This protocol is designed to be a comprehensive supplement plan that covers the needs for you and future baby. Regardless if you test for specific nutrient deficiencies or not, this protocol will at least cover the basics and you can rest-assure that you’re giving your body what it needs to grow the healthiest baby possible!

Below I go through each supplement recommendation and the reason why. I’ve also picked my favorite high-quality brands and added them to my online supplement store, Fullscript. You’re welcome to join my account and access the protocol at a 20% discount. I was sure to add brands that would last you at least two months at a time, to stretch your dollars and time.

Before getting into each supplement, let's talk more about why it's so important.

WHY A 5 TRIMESTERS SUPPLEMENT PLAN?

To put it simply - it's an insurance policy to ensure healthy development of future baby. Many still think that we can get all our nutrients from our food, especially with a healthy diet. However, often this is not the case. In fact, the concentration of vitamins and minerals in our produce has been falling for decades. This is due to poor soil as a result of monocropping, using herbicides and pesticides, and the long distance it takes for produce to get to our grocery stores. Furthermore, processing, storage and cooking further deplete the nutrient density.

I always encourage you purchase locally-grown, organic produce to get the most nutrients from your food. But let's be real, that's not happening every day for most people.

WHY IS THIS IMPORTANT BEFORE YOU'RE PREGNANT AND/OR TRYING TO CONCEIVE?

There are hundreds of studies showing how the state of mom and dads health before conceiving has a lasting impact on their baby. For example, if you're struggling with blood sugar dysregulation at the time of conception, this increases the risk of your future child developing obesity at a young age, type II diabetes and heart disease later in life. Making lifestyle changes before pregnancy has a more significant benefit to the long-term health of your child than waiting until your already pregnant. Having a supplement plan can help regulate many of the chronic conditions that are associated with poor outcomes in pregnancy and baby.

Now let's jump into the specifics!

HIGH-QUALITY PRENATAL

When you're planning to conceive, or at any point you may have a chance to become pregnant, It is recommended to take a quality prenatal supplement everyday. I've had the chance to vet many different brands of prenatal vitamins. There's a lot of junk out there, but there's a lot of good options as well. I can only pick one in my protocol, so I've added my favorite based on quality, affordability and number of capsules (3/day).

If you already have one you like or want to look around, ensure your vitamin meets these following criteria:

• At least 800mcg of an active form of folate (not folic acid) - look for L-Methylfolate, L-5-Methyltetrahydrofolate, Metafolin, L-5-MTHF, folinic acid, or calcium folinate
• Biologically active forms of other B vitamins - such as methylcobalamin instead of cyanocobalamin for B1
• At least some preformed vitamin A (palmitate) instead of only beta-carotene
• Well-absorbed forms of iron - iron bisglycinate or iron picolinate instead of ferrous sulfate
• No harmful ingredients - artificial colors, sweeteners, preservatives, or fillers

When choosing your prenatal vitamin, your primary consideration should be the type and amount of folate included. While most prenatal supplements use synthetic folic acid, this is actually not the most usable form for your body and it is hardly any use at all to women who have an MTHFR genetic variant (not sure what this is? Read this).

Whether you have an MTHFR mutation or not, synthetic folic acid is still not the best choice. Studies have actually demonstrated that a high intake of synthetic folic acid from fortified food and supplements can lead to increased levels of unmetabolized folate in the blood, which can contribute to health problems for you and for your baby.

Although iron is an essential nutrient during preconception and pregnancy, supplementing with poorly absorbed forms of iron can cause nausea and constipation in some women. Ferrous sulfate is typically not the best choice, while forms like iron bisglycinate or iron picolinate tend to be easier on the digestive tract.

Look carefully at the inactive ingredients in your supplement, which are usually listed right below the nutrient table. If you see a huge list of ingredients that you can't pronounce or "numbered" food colorings, it's time to find a new prenatal. Definitely avoid supplements that contain artificial colors (FD&C Red #40, Blue #1, Yellow #6, etc.), artificial sweeteners, talc, hydrogenated oils, and titanium dioxide. Other additives, such as cellulose, l-leucine, magnesium stearate, silica, and ascorbyl palmitate are not concerning and most high-quality brands will have at least a few of these harmless ingredients.

Other brands I like are Seeking Health, NFH, Designs For Health, and Full Circle.

2. OMEGA-3 FISH OIL

It is recommended to consume at least 1000mg of DHA/EPA each day. DHA is critical to your baby's brain development and, because the brain begins developing so early in pregnancy, this is a nutrient that you should begin supplementing with during preconception and continue taking throughout pregnancy and lactation.

Very few prenatal multivitamins contain DHA but you can find either a high-quality fish oil or an algae-based supplement to take alongside a prenatal. High-quality means that it comes from a clean and reputable source and has been tested for contaminants such as PCBs and heavy metals. Supplements should always contain the omega-3 fat eicosapentaenoic acid (EPA) along with DHA.

You can also increase your DHA intake from food, in addition to a high-quality supplement. Top dietary sources of DHA include: fatty cold-water fish, algae, egg yolks from pastured chickens, and grass-fed beef.

It is important to note that there are other plant foods that contain significant amounts of omega-3 fats, such as flaxseeds, chia seeds, and walnuts, but the type of Omega-3 they contain is alpha linolenic acid (ALA), not DHA. Humans are able to convert some ALA to DHA, but the conversion rate is very low. DHA must be consumed directly to ensure sufficient intake.

3. CHOLINE BITARTRATE

It's recommended to get 450-550mg of choline a day during pregnancy, but research shows benefits at higher intake levels, up to 1000mg. Studies also show that sufficient intake of choline is particularly important if you have an MTHFR or PEMT genetic variant.

Given the importance of choline to preventing neural tube defects in the first few weeks of pregnancy, It is recommended to supplement with choline due to the difficulty of getting adequate intake through food alone. I recommend supplementing with 500mg at least 1-3 months before you conceive.

If you want to increase your choline intake above and beyond a supplement, you can focus on these foods: Liver, egg yolks, beef, chicken, seafood, cruciferous vegetables (cabbage, cauliflower, broccoli, Brussels sprouts), legumes (chickpeas, lentils, pinto beans), nuts and seeds (almond, sunflower seeds, pumpkin seeds).

Beef liver is by far the most concentrated choline source at 356mg per 3oz serving. One egg contains about 115mg. Cruciferous vegetables, legumes, nuts, and seeds are the richest vegetarian sources, but all contain less than 75mg per cup, making it very difficult to obtain enough choline from plant sources alone.

4. PROBIOTIC

Although current nutrition recommendations do not typically include probiotics, taking care of the gut microbiome can be very beneficial for overall health and fertility. If you are not regularly consuming probiotic foods, you should be taking a supplement that contains at least 10 billion CFU per day. This may seem like a lot but, by comparison, your body contains trillions of bacterial cells.

Most multivitamins do not contain probiotics so you will likely need to look for a separate supplement. A good probiotic will contain both lactobacillus and bifidobacterium species and be free of unnecessary additives or fillers. I've chosen a specific probiotic in my protocol that supports your urinary and vaginal tract as well as your gut. It's safe to take throughout pregnancy and breastfeeding.

You can also increase your intake of beneficial probiotics from fermented foods, such as: raw sauerkraut or other cultured vegetables, kimch, kefir (milk, water, or coconut-based), full-fat yogurt, kombucha, or beet kvass.

5. VITAMIN D

The current recommended daily intake (RDA) for vitamin D is 400 IU for adults and 600 IU for pregnant women. Most prenatal vitamins contain 400 IU. However, recent research suggests that this is not enough to maintain adequate levels of vitamin D in most people and would definitely not be enough to correct a deficiency.

It’s recommended that both partners supplement with at least 4000 IU per day during preconception and those who are deficient may need to supplement with more.

Multiple studies have demonstrated that 4000 IU per day is safe during pregnancy and is also more effective than 400 IU at achieving adequate vitamin D levels in mother and infant at birth.

Vitamin D deficiency is widespread and it is not currently common practice to test either partner's levels during preconception or to monitor maternal vitamin D status during pregnancy. Given the importance of vitamin D to overall health, fertility, pregnancy, and childhood health, both partners should have vitamin D levels checked with a simple test to measure 25 (OH) D in the blood.

Results can be interpreted as follows:

• < 10 ng/ml - severely deficient
• 10-20 ng/ml - deficient
• 20-32 ng/ml - insufficient
• 32-40 ng/ml - borderline
• 40-50 ng/ml - optimal

Humans were actually designed to get vitamin D from sunlight and we make it in our skin when we are exposed to UVB rays from the sun. However, not all people are able to make the same amount of vitamin D from sunlight. Individual factors that impact vitamin D production in the skin include:

• Skin color - darker skin allows for less vitamin D synthesis
  
• Time of day - greatest capacity for vitamin D synthesis happens around mid-day
• Time of year - less vitamin D can be made in winter months in the U.S.
• Location - almost no vitamin D made in winter above 33 degrees latitude (majority of the U.S.)
• Use of sunscreen/protective clothing - sunscreen blocks ~95% of vitamin D production

After learning your vitamin D status, I recommend appropriate dosage that will allow you to reach at least 40 ng/ml, which may require more than the minimum 4000 IU per day recommended above.

6. BONE NUTRIENTS: CALCIUM, MAGNESIUM, VITAMIN K2

The recommended daily intake for calcium during preconception and pregnancy is 1000mg. Calcium, along with vitamin D, vitamin K2, and magnesium, are critical nutrients for the formation of your baby's skeleton during pregnancy. If you are not eating dairy products regularly, you are likely not meeting your calcium requirements and will need to supplement.

Most prenatal vitamins contain some calcium but it may not be enough to get you to your recommended daily intake. The one I recommend only has 100mg. If you want to increase your calcium intake from food, you can focus on the following:

• Dairy products
• Fortified non-dairy milk
• Sardines
• Canned salmon
• Chia seeds
• Dark leafy greens

Vitamin K2 is a relatively new discovery as an essential preconception and prenatal nutrient and thus there is currently not an official recommended daily amount during pregnancy. However, you should aim for a minimum of 100mcg daily, starting during preconception. You need K2 for proper calcium use in the body, which helps grow healthy bones for your baby and maintain proper bone density for you. Vitamin K2 also helps with insulin sensitivity and blood sugar control and may help with early embryo development.

Most prenatal vitamins do not contain K2 so you will likely need to supplement separately. There are several different types of vitamin K2 (menaquinone - abbreviated MK) and the two most important types for bone mineralization and calcium metabolism are MK-4 and MK-7. When supplementing with K2, it is important to ensure adequate intake of both vitamin D and calcium. You can also increase your intake of K2 by focusing on these foods: natto and fermented dairy products like brie.

The supplement I recommend gives you an additional 500mg of calcium, 200mg of magnesium, and 100mg of vitamin K2. I took this same bone supportive nutrient before and during both of my pregnancies!

Now you have a good understanding why these nutrients are important for your preconception care and future pregnancy! Want a stress-free start? Get my favorite high-quality brands on my online supplement store, Full script. Join and you’ll receive access to the protocol at a 20% discount! I was sure to add brands that would last you at least two months at a time. Keep in mind it's OK if you accidentally miss some doses or days. Just jump back into the rhythm. This supplement organizer really helps keep me on track.

Cheers to super babies… ~ Dr. Haylee