Nutrition and Pregnancy: Pre-conception

In the context of an entire life, the nine months of the typical human pregnancy is not a long time. Yet good nutrition and healthy lifestyle behaviors (physical activity, avoidance of alcohol and tobacco, stress management, control of any pre-existing health conditions) or the lack thereof can have a profound effect not just on the growing fetus or the newborn baby, but on the adult that baby will turn into.

For the best possible pregnancy and the healthiest possible child, it’s not enough to just start thinking about eating more healthfully when you first learn you’re pregnant. What you eat before you become pregnant is even more important than what you eat while you are pregnant (with the exception of foods that raise the risk of foodborne illness). There are two main reasons for that:

  1. There is a narrow “window” of time at the very beginning of pregnancy when good nutrition is vital. This includes fertilization of the egg, implantation of the egg into the uterine lining, and the early rapid cell division and growth to form the embryo. Once this window closes, there is no chance of a “do over.”
  2. Coming into pregnancy well nourished provides a sort of nutritional insurance against events like morning sickness (where eating a nutritious diet may be difficult) and the massive nutritional demands in the second and third trimesters, which are much easier to keep up with if you get off to a good start.
The starkest example of why good nutrition is so important in the earliest days and weeks of pregnancy comes when a baby is born with a neural tube defect. The neural tube is the precursor to our spinal cord and brain. If cells can’t divide and multiply fast enough in order to form a closed, intact neural tube, it can result in traumatic birth defects. Spina bifida is when the part of the neural tube that becomes the spine doesn’t close correctly. Anencephaly is when much of the brain fails to develop.
Neural tube development wraps up around day 21 of pregnancy. That’s three weeks…and a woman can be a few weeks pregnant already by the time she even misses a menstrual period! The rest of the first trimester of pregnancy is also vital, as every major organ system in the developing fetus is in place by the end of week 12.
While everyone could benefit from eating a diet full of a variety of delicious, nutrient-rich foods for both short term (you’ll look and feel your best) and long term (you’ll be more likely to avoid chronic diseases) reasons, its even more important for any woman who is thinking about becoming pregnant in the near future.
When a woman enters pregnancy well-nourished, her body will be stocked up on nutrients that are vital right out of the gate. That will get the baby off to a good start when it counts the most.
As I mentioned, good pre-pregnancy nutrition also provides a nutritional buffer if morning sickness becomes a problem. If you are nauseous and possibly vomiting, are you going to want to eat kale? Probably not…even if you loved kale before you got pregnant. With morning sickness, it can be an effort to keep any food down, and it may simply not be possible to make the most nutritious choices. That becomes much, much less of an worry for women who begin pregnancy well nourished.

Additionally, nutrient needs are huge in the second and third trimesters of pregnancy. Huge! Starting off right makes it easier to have a strong finish. A woman who wants to have more than one child and plans to closely space her pregnancies really need to plan for this: If she is nutritionally depleted from one pregnancy, it can cause problems with the next pregnancy unless she has time to rebuild her nutrient stores.

While many vitamins, minerals and other nutrients found in a varied, healthy diet are important during pregnancy, these are the nutrients that play the most significant roles right at the start of pregnancy:
  • Folate/Folic Acid. This B vitamin (B9) is important in helping to prevent neural tube defects. The 2010 Dietary Guidelines recommend that women who may become pregnant get 400 micrograms (mcg) of folic acid from a vitamin supplement or from fortified foods (many breads and cereals have added folic acid). That’s in addition to eating foods high in natural folate. The best sources of folate include many dark leafy greens (spinach, romaine lettuce and mustard, turnip and collard greens), lentils and beans (such as pinto, black, kidney and garbanzo beans). Avocados have a fair amount, and many other fruits and vegetables contain respectable amounts (so does quinoa).
  • Choline. Our bodies make some choline, but not enough to meet our needs. Evidence is showing that this vitamin is also important for preventing neural tube defects. The richest food source of choline is the humble egg yolk, hands down, providing about 25 percent of the total 425 milligrams (mg) a pregnant woman needs daily. You can also find it in salmon, pork and cauliflower.
  • Iron. The need for iron increases greatly late in pregnancy, when the body is busy increasing blood volume. It’s easy for a woman to develop iron-deficiency anemia during pregnancy (it’s the most common nutrition-related complication of pregnancy), and this increases the risk of pre-term birth. If she enters pregnancy already deficient in iron, it is very difficult to get caught up. The best bet is to be tested for iron-deficiency anemia before trying to become pregnant, then work with a registered dietitian or your doctor to get iron levels to an optimal level with iron-rich foods (and possibly supplements) before conceiving.
What happens if you find out you’re pregnant and your diet has been less than ideal? Don’t freak out, but do start making more nutritious choices right away. It’s not a clear cut issue: No one can say “If you eat a great pre-pregnancy diet you won’t have any problems, but if you don’t then you will have problems.” It’s not that nice and neat. Eating an optimal diet is about reducing the odds of health problems, but it’s never a guarantee. You can’t change what you did yesterday…but you can change what you do today and tomorrow.

Next week: Why “eating for two” is a bad idea