Important Nutrients in the First Trimester
Once a pregnancy is confirmed, many people change certain aspects of their diet and lifestyle. Perhaps girls night now involves mocktails instead of cocktails, maybe Friday night sushi may turn into baked salmon night.
Generally pregnant people know what to abstain from the next (almost) 40ish weeks. But when it comes to including things into their routine, other than folic acid they may be at a loss.
Let’s explore six nutrients are important in the first trimester. We’ll discuss why, what the daily requirements are, and if any foods are rich in these nutrients.
Why are nutrients important?
Nutritional needs in pregnancy change because of fetal development and growth. When nutritional deficiencies exist, it impacts maternal and fetal well-being - specifically around growth, brain development, cognitive ability and more. During the preconception period, it’s critical to ensure that nutritional deficiencies are addressed (ideally) to help ensure healthier outcomes for both mom and baby. Nausea and vomiting can be a concern in the first trimester, so sometimes it’s easier to take supplements than add particular foods during a tough time.
Necessary Nutrients in the First Trimester
Folic Acid
Dosage: 0.4-0.8 mg per day (may be up to 5mg in specific instances)
Dietary Sources: Leafy Greens, legumes, fortified foods (ex. breakfast cereals, bread, other grain products)
Odds are you know folic acid is important during pregnancy - especially early in the first trimester as neural tube defects, which folic acid helps prevent, occur in the first few weeks of pregnancy, often before someone knows they are pregnant
Aside from the neural tube defects, inadequate intake during pregnancy can negatively impact fetal brain development leading to potential long-term neurological issues.
In the pregnant person, insufficient maternal folic acid levels are also linked to adverse outcomes such as low birth weight, preterm delivery, and fetal growth restriction.
Choline
Dosage: 450mg per day
Dietary Sources: Eggs, liver, salmon, quinoa, chicken, milk, and various vegetables (ex. soybeans, Brussels sprouts, and broccoli)
Supplementing with choline during pregnancy plays an important role in neural tube defects and brain development. Studies show that a higher intake of choline during the third trimester correlates with better attention and cognitive function in children by the time they reach 7 years old. Choline is also necessary in maintaining placental health, which is essential for fetal development.
More often than not, choline is NOT included in your typical prenatal vitamin. Instead, this is one nutrient where additional supplementation may be needed, or you choose to consume 2 eggs per day throughout pregnancy.
Iron
Dosage: Minimum of 27mg per day, but likely more based on blood work
Dietary Sources: Red meat, poultry, fish, legumes, dark leafy greens
Did you know that iron deficiency anemia is the most common nutritional deficiency during pregnancy? As blood volume increases during pregnancy, iron requirements also increase.
Deficiencies of iron during the first trimester can result in significant changes in brain structure, leading to long-term cognitive issues such as memory impairment, motor deficiencies, and academic challenges. Poor fetal iron status correlates with language delays, reduced motor skills, and decreased overall intelligence. Adverse pregnancy outcomes include increased risks of maternal and infant mortality, premature birth, and low birth weight.
Testing ferritin and hemoglobin is so important during pregnancy, arguably before and is one of the tests that I strongly advise to be done in both the first and second trimester. Ideally a level above 70 µg/L typically indicates sufficient iron stores, while levels below 30 µg/L suggest that treatment is needed through supplementation.
Iodine
Dosage: 220-250mg per day
Dietary Sources: Iodized salt, sea fish, shellfish, cereals, and grains
Iodine is an important nutrient for fetal thyroid hormone, fetal neurodevelopment, particularly during the first half of pregnancy when proper thyroid hormone levels are necessary for brain development and cognitive function.
Many women, especially those who are vegan or limit dairy and sodium, may not meet daily iodine requirements, putting them at higher risk for deficiency.
Vitamin B12
Dosage: Exact dosage not specified, but would rely on blood work
Dietary Sources: Meat, poultry, fish and shellfish, dairy products, eggs, fortified foods
Vitamin B12 is essential because of its role in fetal neural tube and brain development. Insufficient vitamin B12 levels can lead to significant complications for both the mother and fetus, impacting proper fetal growth and development, and may also lead to small-for-gestational-age newborns in vegan women.
Deficiency may be more prevalent than previously recognized, particularly among groups such as vegetarians, vegans, and individuals on restricted diets. Certain medications, including Metformin, can also contribute to B12 deficiency.
Vitamin D
Dosage: 600IU, but likely more depending on blood work
Dietary Sources: Fatty fish (ex. salmon, mackerel, tuna), cod liver oil, fortified foods (ex. milk, orange juice, cereal, yogurt), egg yolks, mushrooms, beef
Vitamin D is another important nutrient in pregnancy as in early pregnancy as a deficiency has been associated with an increased risk of developing gestational diabetes mellitus (GDM). In addition, there is a correlation between vitamin D deficiency and adverse pregnancy outcomes, including a higher risk of preeclampsia, cesarean birth, and bacterial vaginosis.
In offspring, adequate vitamin D levels may reduce the risk of low birth weight, which is associated with various child health concerns including cognitive disorders, hypertension, increased BMI, diabetes, and asthma.
A vitamin D deficiency is more common during the winter, especially in regions with limited sunlight. Furthermore a deficiency is common among people who follow vegan or vegetarian diets. Screening for vitamin D should ideally happen early in pregnancy (before 20 weeks), followed by appropriate supplementation.
Next Steps
If you’re currently in the first trimester or actively trying to conceive it’s likely that you are taking a prenatal vitamin. Based on your diet or blood levels you may need more of certain nutrients (think iron or vitamin D).
Many Naturopathic Doctors can requisition the above tests to ensure that you have adequate levels, or catch low levels before you get pregnant/early in your pregnancy so you can raise them and improve health outcomes for both you and baby.