One in three women undergoing fertility treatment in the United States read Rebecca Fett’s best-selling guide “It Starts with the Egg.” The book distills the research Rebecca – who has a PhD in molecular biochemistry – did to optimize her own egg quality. Applying her biology background to the task, Rebecca poured over hundreds of scientific studies to maximize her chances of pregnancy with her own eggs through optimum egg quality and everything else that supports a pregnancy. Then, she made the knowledge available to everyone in a book form, easily digestible to those of us without a background in science.
We love this research-driven yet approachable and actionable guide and would recommend it to anyone getting ready for a pregnancy. Today, we highlight 3 prenatal vitamins takeaways from “It Starts with the Egg” – with 1 bonus nutrient from “Brain Health from Birth,” another guide by Rebecca Fett (that we highly recommend, too).
Folate: Nutrient with Two Important Roles
Folate is on top of the priority list for women preparing for a pregnancy, because of its role in the development of the baby’s central nervous system. During early pregnancy, folate supports the formation of the brain and spine, and a healthy level is necessary to prevent neural tube defects (like spina bifida).
Lesser-known potential benefit of folate, Rebecca points out, is around ovulation and egg quality. In a large-scale analysis of over 18,000 women, scientists have discovered that women who take multivitamins containing folate and other B vitamins were more likely to have normal ovulation than those who didn’t take multivitamins. We don’t know the exact mechanism yet, but one hypothesis is that folate may drive healthy ovulatory cycles by encouraging production of progesterone exactly when a high level of progesterone is necessary in ovulatory cycles.
Some studies have also found that folate levels are positively correlated with higher chances of pregnancy among women undergoing fertility treatments. The authors hypothesized that this association may be through folate’s role in supporting higher egg quality.
It Starts with the Egg’s Folate Recommendation
So, as soon as you start trying for a baby, make sure your prenatal vitamins contain at least 600-800 mcg of folic acid – or folate, if you have a MTHFR gene mutation – to support the baby’s brain development, but also to potentially support normal ovulation and egg health.
Vitamin C and Vitamin E: the Prenatal Antioxidants
Prenatal vitamins usually contain Vitamin C and Vitamin E, both potent antioxidants. Antioxidants are molecules that scavenges reactive oxygen species (sometimes called free radicals), normal but harmful byproduct of the metabolic processes. Left untouched, reactive oxygen species cause oxidative damages to cells and DNA, and some scientists suspect that accumulated oxidative damage and lower antioxidant defenses play a part in the age-related changes in our reproductive systems.
There are fewer studies done on the reproductive health effects of Vitamin C and Vitamin E, compared to other antioxidants like melatonin and CoQ10. One 2014 study, for example, showed that women over 35 who were taking Vitamin E needed less time to get pregnant than those who weren’t. Interventional studies that show positive correlation between supplementing with these vitamins and reproductive health outcomes tend to use relatively high doses that may not be the best for general health.
It Starts with the Egg’s Vitamins C & E Recommendation
However, Rebecca points out that “every small incremental improvement in egg quality helps.” If you decide to incorporate Vitamins E and C into your preconception and prenatal routine, “It Starts with the Egg” recommends up to 200 IU of Vitamin E and 500-1,000 IU of Vitamin C.
Vitamin D: For Systemic and Reproductive Health
Vitamin D and reproductive health have been in the spotlight in the last decade, with studies examining its role in pregnancy rates with ART, fertilization rates, implantation rates and uterine receptivity (how easy it is for embryos to implant in the endometrium). While we don’t know how Vitamin D may support female reproductive health, these studies have found positive correlations between higher Vitamin D levels and reproductive success.
Although our skin synthesizes Vitamin D when exposed to the UVB in the sun, inadequate levels of Vitamin D is surprisingly common – and as Rebecca points out, whether the official cut-off value of adequacy, set to support bone health, is really adequate for reproductive health is hotly debated among Vitamin D researchers. Even using the conservative level of adequacy at 30 ng/mL in the blood, about 30% of women in the US are at risk of insufficient Vitamin D levels, according to the CDC.
It Starts with the Egg’s Vitamin D Recommendation
What to do? Rebecca recommends getting tested for Vitamin D levels first. (You can take a home test, or ask your doctor to test it for you.) If your level falls below the 30 ng/mL (or, even better, 40 ng/mL level), you can start supplementing with 4,000-5,000 IU per day of Vitamin D3. If you have a significant deficiency, your doctor may put you on a higher dose for a few weeks to top up.
Choline: Just as Crucial as Folate for Brain Development
In her follow-up book, “Brain Health from Birth,” Rebecca tackles the question of how we can set the stage right for the baby’s brain development, both during pregnancy and in the baby’s first year. One of the most significant takeaways from this book might be the importance of choline in your preconception nutrition.
Choline, like its better-known cousin, folate, plays a crucial role in the baby’s brain growth and cognitive development. It’s an essential building block for nerve cells, and the baby cannot produce nerve cells without a sufficient supply of choline. Furthermore, choline is necessary for the production of a neurotransmitter that regulates the functions of brain cells. (More on choline here.)
Despite its importance, choline is somewhat of a neglected nutrient. A staggering 90-95% of women have inadequate choline in their diet, and most prenatal vitamins don’t contain enough to make up the difference.
Rebecca Fett’s Choline Recommendation
Make sure your prenatal vitamins contain at least 350 mg of choline, if your diet is healthy and contain natural sources of choline like eggs, meat and soybeans, says Rebecca. Vegans and vegetarians may want to supplement with more choline, as it’s difficult to get enough choline from plant sources alone. It’s also essential to get a steady supply of choline when nursing – it’s a key ingredient in breast milk.
In Conclusion
“It Starts with the Egg” is full of actionable advice based on solid science that goes far beyond these prenatal vitamin recommendations. If you are on the TTC journey and have’t read this empowering book, we highly recommend it - and its sequel, "Brain Health from Birth"!
And if you have any questions, please do reach out. We are with you.
