If you are an aspiring mother-to-be, your preconception OB-GYN visit will look a lot like this:
Your doctor or physician’s assistant tells you to start taking folic acid—and with good reason (though we’d strongly advocate for choosing the naturally-found active folate form over synthetic folic acid—but we’ll save that for another time). Research shows that preconception supplementation of this key nutrient taken at least three months prior to conception can decrease the incidence of neural tube defects by approximately 46 percent. Accordingly, the supplementation of this nutrient has become the standard of care.
But, what about the other nutrients that are needed before, during, and after pregnancy? Surely folate isn’t the only thing you and your developing baby need?
While there is a considerable body of research on the benefits of other prenatal nutrients like Omega-3 and Choline for preventing preterm birth, preeclampsia, and brain and neural tube anomalies, you are very unlikely to hear about these nutrients from your OBGYN.
In fact, when it comes to prenatal nutrition, you are far more likely to hear what to avoid (raw fish, unpasteurized cheese, and deli meats—to name but a few “taboo” foods) than what to include.
Why is it that so few pregnant women receive the basic prenatal nutrition advice they need from their doctor?
It’s not for lack of care by their doctors but because, with few exceptions, western-educated medical doctors receive practically no nutrition training.
The typical medical doctor in the U.S. receives less than four hours of nutrition education during the entirety of their four years of medical school (and 4+ years of subsequent training beyond graduation). Contrast this to the countless hours of training on pharmacological uses, and you start to understand the picture.
This problem of limited nutrition guidance from MDs spans socioeconomic classes, but those who lack access (financial or geographic) to care outside of the standard system are especially vulnerable to missing key information.
What are the consequences of missing out on this fundamental nutrition info?
Ask your doctor which prenatal to take and you’re likely to hear “just take anything you can stomach.” In this absence of guidance from our doctors, most of us are left to do our own research—talking to friends, pouring through endless pregnancy websites, reading Amazon reviews, or walking the aisles of the nearest drug store…a far from perfect system. Too often, this nutrition information is overwhelming, confusing, or just plain wrong.
After exhausting oneself on research, it’s tempting to settle for a prenatal vitamin that seems “good enough.” But unfortunately, this “good enough” product is very likely designed to meet bare minimum nutrient levels to avoid series birth defects or fetal complications-falling far short of the comprehensive nutrition you need to be optimally well.
There is a world of difference between avoiding disease and feeling your best. The quality of your prenatal vitamin plays a big role in this.
Why aren’t all prenatal vitamins created equally?
When designing products, vitamin manufacturers are striking a balance between three priorities: 1) minimizing their production cost, 2) making a product that’s as easy to take and marketable to consumers as possible, and 3) making a product that is nutritionally comprehensive.
A nutritionally “complete” supplement requires using more (not fewer) nutrients, that are of higher quality (and cost). The best nutrient forms that are well-absorbed by the body tend to have a larger molecule size than less usable forms, making the higher quality ones more difficult to fit into a “one-a-day” pill. And, the more nutrients included, the more complicated the marketing story becomes. As a result, manufacturers often prioritize cost, ease of use, and ease of marketing at the expense of nutritional completeness.
So, what’s the risk if I take a lower-quality or incomplete prenatal vitamin?
The good news is, except at extreme nutritional deficiencies, your baby will get all that he needs from you. As women, our bodies are designed to give preference to our baby’s wellbeing, quite literally drawing from maternal nutrient stores to build baby’s spine, brain, and other vital organs. In other words, mama is the one who often suffers due to a deficiency.
If you start out pregnancy with nutritional deficiencies (as most every woman does!) or fail to properly supplement throughout pregnancy and breastfeeding, it’s very likely that your nutritional levels will decline as a result of giving so much to baby. These deficiencies can persist for years, leading to maternal hormone and mood imbalances, “mommy brain,” infertility, and more.
Take for example the case of Omega-3, a critical nutrient for fetal brain and eye development, a healthy full-term pregnancy, and maternal health outcomes like pre and postnatal anxiety and depression, hormone balance, and fertility. Despite how critical it is, and the fact that 95 percent of women in the U.S. do not meet their need for Omega-3 through diet alone, the vast majority of prenatal vitamins don’t contain it—or contain far too low a dosage to be meaningful.
Why is that? Well, Omega-3 is a difficult nutrient to formulate due to its marine-like taste and susceptibility to oxidation. Rather than innovating to develop an Omega-3 that’s easy to stomach and protected from oxidation, most supplements manufacturers have chosen to exclude it all together—much to the detriment of women’s health.
So, proper supplementation is needed. But, what about the women who lack access to quality prenatal vitamins, or any vitamins at all?
In the U.S., women who qualify to receive Supplemental Nutrition Assistance (“SNAP,” or food stamps)—aren’t able to purchase prenatal vitamins with federal assistance. The presumption of SNAP seems to be that vitamins/supplements aren’t a necessity. This is simply not true for pregnant and lactating women and their infants.
Supplementation is, unfortunately, needed by every woman, but it is especially important for those with a limited or inadequately nutritious diet. And unlike other vital nutrients like folic acid, which is widely available through fortified food products like bread and cereals, there are no reliable Omega-3-fortified foods that SNAP recipients can purchase. DHA-fortified milk—the most common fortified option, offers just 32mg of DHA per serving, a far cry from the minimum 300mg/day that’s required during pregnancy.
Severely low levels of Omega-3 (<5% DHA by blood volume) are associated with early preterm labor and pre-eclampsia, two leading health complications for maternal and infant health. Perhaps not surprisingly, lower-income women are disproportionately impacted by both Omega-3 deficiencies and these serious complications. In our view, this is a public health crisis that deserves far more attention. There is a great deal of upside to making quality prenatal vitamins accessible to all.
What’s the solution, and where do we go from here?
We think that improving access to quality prenatal nutrition education and products can be achieved through three primary initiatives. This is no small task, and making real change will take a movement of consumers and impact-focused companies and other organizations. Here’s where we’d start:
- Free and universally accessible education for healthcare professionals and consumers on the fundamentals of nutrition along the journey to motherhood. In the meantime, nutrition companies like Needed should offer their educational resources to everyone at no charge.
- Prenatal vitamins that are designed to comprehensively support both mama and baby’s optimal wellbeing, not simply meeting minimum requirements to avoid birth defects
- Overhauling the Supplemental Nutrition Assistance Program so that low-income women can use food stamps to purchase much-needed prenatal vitamins (ideally a high-quality comprehensive one). In the meantime, vitamin companies like Needed can and should partner with local organizations to donate their products to women in need and to support much-needed research on the benefits of supplementation.
We started Needed to empower every woman with the fundamental nutrition information and products they need to achieve optimal nourishment along the journey to motherhood. Join our movement at thisisneeded.com and @nourishmentisneeded.