In this blog, by Nutritionist and founder of Artah Health, Rhian Stephenson, she highlights the importance of four essential nutrients: Folate, Omega-3 Fats,  Iron, and Vitamin A. Why these nutrients are important, how they benefit the mother and the baby, and the best food sources to include in your diet. By understanding the significance of these nutrients for fertility and pregnancy, you can take steps to support a healthy pregnancy and ensure a healthy start to your child's life.

Folic Acid is probably the most well-known nutrient when it comes to a healthy pregnancy and your doctor will likely recommend that you start taking folic acid as soon as you’re considering having a baby or find out you’re pregnant. Before we jump into why it’s important, let’s talk about the difference between Folate and Folic Acid. Folic Acid is the synthetic version of the essential nutrient Folate, otherwise known as Vitamin B9. Folate is critical for the development of the neural tube of your baby, DNA and red blood cell production, as well as the growth and development of every tissue in the body.  

Pre-pregnancy is equally important; it’s required for healthy oocyte (egg) development and ovulation and is also thought to promote ovarian reserve - the reproductive potential left within a woman's two ovaries based on the number and quality of eggs. Folate is found in foods, whereas folic acid is not. Why is this difference important? Folic Acid can be problematic for some individuals – it’s estimated that up to 40% of the population carry a mutation in one of our genes which prevents us from adequately converting synthetic Folic Acid into its active Folate form. This is why supplementing with the higher-quality Methylfolate form is recommended both during pregnancy and whilst you are trying to conceive.  

In addition to getting it in a supplemental form, it is important to prioritise food sources of Folate throughout your fertility journey. Folate is abundant in plant foods like dark leafy greens, lentils, asparagus, spinach, artichoke, avocado, beets, mango, citrus fruit, brussels sprouts, beans, peanuts, peas, quinoa, millet, wild rice, papaya and banana are all food sources of folate. Animal foods also contain Folate; eggs are a good source, but most fish and meat have limited amounts, which is why plant foods should be your primary source of dietary Folate. 

Best sources: dark leafy vegetables, beans, lentils, asparagus. 

FEicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) are long chain omega-3 fatty acids that are critical for both foetal and maternal health. Pre-pregnancy, omega-3s are essential for hormone balance, oocyte (egg) quality, ovulation and to combat inflammation. Their benefits are heightened once pregnancy is underway. DHA is a vital component of your baby’s brain development and supports their vision, cardiovascular health, immune system and more. Increased EPA and DHA consumption throughout pregnancy can also support overall maternal health, and some studies have suggested supplementing may help prevent pre-term labour, lower the risk of pre-eclampsia, and combat perinatal and post-natal depression, although more research is needed.

The best food sources of these essential omegas are animal based – namely fish and seafood – however it is possible to get a limited amount of from plant-based foods. Walnuts, chia, flaxseeds, leafy green veg, seeds, and beans all have an omega-3 fat called Alpha-Linoleic Acid, which can be converted into EPA and DHA. This conversion, however, is inefficient; only around 8% of dietary ALA is converted into EPA, and 5% into DHA, so it can be quite difficult to get an optimal amount of EPA/DHA from plants alone as our requirements in pregnancy increase. Even populations who eat fish regularly have been shown to have an inadequate intake of EPA and DHA, which is why I recommend that all women consider supplementing with a good quality fish oil throughout pregnancy, especially those who follow a plant-based diet or who don’t like fish. For those who are uncomfortable taking omegas derived from fish, look for vegan omegas, which will be derived from algae.

Best sources: salmon, sardines, mackerel, shellfish, herring.   

Iron is an essential trace mineral required to produce hemoglobin - the protein in our red blood cells that carries oxygen to our tissues - and myoglobin - the protein in our muscles that stores oxygen. Iron becomes particularly relevant in pregnancy because our blood volume increases by 45% - with most of this change happening across the second and third trimester. In addition to being vital for the oxygenation of your tissues, it is also involved in your baby’s growth and neurodevelopment.

There are two types of dietary iron – heme iron and non-heme iron. Heme iron is found in animal-based foods, like meat, poultry, and fish, whereas non heme iron is found in plant-based foods; certain grains, nuts, leafy greens, and legumes can be sources of iron. The best sources of heme iron include game meats like bison and venison, beef, the dark meat in poultry, sardines, and clams. The best sources of non-heme iron include lentils, spinach, black beans, quinoa, spirulina (1 tbsp), and broccoli, however, non-heme iron is not absorbed as well by the body as heme iron. Whilst up to 25% of UK women become anemic during pregnancy, it is worth noting that vegetarians and vegans who eat a varied diet rich in legumes, nuts, seeds, green leafy veg, and whole grains are generally not at any greater risk of iron-deficiency than non-vegetarians. A few things to be mindful of: eating iron-rich foods alongside Vitamin C-rich and fermented foods can help improve absorption, whereas eating them with dairy products can significantly reduce absorption.  

You may have your iron levels checked in pregnancy, however if you are trying to conceive and are unsure about your iron intake, I would suggest getting a test to check your levels. Iron supplementation is common during pregnancy but as they are infamous for having unpleasant gastric side effects, taking a proactive approach to increasing your intake from food is a great first step.  

If you do need to take iron or wish to include it proactively in the latter part of pregnancy to prevent depletion, look for Iron Bisglycinate with added Vitamin C to improve absorption, as it is a gentle, better tolerated form. Ferrous fumarate and ferrous sulphate are more likely to cause unwanted side effects and should be avoided whenever possible.

Best sources of heme iron: beef, lamb, sardines, turkey. 

Best sources of non-heme iron: spirulina, lentils, spinach.  

Vitamin A is a fat-soluble vitamin that has a critical role in fetal development. A quick caveat; whilst food-based Vitamin A is required for a healthy pregnancy, excess supplementation of Vitamin A has been linked to an increased risk of congenital malformations, which is why it is important to avoid supplementing with Vitamin A throughout pregnancy. Prenatal vitamins will often leave this vitamin out of their formula to be on the safe side, however some will still have the RDA/NRV. If you are taking a prenatal vitamin with Vitamin A, make sure it does not have more than 800mcg of retinyl-palmitate. It is also important to do a quick audit of any other supplements you are taking to ensure you are not inadvertently consuming it in another formula; it is often found in skin and immune complexes.  

Whilst I do not recommend Vitamin A supplementation in pregnancy, it is vital to include Vitamin A-rich foods during this time. Vitamin A is important for the development of the fetal skeleton, immune system, and ocular health, and is also important for maternal health. There are two types of Vitamin A you can get from the diet – preformed Vitamin A (or Retinol), which comes from animal foods, and as carotenoids, also referred to as Provitamin A. Beta carotene is the best carotenoid source of Provitamin A and is found in rich yellow, orange, green and red plant foods, like sweet potato, carrot, squash, red peppers, mango, papaya, and apricots. The conversion is about 12-1, so you need 12mg of beta-carotene to get 1mg of Vitamin A.  It’s worth noting that the best food source of Vitamin A is liver; however, liver should be limited or avoided in pregnancy due to its high Vitamin A content and potentially elevated levels of accumulated toxins (although this is less likely in high-quality, grass-fed sources).

Best sources of Vitamin A: meat, fish, whole dairy, eggs.

Best source of Beta Carotene: sweet potatoes, carrots, dark leafy greens, red pepper, butternut squash, cantaloupe, papaya.