As part of a blog series on fertility nutrition, we interviewed SGF’s Executive Senior Medical Officer, Dr. Eric Widra, to discuss the difference between preconception vitamins and traditional prenatal vitamins.
We have known for years that a woman’s nutrient needs prior to conception are different than they are throughout pregnancy. Dr. Widra recommends that all SGF patients take an appropriate preconception vitamin while trying to conceive.
What is the main difference between preconception vitamins and prenatal vitamins?
According to Dr. Widra, “Preconception vitamins are designed to set the stage for a healthy pregnancy. As women transition into pregnancy their requirements are different.”
It is important to start taking a preconception vitamin as soon as you begin trying to conceive.
Taking a high-quality preconception vitamin, along with eating a healthful diet, helps prepare your body for conception and a healthy pregnancy.
What nutrients do you think are most important to prepare any woman’s body for pregnancy?
A preconception vitamin should provide a complete range of nutrients including folate (folic acid), choline, iodine, and vitamin D. Dr. Widra explains that the primary requirements for a preconception vitamin include having adequate folic acid and vitamin D, and overall good nutritional support.
Folic acid is a B vitamin that is involved in many of the body’s normal processes. Reducing the risk for certain birth defects is perhaps folic acid’s most well-known benefit. These birth defects are called neural tube defects.
The neural tube, which eventually forms into the brain and spinal cord, closes at approximately 28 days after conception. A neural tube defect results when the tube does not close properly. Because the neural tube closes during the early weeks of pregnancy, taking folic acid while you are trying to conceive is very important. Research shows that taking 400 mcg of folic acid for at least 1 month before pregnancy can reduce the risk of neural tube defects by about 36 percent.
When a person consumes folic acid, the body converts it to the metabolically active form called methylated folate. Although Dr. Widra points out that most patients have normal folate metabolism, some women have a genetic defect (called MTHFR polymorphism) that reduces their ability to activate folic acid. A preconception supplement with methylated folate may be of benefit for these women, particularly while trying to conceive and through early pregnancy.
Why is vitamin D so critical for preconception?
Believe it or not, vitamin D is still a somewhat controversial topic. However, studies have generally demonstrated better in vitro fertilization (IVF) success rates in women with normal vitamin D levels (>30 ng/ml) compared with those with low levels. One study found a 6 percent increase in clinical pregnancy rate with each ng/ml increase in vitamin D level.
Dr. Widra explains, “With those data in hand, and the very low cost and low risk associated with using vitamin D, Shady Grove Fertility tests patients’ vitamin D level and recommends supplementation if it is low.”
Do you recommend any specific supplements for women with advanced maternal age or diminished ovarian reserve?
There are limitations to the data supporting the routine recommendation of any specific supplements for these patients. However, for patients who really want to do something, or have found their way to the supplement world on their own, we do offer them coenzyme Q10 or DHEAS.
Coenzyme Q10 (CoQ10)
Many women look to CoQ10 because it plays a crucial role in energy production inside cells (including egg cells). CoQ10 levels decline with age. Therefore, a woman’s eggs become less efficient at producing energy as she ages. This is thought to contribute to poorer egg quality, which can adversely affect fertility and pregnancy outcome.
This Fertility and Sterility study explains that nutrients such as CoQ10 can increase cellular energy production, which may have a positive impact on fertility in older women trying to conceive. Animal data also supports CoQ10’s role in promoting egg quality as women age.
Enrolling participants in fertility studies can be difficult, and there has only been one human study examining CoQ10 supplementation for female fertility. Although the results were promising, the study was too small for the findings to be statistically significant.
DHEAS
Dehydroepiandrosterone Sulfate (DHEAS) is a hormone produced in the adrenal glands. DHEA production declines with age. Although the use of DHEAS for female fertility is somewhat controversial, research has shown that it may improve IVF success in women with diminished ovarian reserve.
When appropriate, women can take 75 mg of DHEAS for at least 4 weeks, and up to 4 months prior to IVF.
Do you see a benefit of using inositols for your patients with PCOS?
Yes. The studies on inositols and PCOS are relatively convincing that they help promote ovulation and an ovulatory response to medications. Therefore, SGF recommends inositols for its patients with PCOS.
In addition, studies have found that inositols reduce insulin resistance and decrease testosterone levels in women with PCOS. Inositols may also promote egg quality and ovarian response to medications in women undergoing IVF.
Research shows that taking a combination of two forms of inositol (myo-inositol and D-chiro-inositol) in the body’s naturally occurring ratio of 40:1, is more beneficial than taking either form alone.
When do you recommend that your patients switch to a traditional prenatal?
A woman’s nutritional needs change as she transitions from preconception and early pregnancy to the second trimester. Therefore, all SGF patients are advised to switch to a traditional prenatal vitamin by 10 weeks of pregnancy.
What do you tell your patients to look for in a traditional prenatal that they might not need in their preconception vitamins?
Dr. Widra explains that there is good evidence that supplementing with DHA after the first trimester has benefits for pregnancy in terms of both fetal development and reduction in preterm labor and delivery. Also, a woman’s iron requirements increase during the second and third trimesters of pregnancy.
Docosahexaenoic acid (DHA)
DHA is an omega-3 fat found in certain fish and algae. DHA supplementation during pregnancy has been associated with improved birth weights and a reduced risk for preterm delivery. DHA may also support fetal mental and visual development. A traditional prenatal should meet the recommended daily intake of 250-300 mg a day.
Iron
A woman’s iron needs are generally the same while trying to conceive and during the first trimester of pregnancy as they are for any premenopausal woman. A preconception supplement should contain 18 mg, the Recommended Dietary Allowance (RDA) for premenopausal women.
Iron needs increase during the second and third trimesters of pregnancy due to greater iron use by the developing baby. A traditional prenatal should contain 27 mg of iron, the RDA for pregnant women.
Why do you choose to recommend Luminary Vitamins to your patients?
Shady Grove Fertility is proud to recommend Luminary Vitamins and Theralogix to offer high-quality, evidence-based nutritional supplements patients can trust.
Nutritional supplements can be an important complement to your fertility treatment but they do not replace fertility evaluation and care.
You should have your fertility evaluated if you are under 35 years old and have been trying for 1 year, after 6 months if you are between the ages of 35-39 and after 3 months if you are 40 and over. Women should consult their reproductive endocrinologist before beginning any vitamin regimen.
To learn more about preconception and prenatal vitamins, or to schedule an appointment, please call our New Patient Center at 1-877-971-7755 or click here to complete our online form.
Medical contribution by Eric A. Widra, M.D.
Eric A. Widra, M.D., is the Executive Senior Medical Officer for Shady Grove Fertility and the associate director of the Combined Federal Fellowship in Reproductive Endocrinology and Infertility—a post-graduate training program for future leaders in this subspecialty, operated through the National Institutes of Health, Walter Reed National Military Medical Center, and Shady Grove Fertility.
