Nutrient Deficiencies in Pregnancy

By Shira Sussi

As a registered dietitian working in a OB practice, I see countless women during their pregnancies referred to me for various nutrient deficiencies that arise during the nine months. Sometimes I have lab values to work off of; for example all pregnant women have their hemoglobin and hematocrit checked during pregnancy, which can be a measure of iron levels. But more often than not for all other nutrients I have physical symptoms and a diet recall to rely on. A diet recall is when the expecting mothers recalls all the foods and beverages she consumed in the last 24-48 hours. By getting an idea of her typical diet through food, I can quantitatively assess what nutrients she may be lacking. Here, the most common deficiencies I see in my pregnant mamas:

Calcium

Calcium is essential for building a baby’s bones and teeth. Many women are not getting enough calcium before pregnancy putting them at risk for bone loss during pregnancy. A lot of women today are also avoiding dairy due to digestive discomfort. Additionally, most people aren’t drinking a glass of milk with their lunch like they used to!  Dairy products, including milk, cheese and yogurt provide the best sources of calcium, however, other great non-dairy sources of calcium include sardines, tofu, fortified orange juice or soy milk and dark leafy greens. A calcium supplement is always an option, but keep in mind it can be constipating for some women (especially calcium carbonate).

Iron

During pregnancy women need additional iron to help red blood cells deliver more blood to supply oxygen to the baby. Iron is more easily absorbed as heme iron, the type of iron found in animal foods such as red meat, chicken and fish. Quite often women experience aversions to animal protein during pregnancy making it difficult to meet their increased iron and protein nutritional needs. Check to make sure your prenatal vitamin includes iron (not all do). Consume iron-rich vegetables, like spinach, and legumes such as beans and chickpeas, and fortified breakfast cereals. If able, eat iron-rich foods with vitamin C, like orange juice or tomatoes, which enhances the body’s absorption of iron. If found to be anemic during pregbacy you may be recommended an additional iron supplement. Take it with Vitamin C, too.

Vitamin D

Even when not pregnant most women aren’t getting enough Vitamin D, which is mainly absorbed from sunlight, fortified milk and fatty fish. Vitamin D works with calcium to help build a baby’s bones and teeth. It also is necessary for skin and eyesight development. Most prenatal vitamins have 400 IU of Vitamin D, while 600 IU is recommended for pregnancy or breastfeeding. The majority of women are either indoors or outside slathered in sunscreen during peak sunlight hours in the summer months. So where to get that much-needed Vitamin D? Like calcium and iron, opt for foods such as cereals or beverages that have been fortified with Vitamin D, or aim for a few servings of salmon or sardines per week. Ask to have your Vitamin D levels checked before conceiving and if your levels are low consider adding a supplement.

DHA

Fish is not only a great source of protein but high in omega-3 fatty acids (or as we know it, EPA and DHA, with EPA being the precursor metabolized to DHA in the liver). Intake of omega 3’s is important for the baby’s visual and cognitive development. However, most women during pregnancy limit their fish consumption due to concerns about mercury levels and other environmental toxins. Some foods, like eggs, flaxseeds and walnuts are high in omega 3’s, but just to be on the safe side consider either a prenatal vitamin with DHA or a DHA supplement.

Folate

It’s recommended to take a minimum of 400 mg of folic acid daily for at least one month prior to conception and throughout pregnancy as research has shown it may prevent birth defects to the baby’s brain and spine. Folate is also important for general growth and development of the baby and placenta. It’s the natural occurring B-vitamin found in foods, while the more commonly known folic acid is the synthetic version of folate added to foods. Just because mom is taking a prenatal vitamin doesn’t mean she shouldn’t make an effort to consume folate-rich foods. Like the other vitamins and minerals, many foods today are fortified with folic acid including cereals, breads, pastas and orange juice. Make it a priority to increase intake of these foods plus dark leafy green vegetables and legumes (beans, lentils, peanuts) especially when trying to conceive and during the early months of pregnancy.

Fiber

Constipation during pregnancy is one of the biggest side effects my pregnant mother’s vent to me about. While it’s likely caused by hormonal changes that affect the small bowel, most women aren’t meeting the recommended 25-30 grams of fiber per day. Increase fiber intake slowly to prevent bloating by eating fruits and vegetables with their skins/peels, dried fruits such as prunes, and whole grains such as brown rice, oatmeal, quinoa and bran. Increasing fiber intake doesn’t always work on it’s own – make sure to drink adequate fluids (12 8 oz cups/day) and incorporate movement or light exercise into your routine.