive! This is all being done at the same time as your body is healing from your birth. While nothing replaces the nutrient dense foods that most traditional cultures value for this demanding period (do yourself a favour and check out ‘The First Forty Days’ by Heng Ou and ‘The Golden Month: Caring for the World’s Mother’s after Childbirth’ by Jenny Allison to get some good ideas), taking a prenatal can be a nice adjunct to ensure the major nutrients are all well covered. Nutritional deficiencies can also have an impact on mood and emotional wellbeing. Its hard to feel upbeat and positive when you’re physically so depleted your body is struggling to repair let alone make all those neurotransmitters we rely on. While postpartum depression is a complex and multidimensional issue that can not be reduced to nutritional status, ensuring good nutrition can be one element that can help.
And finally, it’s all about quality. In my view, despite all the reasons I have listed that prenatal supplements are a good idea, you are probably better off taking nothing than some of the common prenatal supplements at your local pharmacy. Usually you will find a good prenatal that suits your individual requirements if you are working with a health practitioner to optimise your preconception health. But even if you don’t have access to a good practitioner, there are some good options out there. What to look for to identify a good prenatal or male fertility support is a whole separate post that I will cover another day.
 Wang, H. et al. Maternal zinc deficiency during pregnancy elevates the risks of foetal growth restriction: a population-based birth cohort study. Sci. Rep. 5, 11262; doi: 10.1038/srep11262 (2015). https://www.nature.com/articles/srep11262
 Barker, D. J. et al. Fetal nutrition and cardiovascular disease in adult life. Lancet. 341, 938–941 (1993).
 Adam J. Watkins, Irundika Dias, Heather Tsuro, Danielle Allen, Richard D. Emes, Joanna Moreton, Ray Wilson, Richard J. M. Ingram, Kevin D. Sinclair. Paternal diet programs offspring health through sperm- and seminal plasma-specific pathways in mice. Proceedings of the National Academy of Sciences, 2018; 201806333 DOI: 10.1073/pnas.1806333115