The most important nutrients for pregnant women - the key to optimal child development and mother's health
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The most important nutrients for pregnant women are folate, iron, iodine, vitamin D, the omega-3 fatty acid DHA, vitamin B12, choline, calcium and magnesium. The saying "eating for two" does not hold: according to EFSA, energy needs rise by only 70 kcal a day in the first trimester and by 500 kcal in the third. The need for many vitamins and minerals, however, rises faster than the need for energy. That is why experts now talk about "nourishing for two": the quality of the diet matters more than its quantity. Folate contributes to maternal tissue growth during pregnancy.
What will you learn in this article?
- The most common nutritional deficiencies in pregnant women
- How much of each nutrient you need in pregnancy: EFSA overview
- Trimester guide: how nutritional needs change
- Supplementation before conception vs. during pregnancy
- Key takeaways
The most common nutritional deficiencies in pregnant women
Even in Europe, where food is plentiful, pregnant women often lack some micronutrients. The reasons are the higher demands of the body, modern eating habits and the fact that some nutrients are hard to cover from an everyday diet.
Folate and folic acid (vitamin B9)
Folate has a role in the process of cell division and contributes to maternal tissue growth during pregnancy. It matters most in the first weeks after conception. The neural tube, which develops into the brain and spinal cord, closes 26 to 28 days after fertilisation.[1] At that point many women do not yet know they are pregnant.
EU legislation therefore authorises the claim: Supplemental folic acid intake increases maternal folate status. Low maternal folate status is a risk factor in the development of neural tube defects in the developing foetus. The beneficial effect is obtained with a daily intake of 400 µg of folic acid for at least one month before and up to three months after conception.[2] The US Preventive Services Task Force (USPSTF) recommends 400 to 800 µg a day.[1] According to EFSA, total folate intake in pregnancy should reach 600 µg DFE (dietary folate equivalents) a day.[3] Folate is found in dark leafy greens, legumes and liver, but it breaks down easily with heat and light. Read more in our article Folate: the health gem you might be missing.
The body converts synthetic folic acid into its active form (methylfolate) with the help of the MTHFR enzyme. About 12% of Europeans carry the MTHFR C677T variant in both gene copies and another 38% in one copy.[4] In these people the enzyme works less efficiently. The active form skips this step. That is why we added 400 µg of the patented active folate Quatrefolic® to Pregnancy Essentials.
Iron
During pregnancy, plasma volume increases by about 50%, while red blood cell mass grows less. The blood becomes naturally "diluted" and haemoglobin levels fall.[5] Iron contributes to normal formation of red blood cells and haemoglobin.
Recommendations differ here. EFSA set the same intake for pregnant women as for other women, 16 mg a day, because it takes iron stores and better absorption during pregnancy into account.[6] The World Health Organization (WHO) recommends that pregnant women take 30 to 60 mg of iron a day together with 400 µg of folic acid.[7] How much iron to supplement is therefore best decided by a blood test and your doctor. Iron deficiency shows as tiredness, shortness of breath and pallor.
In Pregnancy Essentials, iron comes in a separate capsule, apart from the other ingredients, as iron bisglycinate (a chelate).
Iodine
A systematic review by Bath and colleagues (2022) showed that iodine intake is insufficient in many European countries, including among women of reproductive age.[8] Iodine contributes to the normal production of thyroid hormones and normal thyroid function. In the first half of pregnancy the foetus depends on the mother's thyroid hormones. EFSA recommends 200 µg of iodine a day for pregnant women.[9]
The British ALSPAC study (Bath et al., 2013) followed mothers and their children. Children of women with mild iodine deficiency in pregnancy scored lower on verbal IQ and reading tests at ages eight and nine.[10] The risk of deficiency rises with less iodised salt and with plant-based diets that leave out dairy, eggs and sea fish.
Vitamin D
Vitamin D deficiency is common in Europe in winter, because the skin cannot make it without enough sunlight. Vitamin D contributes to the maintenance of normal bones and to the normal function of the immune system. EFSA recommends 15 µg (600 IU) a day for pregnant women and other adults, and considers a blood 25(OH)D level of at least 50 nmol/L sufficient.[11]
A review of 31 observational studies (Aghajafari et al., 2013) linked low vitamin D levels in pregnancy with more frequent gestational diabetes, preeclampsia and low birth weight.[12] This is an association, not proven cause and effect. Vitamin D contributes to normal absorption of calcium, and vitamin K contributes to the maintenance of normal bones.
Pregnancy Essentials contains 1,000 IU (25 µg) of vitamin D3. A blood test shows your current level, and your doctor can adjust the dose based on the result.
Omega-3 fatty acids (DHA and EPA)
DHA is a building block of the brain and retina. EFSA recommends 250 mg of EPA and DHA a day for adults, plus an extra 100 to 200 mg of DHA in pregnancy.[13] Maternal intake of DHA contributes to the normal brain and eye development of the foetus and breastfed infants.*
A Cochrane review of 70 trials (Middleton et al., 2018) found that omega-3 supplementation in pregnancy reduced preterm birth before 37 weeks by 11% and before 34 weeks by 42%.[14] Research is also looking at omega-3 and depression during and after pregnancy, but there are no clear conclusions yet.[15]
The main source is oily sea fish. Some species need to be limited in pregnancy because of their mercury content, so many women eat little of them. A supplement such as Krill Oil+, which provides omega-3 fatty acids in phospholipid form, can help.
*The beneficial effect is obtained with a daily intake of 200 mg of DHA in addition to the recommended daily intake of omega-3 fatty acids for adults, i.e. 250 mg of DHA and EPA.
Vitamin B12
Vitamin B12 contributes to normal red blood cell formation and to the normal functioning of the nervous system, and has a role in the process of cell division. It occurs naturally only in animal foods, so vegans and vegetarians need to pay particular attention to it. EFSA recommends 4.5 µg a day in pregnancy.[16] Pregnancy Essentials contains 5 µg of vitamin B12 as methylcobalamin.
Choline
Choline is an often overlooked nutrient in pregnancy. The body needs it to build cell membranes and transmit nerve signals. Choline contributes to the maintenance of normal liver function and to normal lipid metabolism. EFSA raises the recommended intake in pregnancy from 400 to 480 mg a day.[17] The main sources are eggs, meat and fish. Pregnancy Essentials contains choline as choline bitartrate.
Calcium and magnesium
Calcium is needed for the maintenance of normal bones and teeth. In pregnancy, calcium absorption from food increases naturally. That is why EFSA does not raise the recommended intake for pregnant women: it stays at 950 mg a day, or 1,000 mg for women under 25.[18] If you regularly eat dairy, your calcium intake is usually sufficient. A supplement makes sense mainly with a low intake, for example on a plant-based diet.
Magnesium contributes to normal muscle function, to normal functioning of the nervous system and to the reduction of tiredness and fatigue. EFSA recommends 300 mg of magnesium a day for women, including pregnant women.[19]
How much of each nutrient you need in pregnancy: EFSA overview
The table sums up recommended daily intakes set by the European Food Safety Authority (EFSA). They refer to total intake from food and supplements.
| Nutrient | Adult woman | Pregnant woman |
|---|---|---|
| Folate | 330 µg DFE | 600 µg DFE[3] |
| Iron | 16 mg | 16 mg[6] |
| Iodine | 150 µg | 200 µg[9] |
| Vitamin D | 15 µg | 15 µg[11] |
| DHA | 250 mg EPA + DHA | +100 to 200 mg DHA[13] |
| Vitamin B12 | 4 µg | 4.5 µg[16] |
| Choline | 400 mg | 480 mg[17] |
| Calcium | 950 mg | 950 mg[18] |
| Magnesium | 300 mg | 300 mg[19] |
Trimester guide: how nutritional needs change
A pregnant woman's needs change as the foetus develops and the mother's body adapts.
First trimester (weeks 1–12): organ development
In the first trimester all major organs of the foetus form: the heart, brain, spine and limbs. At this stage the foetus is most sensitive to alcohol, some medicines and an excess of some nutrients, such as vitamin A in the form of retinol. Energy needs rise by only 70 kcal a day and protein needs by 1 g a day.[20][21] In this period, focus mainly on:
Folate: has a role in the process of cell division and contributes to maternal tissue growth during pregnancy.
Vitamin B12: together with folate has a role in cell division and contributes to normal red blood cell formation.
Iodine: contributes to the normal production of thyroid hormones, on which the foetus depends at this stage.
Zinc: contributes to normal DNA synthesis and has a role in the process of cell division.
Vitamin B6: contributes to normal functioning of the nervous system and to the reduction of tiredness and fatigue.
Second trimester (weeks 13–26): rapid growth
Morning sickness usually eases and the foetus grows fast. Its skeleton and muscles develop and the mother starts to feel the first movements. Energy needs rise by 260 kcal a day, roughly a plain yoghurt with fruit and a handful of nuts. Protein needs rise by 9 g a day.[20][21] These nutrients move to the front:
Iron: the mother's blood volume grows quickly.
Calcium and vitamin D: needed for the maintenance of normal bones; calcium deposition in the foetal skeleton speeds up in this period.
Magnesium: contributes to normal muscle function.
Vitamin C: contributes to normal collagen formation.
Omega-3 (DHA): the higher need for DHA lasts throughout pregnancy.
Third trimester (weeks 27–40): building stores
The foetus gains weight, its lungs mature and the brain goes through its most intense development. The foetus also builds its own iron stores. The growing uterus presses on the stomach, so larger meals become uncomfortable and heartburn is more common. Energy needs rise by 500 kcal a day and protein needs by 28 g a day.[20][21] Key nutrients:
Iron: the foetus builds its stores, and the mother's risk of anaemia is highest in the third trimester.
Omega-3 (DHA): maternal intake of DHA contributes to the normal brain and eye development of the foetus.*
Calcium and vitamin D: mineralisation of the foetal skeleton is completed.
Magnesium: contributes to normal muscle function and to the reduction of tiredness and fatigue.
Supplementation before conception vs. during pregnancy
Supplementation before and during pregnancy has different goals. Before conception the aim is preparation: building up nutrient stores so that a woman enters pregnancy without deficiencies. The most sensitive stages of embryonic development take place in the first weeks after conception, often before a woman knows she is pregnant. Why it pays to start prenatal vitamins while you are still planning is explained in our article Planning a baby? Why prenatal vitamins are the first step to a healthy pregnancy.
Once pregnancy is confirmed, the aim shifts to meeting the growing needs of the foetus, placenta and mother. It is best to match the doses of individual nutrients to blood test results and your doctor's advice.
Key takeaways
Nourish for two, don't eat for two: energy needs rise by 70 to 500 kcal a day depending on the trimester, micronutrient needs rise faster.
Folic acid before conception: 400 µg a day for at least one month before and three months after conception. The neural tube closes by day 28 after fertilisation.
Iron based on a blood test: EFSA sets 16 mg a day, WHO recommends supplementing 30 to 60 mg. Your doctor decides the dose based on the results.
Iodine and vitamin D are often short in Europe: pregnant women need 200 µg of iodine and 15 µg of vitamin D a day.
DHA for the baby's brain and eyes: pregnant women need an extra 100 to 200 mg of DHA a day on top of their usual omega-3 intake.
Each trimester has its own priorities: folate, B12 and iodine in the first, iron, calcium and vitamin D in the second, iron and DHA in the third.
Sources:
[1] US Preventive Services Task Force. Folic acid supplementation to prevent neural tube defects: US Preventive Services Task Force recommendation statement. 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication
[2] Commission Regulation (EU) No 1135/2014 of 24 October 2014 on the authorisation of a health claim made on foods and referring to the reduction of disease risk. Official Journal of the EU, L 307. https://eur-lex.europa.eu/eli/reg/2014/1135/oj
[3] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for folate. EFSA Journal, 2014; 12(11): 3893. https://doi.org/10.2903/j.efsa.2014.3893
[4] KNMP. Pharmacogenetics: Methylenetetrahydrofolate reductase (MTHFR). 2020. https://www.knmp.nl/sites/default/files/2023-11/MTHFR_English.pdf
[5] Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr, 2016; 27(2): 89–94. https://pmc.ncbi.nlm.nih.gov/articles/PMC4928162/
[6] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for iron. EFSA Journal, 2015; 13(10): 4254. https://doi.org/10.2903/j.efsa.2015.4254
[7] World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. 2016. https://www.who.int/news/item/07-11-2016-new-guidelines-on-antenatal-care-for-a-positive-pregnancy-experience
[8] Bath SC, Verkaik-Kloosterman J, Sabatier M, ter Borg S, Eilander A, Hora K, et al. A systematic review of iodine intake in children, adults, and pregnant women in Europe: comparison against dietary recommendations and evaluation of dietary iodine sources. Nutr Rev, 2022; 80(11): 2154–2177. https://doi.org/10.1093/nutrit/nuac032
[9] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for iodine. EFSA Journal, 2014; 12(5): 3660. https://doi.org/10.2903/j.efsa.2014.3660
[10] Bath SC, Steer CD, Golding J, Emmett PM, Rayman MP. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet, 2013; 382(9889): 331–337. https://doi.org/10.1016/S0140-6736(13)60436-5
[11] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Dietary reference values for vitamin D. EFSA Journal, 2016; 14(10): 4547. https://doi.org/10.2903/j.efsa.2016.4547
[12] Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O'Beirne M, Rabi DM. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ, 2013; 346: f1169. https://doi.org/10.1136/bmj.f1169
[13] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for fats. EFSA Journal, 2010; 8(3): 1461. https://doi.org/10.2903/j.efsa.2010.1461
[14] Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database Syst Rev, 2018; 11: CD003402. https://doi.org/10.1002/14651858.CD003402.pub3
[15] Hsu MC, Tung CY, Chen HE. Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: putative mechanism and recommendation. J Affect Disord, 2018; 238: 47–61. https://doi.org/10.1016/j.jad.2018.05.018
[16] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for cobalamin (vitamin B12). EFSA Journal, 2015; 13(7): 4150. https://doi.org/10.2903/j.efsa.2015.4150
[17] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Dietary Reference Values for choline. EFSA Journal, 2016; 14(8): 4484. https://doi.org/10.2903/j.efsa.2016.4484
[18] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for calcium. EFSA Journal, 2015; 13(5): 4101. https://doi.org/10.2903/j.efsa.2015.4101
[19] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for magnesium. EFSA Journal, 2015; 13(7): 4186. https://doi.org/10.2903/j.efsa.2015.4186
[20] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for energy. EFSA Journal, 2013; 11(1): 3005. https://doi.org/10.2903/j.efsa.2013.3005
[21] EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for protein. EFSA Journal, 2012; 10(2): 2557. https://doi.org/10.2903/j.efsa.2012.2557
