Fetal brain development is a topic that many new moms are curious about. And fortunately, there are some critical nutrients we can prioritize in pregnancy and early childhood that can have a big influence our brain development in childhood. Read on to learn about the specific nutrients that have an effect on optimal brain development in early childhood.
Choline
The neurodevelopmental benefits of choline are realized before the baby is born, and mother’s intake of choline influences the development of the fetal brain and has long-lasting impacts on the child’s memory, cognition, and behavior.
Adequate prenatal choline intake has been suggested to:
Improve neurological function and lessen intellectual disability in children with Down Syndrome
Improve cognitive deficits caused by prenatal exposure to alcohol
Protect against neurologic and psychological disorders associated with fetal iron deficiency
Reduce anxiety- related behavior in children who were impacted by maternal stress within the womb.
In childhood, choline is further responsible for neuron signaling, memory, and neurotransmitter production and metabolism.
Prenatal Daily Intake Goal:
The RDA is 450 mg daily and 550 mg daily for pregnancy and lactation, respectively.
Food Source:
Eggs, liver, peanuts, fish, beef, chicken are all good sources of choline. Unfortunately, the vast majority are not reaching the RDA amount via dietary measures alone.
Supplemental Source:
Supplementation is often necessary in order to reach the RDA during pregnancy and lactation. Even if you consume several eggs daily, some individuals require more than the RDA due to certain genetic polymorphisms, such as, PEMT. For this reason, I recommend a prenatal that supplies the RDA amount. The only prenatal on the market that is currently meeting the RDA amount is Needed prenatal. If you are on a different prenatal, you a breastfeeding, or you want to offer your baby’s brain further protection, I recommend supplementing with phosphatidylcholine from Body Bio or Seeking Health.
Preferred Prenatal:
Preferred Phosphatidylcholine Supplements:
For More information on the benefits of choline in pregnancy, head over to our blog- Choline- An Essential Nutrient to Support Baby’s Brain in Utero and Beyond.
DHA (Docosahexaenoic acid)
DHA, an Omega-3 fatty acid, is present in the cell membrane of the brain and is necessary for the growth and maturation of an infant’s brain.
The accumulation of DHA in the child’s brain is primarily determined by maternal intake while in the women through dietary intake until 2 years of age.
Pregnancy:
Children of mother’s with higher levels of DHA have been shown to have better visual motor skills, cognitive abilities, behavior, attention, and learning. Research out of the University of Kansas, found that infants born to mothers with higher blood levels of DHA at delivery had advanced attention spans (an indicator of intelligence) well into their second year of life.
Lactation:
The benefits of maternal intake of DHA don’t stop in pregnancy. High DHA concentrations in breast milk have been associated with several brain-related positive health benefits in infants.
Prenatal Daily Intake Goal:
Guidelines from the World Health Organization (WHO) recommend that pregnant and nursing women consume an average of 300mg per day or more of DHA, either by eating fish or taking an omega-3 supplement.
Food Source:
Best source is through fish, though it is recommended that fish consumption is limited to 1x weekly during pregnancy due to mercury contamination. Therefore, supplementation is recommended .
Supplemental Source:
Needed Prenatal Omega- 3 is a vegan, highly absorbable version, combined with choline and potent antioxidants. These nutrients work synergistically to supports baby's optimal brain, nerve, and eye development, mama's mood and more.
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Iodine
Iodine is an essential mineral for thyroid production. Without sufficient iodine intake, thyroid hormone cannot be synthesized. This poses great risk in pregnancy, as thyroid hormone is essential for fetal growth and development, especially neurodevelopment. We’ve known for some time that low thyroid in pregnancy can increase risk of various neurodevelopmental disorders, including lower IQ. Likewise, prenatal iodine deficiency can results in deficits in intelligence, behavioral disorders, and language in offspring.
Iodine continues to be important during lactation, and the demands actually increase during this time, as the iodine content of breastmilk depends on maternal consumption. Iodine deficiency in early childhood can have harmful effects on the development of the child’s brain and nervous system.
After reading this, you may have the desire to take large amounts of iodine supplements. However, excess supplementation is not necessary and may have detrimental impacts for certain individuals.
Daily Intake Goal:
250 mcg/day during pregnancy; 290 mcg/day during lactation.
Food Source:
Seaweed is by far the best food source of naturally derived iodine, followed by seafood. As I typically don’t recommend sushi during pregnancy, one easy way to regularly consume seaweed is though seaweed snacks, which average about 50 mcg per pack. Fish needs to be consumed sparingly during pregnancy because of contamination with mercury, but shrimp and oysters have lower mercury content and can be consumed more regularly. Other sources of dietary iodine include dairy and eggs; however, attaining enough dietary iodine without the use of seaweed and seafood is difficult. This is why iodized salt and fortified foods became available. In those who eat mostly whole foods and use sea salt, I typically recommend a multi-vitamin supplement that contains iodine.
Supplemental Source:
I recommend looking for a prenatal that contains at least 150 mcg of iodine. However, for those who are eating a whole foods diet and consuming sea salt in lieu of iodized salt, a prenatal containing 250 -300 mcg of iodine is necessary. If your prenatal is not meeting these recommended amounts, but is meeting your needs in other ways, you can supplement with additional iodine.
Iron
Iron deficiency is the most common micronutrient deficiency around the world, and pregnant women are particularly vulnerable due to increased blood volume. In the prenatal period, iron plays a major role in neurodevelopment and a deficiency can result in long term neurobehavioral defects, including altered temperament, memory deficits, impaired fine motor skills and worse language ability.
Women should be screened for iron deficiency early on in pregnancy; however, screenings are often insufficient and only look at hemoglobin and hematocrit. I recommend a full iron panel, CBC, and ferritin. Ferritin levels are typically the most sensitive marker (as long as mom is not suffering from any inflammatory condition) and should be above 40 ng/mL.
Daily Intake Goal:
27 mg/day is recommended during pregnancy to maintain adequate levels; however, more will be needed if you have an iron deficiency.
Food Source:
Lean beef, lamb, venison, elk, oysters, chicken, and turkey are all great sources of iron. Iron from vegetables is poorly assimilated. For this population, I recommend black strap molasses and regular use of cast iron pans.
Supplemental Source:
If you are going to be supplementing, Iron Bisglycinate is typically recommended as the most gentle form of iron for your tummy. For those that can’t swallow another pill, Seeking Health Optimal Iron (chewable) or Floradix (liquid) are great choices.
Excess iron supplementation is not recommended, as too much iron can increase reactive oxygen species (leading to oxidative stress) and alter the gut microbiome towards a more dysbiotic profile that includes more pathogenic species.
Folate:
Folate is heralded as THE pregnancy nutrient of most importance… but yet there is still a lot of confusion surrounding the most appropriate form and amount. Folate is an essential nutrient in DNA synthesis and has an important role in methylation, and we have long known the importance of folate in preventing neural tube defects of the brain and spinal cord. However, recently, we’ve come to find that more may not always be better (especially in the case of folic acid). Let me explain…
In order to prevent neural tube defects, the US Public Health Service recommended in 1992 that women of reproductive age consume 400 mcg of folic acid before and during pregnancy. Folic acid is a synthetic form of folate that is used to fortify foods and within supplements. Around this same time, fortification of cereal products was increased. After this time period, average serum folate levels in the United States increased by 2.5 times! Evidence then began to emerge that too much unmetabolized folic acid could be increasing rates of autism.
An article published in 2017 in the Journal of Paediatric and Perinatal Epidemiology reports a “U” shaped relationship between maternal folic acid supplementation and risk of autism. This study found that while deficiencies in folate can lead to increased risk of autism, so can extremely elevated maternal levels of folate. So what is the right amount and does form matter?
So what form is best?
Important Role in Methylation:
One important distinguishing factor between different forms of folate is how the form regulates methylation. Methylation is a pivotal process that takes place in the body regulating gene expression. Too little methylation or too much methylation BOTH have their own set of risk factors. We don’t want either. There is competition between the acetyl (unmethylated groups) and the methyl groups which often determines whether a gene is expressed or silenced. Methyl groups are powerful modifiers of DNA that can inhibit gene expression, while acetyl groups promote gene expression.
In order to be utilized by the body, folate must be methylated. For this reason, nutrients such as folic acid steal methyl groups, decreasing available methyl groups, while methylfolate act as methyl donors, thereby, contributing to methylation.
Folic Acid:
While folic acid supplementation and food fortification has certainly been shown to prevent neural tube defects when used in the preconception time period and first trimester, high intake throughout pregnancy has been associated with an increased risk of autism and undesirable neurodevelopmental outcomes in the offspring. This is believed to be associated with both the direct toxicity of unmetabolized folic acid, as well as, the way it interrupts methylation.
Folic acid is the MOST common form of folate used within prenatal supplements, our food supply, and recommended by many reproductive health professionals. While it is cheap and widely available, it is not the best form. In fact, it turns out that folic acid could actually be harmful. Folic acid is a synthetic, oxidized form of folate (vitamin B9) that does not exist in nature. In order for the body to utilize this form of folate, it must first be reduced by DHFR (dihydrofolate reductase) and then activated by the addition of a methyl group via the enzyme MTHFR (methylenetetrahydrofolate reductase). Some individuals are not able to do this appropriately, due to polymorphisms in these genes. When taking high levels of folic acid in combination with polymorphisms in folate metabolism enzymes (most notably, MTHFR), unmetabolized folic acid can build up within the bloodstream and have toxic effects on our cells.
Folinic Acid:
Folinic acid is a naturally occurring, reduced form of folic acid. Often, health professionals use the terms folic acid and folinic acid interchangeably, but they are, in fact, not the same. Folinic acid exists naturally and is biologically active. Folinic acid readily converts to methylfolate and is considered to be a good alternative for those who cannot take methylfolate due to a tendency towards “overmethylation.”
Methylfolate:
Methylfolate is the biologically active form of folate, folate with a CH3 (methyl) group attached. This means that methylfolate is the only form that is ready to be immediately utilized by the body and is not impacted by polymorphisms in the DHFR or MTHFR genes. For this reason, methylfolate is the preferred form of folate for the vast majority of individuals, and is recommended by the American Pregnancy Association, as well as, most functional medicine and integrative medicine physicians and nutritionists.
Unfortunately, this is still not well recognized by the mainstream medical community. Folic acid is still recommended by the CDC and the American Congress of Obstetricians and Gynecologists (ACOG).
Daily Intake Goal:
The Minimum:
The RDA for folate in pregnancy is 600 mcg DFE. Regardless of what form you use, your supplement supplier should report the DFE, which stands for dietary folate equivalent.
Who May Need More?
Genetic Mutations: People with a MTHFR single nucleotide polymorphism may need more folate, as they have an impaired ability to convert folate into its active form.
Medications: Methotrexate, a medication used for certain autoimmune conditions and cancer, phenytoin, a seizure medication, trimethoprim, a common antibiotic used for UTIs, and metformin, a first line treatment in diabetes, have all been shown to impact folate levels.
Malabsorption: Those with conditions, such as, celiac disease, inflammatory bowel disease, and diminished gastric secretions have diminished folate absorption.
Testing: Serum folate is typically ordered by providers, as it is the cheapest test for folate levels. Unfortunately, it is not as accurate as RBC folate. RBC folate in pregnancy should be above 400ng/mL in order to minimize risk of neural tube defects.
Food Source:
Folate: leafy green vegetables, lentils, broccoli, asparagus, nuts and seeds, avocados, oranges, and many more fruits and vegetables.
Supplemental Source:
Most individuals should meet their daily requirements through their prenatal, though your physician may add additional folate if you are at risk for deficiency. To see my favorite prenatals, visit my Online Dispensary and head to “Prenatal Support” in the Favorite Category.
