Pregnancy Support

FUNCTIONAL MEDICINE SUPPORT FOR PREGNANCY

Pregnancy is a wonderful period with much to celebrate with the expecting arrival of a child.  Preparation and care should be taken prior to conception and during pregnancy to ensure the mother’s body is in good condition, well-nourished and able to provide the necessary nutrients throughout the duration of gestation. 

Key nutrients required in Pregnancy

Utilising active forms of folate is extremely important in assisting to prevent birth defects, cleft palates and other abnormalities.  Understanding the different requirements of the fetus through the stages of pregnancy is important to ensure enough nutrition is providing throughout key developmental stages.

Ideally, pregnancy should follow a pre-conception care program in which the body is detoxified and nutritional status is optimised.

Women need additional nutritional support during pregnancy to ensure the health of the child. Nutritional deficiencies during the critical periods of development can impact upon the health of the fetus and predispose them to a range of metabolic, immune, nervous system and behavioural disorders.

Prior to conception, we support women if preparation for pregnancy, improving gut health, optimizing methylation, ensuring vitamin and mineral levels are optimal and detoxification pathways are open.

Risk factors

• Poor diet / nutrient deficiency
• Poor digestive function affecting nutrient absorption
• Excessive or chronic stress
• Pre-existing medical conditions
• High toxic load
• Dysbiosis and/or leaky gut
• Methylation imbalances

Signs & symptoms of Pregnancy nutrient imbalances

Common symptoms of nutritional imbalances during pregnancy include:

• Fatigue
• Anemia
• Faintness, dizziness, lightheadedness
• Gastro-intestinal disturbances e.g. morning sickness
• Gestational diabetes
• Poor immune function
• Pre-eclampsia
• Depression
• Threatened miscarriage

TREATMENT STRATEGY TO OPTIMISE PREGNANCY

• Ensure adequate nutrition through diet
• Provide additional nutritional support specific to pregnancy and fetal development
• Prevent / treat undesirable symptoms of pregnancy
• Maintain healthy weight

TREATMENT OPTIONS FOR PREGNANCY

Dietary considerations

• Well-balanced, nutrient-dense, low glycemic load, whole food diet, high in fruits and vegetables, whole grains, nuts and seeds, healthy fats and protein
• Avoid all sugars, refined carbohydrates, trans fats, processed and refined foods and artificial food additives
• Additional energy is needed in pregnancy and lactation to cover the needs of the growing fetus, the placenta, expanding maternal tissues and production of breast milk in lactation.  Additional energy intake should come from healthy sources e.g. complex carbohydrates, healthy fats, etc.
  • No additional energy in needed in the first trimester
  • An additional 1400 kJ is needed in the second trimester
  • An additional 1900 kJ is needed in the third trimester
• Protein intake should increase to 1.1 g/kg of body weight: protein should come from a variety of sources, including plant proteins
• Foods rich in omega-3 essential fatty acids: critical for fetal brain development. Sources include oily fish, linseeds, free-range eggs, green leafy vegetables. Fish is the optimal source; however, due to the potential dangers of eating fish supplementation is recommended.
• Foods rich in folate, vitamin C, iron, zinc and calcium: critical nutrients in the developing fetus.  Those with the MTHFR polymorphism should avoid foods fortified with folic acid, supplements should be with folinic acid or methyl folate.  Uncooked leafy greens provide a great source of folate.
• Pre- and probiotic foods – to ensure healthy gut microflora that is passed on to the infant during birth and lactation
• Alcohol should be completely avoided
  • Alcohol is linked to a broad spectrum of disorders in the infant, including fetal alcohol syndrome (FAS) and other alcohol-related birth defects and neuro-developmental disorders.
  • There is currently no safe level of alcohol established in pregnancy
• Fish consumption should be approached with care due to exposure to mercury – Large fish species (e.g. shark, swordfish, king mackerel and tuna) should be avoided, while up to 360 g/week of smaller species (e.g. sardines and white fish) may be safely consumed
• Foods potentially contaminated with Listeria monocytogenes: may cause miscarriage, stillbirth and fetal infection. Includes unpasteurised milk, undercooked or raw animal products, pates, meat spreads, soft cheeses and unwashed fruit and vegetables
• Caffeine: associated with fetal growth restriction and low-birth weight infants as the enzyme needed for caffeine clearance is not present in the fetus. It is recommended that pregnant women consume no more than 200 mg/day of caffeine throughout pregnancy (1 brewed coffee = 95-200 mg caffeine; 1 black tea = 14-70 mg caffeine; 1 green tea = 25-45 mg caffeine)
• Manage morning sickness:
• Eating small meals regularly through the day can help balance blood sugars, maintain energy levels and avoid morning sickness
• Eating protein just before bed at night can help reduce morning sickness
• Manage constipation:
  • Ensure adequate fibre and fluid intake

Pregnancy supplement considerations

• Support overall nutrition of mother and fetus:
  • Good quality pregnancy-specific multi-mineral and vitamin supplement: need good level of B- vitamins, folinic acid or methyl folate, zinc, iron and selenium.  Those with the MTHFR polymorphism (30+% of population) should avoid synthetic folic acid and use the more active forms in folinic acid and methyl folate. Active forms of folate such as methylfolate have been shown to be more effective than Folic Acid. (1)
  • Antioxidant supplement or green superfood powder e.g. spirulina, broccoli sprouts, green tea, wheat grass etc. To provide beneficial bacteria, protect baby at birth and support maternal and infant immunity:

• Good quality probiotic: to ensure healthy gut microflora – transferred to infant during birth and lactation and reduces incidence of allergies in infant

Fetal neurological & immune development and protect maternal reserves:

• Omega-3 EFA supplement (especially DHA): critical building blocks of the fetal brain and retina; also influence length of gestation and help prevent post-natal depression
  • Folate – min 400 ug/day in 1st trimester; 200 ug/day in 2nd and 3rd trimesters
  • D3 – if deficient

Fetal bone and tooth development and prevention of pre-eclampsia and premature birth:

• Calcium
  • Magnesium
  • D3

If anaemic:

• Iron with Vitamin C: commonly deficient due to demands of pregnancy and increased blood volume. Iron supplementation should only be given in iron deficiency as high levels of iron can cause oxidative stress
• If zinc deficient (linked to miscarriage, low birth weight, poor immunity, stretch marks, etc):
  • Zinc (do not exceed 75 mg/day)
• If protein deficient (linked to birth defects):
  • Protein supplement

If over 35 or have history of pre-eclampsia or miscarriage

• CoQ10 150mg/day
  • Vitamin C + bioflavonoids

To help reduce labour pain:

• Vitamin C + bioflavonoids in divided doses just before delivery

Herbal Medicine Considerations while Pregnant

Many herbs are contraindicated in pregnancy. There is a need to use extreme caution when using herbs in pregnancy, especially during first trimester. It is recommended to avoid using herbal medicines in pregnancy in general unless clearly necessary.  For that reason, I will not list any here.

Lifestyle / Physical measures during Pregnancy

• Moderate, regular physical activity
• Regular exposure to sunlight: to ensure adequate vitamin D status
• Stress management: strategies include breathing, relaxation, yoga, massage, music, counselling and/or psychological support
• Reduce exposure to environmental toxins: exposure to pesticides, PCBs, heavy metals, phthalates and polycyclic aromatic hydrocarbons (PAHs), is associated with a higher risk of miscarriage and childhood disorders such as ADHD and autism spectrum disorder (ASD)
• Smoking: smoking during pregnancy (or exposure to second-hand smoke) is linked to miscarriage, reduced fetal brain development, infant asthma and ADHD, and increased infant risk of adult development of diabetes, hypertension and metabolic syndrome.

At our Perth clinic of Advanced Functional Medicine we have experience with expecting mothers and those planning for pregnancy.  If you are pregnant or planning to conceive in the next 12 months we would love to hear from you.  What supplements do you use during pregnancy?  Have you investigated your MTHFR status?  How have you managed any morning sickness and cravings?  Please leave a comment below.

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