Do You Need More Calcium and Vitamin D? | Healthy Pregnancy Diet Tips
Balancing the Vegetarian Way for a Healthy Pregnancy: PART 2
This week’s nutrition blog is Part 2 for vegetarian meal planning prior to and during pregnancy. To recap from last week's fertility nutrition post: Cooking healthy vegetarian choices requires planning meals with a variety of foods. The more restrictive you choose to be, such as adopting a vegan lifestyle, the more effort is needed for adequate intake of calcium, iodine, iron, omega-3 fatty acids, protein, Vitamin B12, Vitamin D, and zinc.
Please refer to last week’s Vegetatian Way and Healthy Pregnancy - Part 1 blog for a discussion on protein, Vitamin B12, and iron. Today’s blog addresses the importance of calcium and Vitamin D prior to and during pregnancy.
Meet Nutritional Needs first for Mother before Baby . . .
Calcium and Pregnancy
CALCIUM - The recommendation for calcium for women age 19 and older is 1000 mg/day. If 1000mg /day of calcium is consumed prior to pregnancy, then once pregnant an increase is not greatly necessary. Unfortunately, vegetarian or not, many women are deficient in dietary calcium. Calcium is necessary to build strong teeth and bones, to assist in muscle, heart and nerve function, blood pressure regulation, and for boosting immune response.
Several factors influence intestinal calcium absorption, including vitamin D level; the amount of calcium rich foods consumed; the activity of calcium regulatory hormones; and the chemical composition of foods we eat. If excessive levels of dietary protein, caffeine, sodium or foods high in oxalates are consumed, then calcium is lost through urinary excretion. Oxalates, substances found in many plants (spinach, tea, rhubarb, beets, peanuts, chocolate), phytates (found in legumes and whole grains), and dietary fiber can bond with calcium and decrease its absorption. If recommended amounts of calcium intake is consumed and the meals and snacks are balanced with a variety of food choices, calcium absorption is not a huge factor.
Any vegetarian women who do not consume 3-4 servings of milk, yogurt, and cheese should add calcium rich foods (dairy and/or nondairy) at meals and snacks and consider discussing the need for a prenatal calcium supplement with her physician. Note: Calcium supplements can inhibit iron absorption and interfere with thyroid medicine so should not be taken at the same time of these medications. (More on calcium supplements in a future blog.)
Calcium is needed in pregnancy for synthesis of fetal bones and teeth. Increasing dietary calcium is vital to protect a mother’s own bone density. Adequate calcium intake can lower the risk for high blood pressure (preeclampsia) in pregnancy. If calcium intake is low in pregnancy, the baby will take needed calcium from maternal stores and thus put the mother at great risk for osteoporosis later in life.
To find cow’s milk/yogurt, soymilk/yogurt that are fertility diet friendly, look for those without growth hormones, pesticides, or herbicides, and not produced with chemical fertilizers.
Calcium Rich Food Sources: Good sources include cow milk and yogurt, fortified soy milk, calcium-set tofu, soy yogurt, soybeans/nuts, cheese, salmon with bones, sardines, collard greens, turnip greens, rhubarb, spinach. Moderate-Low sources include kale, bok choy, broccoli, sesame seeds, almonds, figs, cottage cheese, almonds.
Vitamin D and Pregnancy
VITAMIN D - Vitamin D is a vitamin and a hormone. Vitamin D plays a critical role in calcium absorption, immune function, cellular repair and, in addition, our team of integrated infertility specialists at RMA of CT are observing the important role that vitamin D plays with pregnancy and increasing fertility. Vitamin D assists reproductive hormones and in healthy (oocyte) egg formation and insulin sensitivity—which is helpful in ovulatory regulation.1
Who is at risk for vitamin D deficiency? Many women and men are low in Vitamin D or vitamin D deficient. Our skin makes vitamin D with the help of sunshine. If we are inside most days, live in northern climates, wear sunscreen and cover ups, and do not consume fish and milk, then we are at risk for deficiency. Ethnicity also plays a role in deficiency risk. Darker skinned men and women have more melanin in their skin, which acts as a natural sunscreen and inhibits sun/skin production of vitamin D. In addition, women with PCOS, gastric by-pass, ovulatory dysfunction, and/or who are overweight are all at increased risk for vitamin D deficiency.
All women at RMA of CT get their vitamin D levels tested. If deficient, a supplement is recommended and sold in RMA of CT offices. Vegan formulation vitamin D supplements are available in area drug stores. Vitamin D supplements should never be self-prescribed and dosages should be supervised when trying to become pregnant and during pregnancy. Supplement absorption is greater when consumed at a meal with a fatty food, such as lunch and/or dinner.
Maternal vitamin D deficiency exists in many women and, if pregnant, is associated with several disorders of calcium in both the mother and infant, infant rickets, and increased rates of preeclampsia, premature births, low birth weights, and autoimmune risk later in life. Consumption of adequate levels of vitamin D is challenging since very few foods are rich in this nutrient. If your vitamin D serum levels are optimal (40-60ng/dl), then at least 600 iu of vitamin D3 per day is recommended. No more than 2,000 iu vitamin D3 daily should be used to increase vitamin D levels.
Vitamin D Food Sources: Fortified milk-cow, soy, almond, rice milk and orange juice have only 100 iu per 8 oz serving. Fatty fish, egg yolks, butter and fortified fat spread provide 40 iu or less per serving. Cod liver oil is NOT recommended for vitamin D because of it toxic levels of vitamin A.
- Ogle, Amy and Lisa Mazzullo. Before Your Pregnancy-A 90 Day Guide for Couples on How to Prepare for a Healthy Conception. New York: Random House, 2011.
About Lisa Rosenthal
Lisa has over thirty years of experience in the fertility field. After her personal infertility journey, she felt dissatisfied with the lack of comprehensive services available to support her. She was determined to help others undergoing fertility treatment. Lisa has been with RMACT for eleven years and serves as Patient Advocate and the Strategic Content Lead.
Lisa is the teacher and founder of Fertile Yoga, a program designed to support men and women on their quest for their families through gentle movement and meditation.
Lisa’s true passion is supporting patients getting into treatment, being able to stay in treatment and staying whole and complete throughout the process. Lisa is also a Certified Grief Recovery Specialist, which is helpful in her work with fertility patients.
Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association (now Path2Parenthood), where she was Educational Coordinator, Conference Director and Assistant Executive Director.