A couple of years ago I wrote about research that, frankly, should have received far more attention.
Researchers looked at women in high income countries, including the UK, before they became pregnant.
Despite living in affluent countries with plentiful food, more than 90% were low or marginal in at least one key nutrient.
With a massive 82% low or marginal in B2 (riboflavin) and 85% low or insufficient in vitamin D.
And then they got pregnant.
Think about that for a moment.
Pregnancy is the most nutritionally demanding thing the human body ever does. You are literally making another human being.
More cells. More blood. A skeleton. A brain. A nervous system.
Yet our nutritional advice can sometimes amount to little more than:
“Eat a balanced diet and take a pregnancy multivitamin.”
The problem is that not all pregnancy multivitamins are created equal.
Do we want minimum/basic nutrition or optimal nutrition?
Walk into a high street chemist and you’ll find plenty of pregnancy multivitamins.
But look beyond the marketing and actually read the labels – the devil is in the details.
Many contain relatively low doses of certain nutrients, use cheaper or less desirable forms, or omit potentially important nutrients altogether.
That’s exactly what I wanted to address when developing the IN Health Optimal Pregnancy Multivitamin.
We wanted better forms, meaningful doses and premium ingredients, using clinically researched ingredients wherever possible.
Our formula therefore includes patented methylfolate (not folic acid), methyl B12 plus supporting B vitamins, iron bisglycinate, magnesium bisglycinate, whole food calcium from Aquamin and 150 μg of vitamin K2 in two forms.
All illustrated here with our new infographic (see attached and available as card A4 and strut board).
But two ingredients illustrate the difference particularly well.
Folate – it is the form that matter
But rather than using ordinary folic acid, or even an unnamed generic methylfolate, IN Health Optimal Pregnancy multi uses patented Quatrefolic® 5-MTHF.
5-MTHF is the biologically active form of folate.
Folic acid has to pass through a series of metabolic steps before ultimately entering the biologically active folate pool.
And only a small amount of folic acid makes it part the first enzyme, meaning less methyl folate AND, unmetabolised folic acid competing for the receptor.
Quatrefolic® supplies 5-MTHF directly.
Even more importantly, Quatrefolic® isn’t simply an ingredient that looks impressive on a label.
It’s been tested in clinical studies involving more than 1,000 pregnant women, including studies assessing folate status and safety.
That’s an important distinction for us.
Where possible, we don’t simply want a nutrient that theoretically does the job. We want the actual ingredient that has been researched.
Vitamin D provides another good example of the difference between simply avoiding deficiency and trying to achieve better nutritional status.
Optimal Pregnancy provides 4,000 IU or 100 μg vitamin D3 per day.
Why so much more than many standard pregnancy multivitamins?
Because 4,000 IU has actually been studied and is a meaningful physiological dose.
In a double-blind randomised controlled trial, pregnant women received 400, 2,000 or 4,000 IU of vitamin D3 daily from 12–16 weeks until delivery.
Around delivery, the proportion reaching the researchers’ target 25(OH)D concentration of at least 80 nmol/L was:
The researchers found no difference between groups in safety measures and no adverse event was attributed to vitamin D supplementation.
They concluded that 4,000 IU/day was safe and the most effective of the doses tested for achieving vitamin D sufficiency in mothers and their newborns.
That is considerably more meaningful to us than simply formulating around the minimum amount (usually 400 iu or 10 mcg) – remember you can make 20,000 IU (500 mcg) within thirty minutes of sunbathing.
So 4000 IU (100mcg) looks like a lot compared to the RDA of 200 IU (a meaningless dose), but a modest dose compared to what your body can make.
But pregnancy nutrition doesn’t finish at 12 weeks
There is another problem with how we traditionally think about pregnancy nutrition.
Our attention tends to be front loaded.
Folic acid. Neural tube defects. First trimester.
But it can leave women with the impression that the first few months are when nutrition really matters.
I have heard this a few times with pregnant patients saying they were taking supplements previously, but no longer, as they are past the danger zone.
In reality, the third trimester represents an extraordinary period of fetal growth, brain development, skeletal mineralisation and nutrient transfer.
And those nutrients have to come from somewhere, and it is from Mum!
Look what happens to iron stores 🤯
A recent Norwegian longitudinal study followed women from 18 weeks through late pregnancy and after birth.
At 18 weeks, 44% already had depleted iron stores, defined as ferritin below 30 μg/L.
By 36 weeks?
95%.
In my opinion, we should be screening for ferritin before women get pregnant.
Note the OPTIMAL pregnancy product has 15 mg of iron as bisglycinate. Is that enough?
For some yes, but in the third trimester, I would look to add another 20 mg via our Iron Bisglycinate product.
And giving birth didn’t magically restore those reserves.
At three months postpartum, 67% still had ferritin below 30 μg/L, with a similar figure at six months.
Looking after a newborn is exhausting, but it is easier if your iron is optimal and you have your maximum energy. If you are still deficient, it only makes it all harder.
That changes the question.
We aren’t simply asking:
“Did mum have enough nutrients to make a healthy baby?”
We also need to ask:
“What’s left in mum afterwards?”
And might it increase her risk of post-partum depression? Her ability to cope?
B12 and folate tell a similar story:
A large longitudinal study followed 406 healthy pregnant women, measuring B12 at 18, 32 and 39 weeks and again eight weeks postpartum.
Median B12 fell steadily from an already potentially low 225 pmol/L to 161 pmol/L.
I can tell you from clinical experience, many patients at 161 pmol/L feel so much better once they are up past 500 pmol/L.
Folate drops too consistently throughout pregnancy.
This is another reason why I dislike the idea that folate is something women need to think about until week 12 and then forget.
The developing baby certainly hasn’t stopped requiring nutrients or growing at 12 weeks. The 3rd trimester is time for rapid growth and a huge nutritional demand.
The Optimal Pregnancy TRIO
This is why we’ve moved beyond simply producing another pregnancy multivitamin.
1. Optimal Pregnancy Multivitamin and mineral
Premium nutrient forms and meaningful doses, including patented Quatrefolic® 5-MTHF, methyl B12, iron bisglycinate, magnesium bisglycinate, Aquamin whole food calcium, two forms of vitamin K2 and 4,000 IU vitamin D3.
2. IN Health Choline
Featuring patented VitaCholine®, the same choline ingredient used in clinical pregnancy research.
Like this:
“these findings suggest that the choline AI for pregnant women may not be sufficient for optimal child cognition because consumption of 930 mg choline/d produced superior child cognition relative to consumption of approximately the AI (480 mg). These findings raise concerns about the evidence that approximately 90% of pregnant women in North America consume choline at levels below the AI and that prenatal vitamins commonly contain little or no choline.”
Note: 90% of women are not getting enough
3. Omega 3 Fish Oil
Wild sardine sourced EPA and DHA to support essential fatty acid intake throughout pregnancy and breastfeeding.
None of this replaces food.
We still want a nutrient dense diet providing adequate protein, eggs, dairy where tolerated, meat, vegetables, fruit and appropriate oily fish.
Pregnancy is not the time to aim for the nutritional minimum.
Nor should our attention end at 12 weeks.
We need to nourish the developing baby, support the breastfeeding infant and remember to replenish mum.