Preconception Nutrition for Women and Men

By Caitlin Beale, MS, RDN⁺

It’s not uncommon to consider the importance of your diet once you or your partner is pregnant, but what about before?  Optimizing the health of both partners, along with consulting your physicians, can set the stage for a healthy pregnancy.

The months leading up to pregnancy are considered a “critical period” to ensure healthy nutrient stores that optimize health before, during, and after pregnancy.[1]  If you are planning to get pregnant or even think you may want to have a baby someday, taking a closer look at your nutrition ahead of time is a smart move.

While many factors contribute to a healthy pregnancy, these nutrients are especially beneficial.

Folic Acid

Most people are at least aware that folic acid is a critical nutrient for pregnancy.  Folic acid is the synthetic version of folate, a B vitamin necessary for red blood cell formation and cellular health. The terms “folic acid” and “folate” often are used interchangeably. However, folate is a general term used to describe the many different forms of vitamin B9 including folic acid.[2]

When it was discovered that adequate folate (folic acid) before pregnancy reduced the risk of birth defects involving the brain and spinal cord, public health officials from many countries campaigned to ensure women were getting enough.  It was added to foods like flour, and health care practitioners began to recommend it as part of prenatal vitamins.[3]

While that critical window before pregnancy is so important, many women don’t even realize they are pregnant until several weeks after conception.  For example, in the United States, it’s been estimated that around forty-five percent of all pregnancies are unplanned.[4]  But research supports supplementation with folic acid works best when started during the critical period.[5]  Folic acid could also help mom stay healthy and avoid complications during pregnancy.[6]

Aside from fortified foods, leafy greens, beans, and citrus are all sources of folate, but many women don’t meet the recommended amount through diet alone. One study concluded that almost one-third of women don’t meet folate recommendations without supplements.[7] As a result, it’s recommended to start taking folate (methylfolate and folic acid) or prenatal supplements well before pregnancy to ensure optimal amounts.

Zinc

You may consider zinc important for your immune system. Likewise, in studies, zinc supplementation was associated with a reduction in preterm birth.[8]  Studies suggest that lower zinc levels could also increase how long it takes to get pregnant.[9]

Zinc is an antioxidant.  Antioxidants are free-radical scavengers that help reduce the impact of oxidative stress.[10]  Oxidative damage from excessive free radicals could negatively impact egg and sperm health.[11]  Zinc helps support healthy sperm function and quality, while low zinc levels are associated with sperm abnormalities.[12]

However, even though zinc is an essential nutrient for reproduction, studies on how much zinc helps are mixed.  A recent study focused on couples trying to get pregnant concluded that it didn’t improve outcomes when men supplemented with zinc.[13]

Still, it’s crucial to have optimal amounts early on.  Subjects in this study already had difficulty getting pregnant, so other factors could have impacted their ability to get pregnant.

Since you can’t store zinc in your body, you need to obtain it through diet and supplementation.  Zinc is found in foods like oysters and pumpkin seeds, but recommended supplementation doses can also ensure you get enough if you don’t eat many zinc-rich foods.

Omega-3 Fatty Acids

Omega-3 fatty acids are nutrients that support a baby’s developing brain if taken at appropriate doses.[14]  They are also important for placental development.[15] A Cochrane Review of seventy different studies on intake from food or supplements during pregnancy concluded that omega-3’s could lead to better outcomes in early labor and delivery, having an underweight baby.  Intake was also linked to a reduced risk of more severe outcomes for the mom.[16]

Further, getting enough omega-3 in your diet may support healthy pregnancies.  One study showed that couples who regularly ate more seafood got pregnant sooner than those who didn’t eat fish.[17]  Another study found a relationship between healthy sperm and higher sperm counts for men taking omega-3 fatty acids.[18]

The best sources of omega-3 are fatty fish like salmon or sardines.  You can also get some from flax and chia seeds. Still, many people also choose to supplement if seafood isn’t a regular part of their diet.

CoQ10       

Coenzyme-Q 10 (CoQ10) is a nutrient naturally found in the body necessary for energy production.  It also acts as an antioxidant to help protect cells against oxidative damage.  As mentioned earlier, there is a negative relationship between oxidative stress and reproductive health for both men and women. Antioxidants like CoQ10 could help minimize the free radical damage in the body that could negatively impact eggs and sperm.[19] [20]

CoQ10 may also play a role in supporting healthy ovarian reserve, or the number and quality of a woman’s eggs.[21]  It also may help with healthy sperm counts and motility (the ability of sperm to swim) while contributing to reductions in oxidative stress markers.[22]

Your body does make CoQ10, but the amount produced goes down with age.[23]  While you can get some CoQ10 from foods like organ meat, fatty fish, or poultry, they are generally not a good source of CoQ10, so supplements can be helpful.

Selenium

Selenium contributes to normal spermatogenesis. The sperm mitochondrial capsule selenoprotein has a structural as well as an enzymatic role, and it is responsible for both the maintenance of motility and the structural integrity of the tail of the sperm. Both human and other mammals exhibit reduced sperm motility and increased sperm rupture under conditions of low selenium supply.[24]

Preconception Nutrition Starts Early

On top of other behaviors like maintaining a healthy weight and moving your body regularly, nutrition is a critical but often overlooked piece of preconception.  These five nutrients should be optimized through your diet or supplementation well before getting pregnant to create a foundation for a healthy pregnancy. If pregnant or lactating, always consult your physician before taking any supplements.

Caitlin Beale, MS, RDN is a registered dietitian and freelance health writer. She has a master’s degree in nutrition and over ten years of experience as a registered dietitian. You can learn more about Caitlin Beale, MS, RDN at www.caitlinbealewellness.com. [optional]

⁺The views expressed in this article are those of the authors. They do not reflect the opinions or views of Pure Encapsulations®.

References

[1] Stephenson, Judith, Nicola Heslehurst, Jennifer Hall, Danielle A.J.M. Schoenaker, Jayne Hutchinson, Janet Cade, Lucilla Poston, et al. “Before the Beginning: Nutrition and Lifestyle in the Preconception Period and Its Importance for Future Health.” Lancet (London, England) 391, no. 10132 (May 5, 2018): 1830–41. https://doi.org/10.1016/S0140-6736(18)30311-8.

[2] Crider KS, Bailey LB, Berry RJ. Folic acid food fortification-its history, effect, concerns, and future directions. Nutrients 2011;3(3):370-84. doi: 10.3390/nu3030370.

[3] Wald, Nicholas J, FRS. “Commentary: A Brief History of Folic Acid in the Prevention of Neural Tube Defects.” International Journal of Epidemiology 40, no. 5 (October 1, 2011): 1154–56. https://doi.org/10.1093/ije/dyr131.

[4] Finer, Lawrence B., and Mia R. Zolna. “Declines in Unintended Pregnancy in the United States, 2008-2011.” The New England Journal of Medicine 374, no. 9 (March 3, 2016): 843–52. https://doi.org/10.1056/NEJMsa1506575.

[5] De-Regil, Luz Maria, Juan Pablo Peña-Rosas, Ana C. Fernández-Gaxiola, and Pura Rayco-Solon. “Effects and Safety of Periconceptional Oral Folate Supplementation for Preventing Birth Defects.” The Cochrane Database of Systematic Reviews, no. 12 (December 14, 2015): CD007950. https://doi.org/10.1002/14651858.CD007950.pub3.

[6] Yuan He, An Pan, Frank B Hu, Xu Ma.  “Folic acid supplementation, birth defects, and adverse pregnancy outcomes in Chinese women: a population-based mega-cohort study.”  The Lancet, Volume 388, Supplement 1, 2016, Page S91.  https://doi.org/10.1016/S0140-6736(16)32018-9.

[7] Bailey, Regan L., Susan G. Pac, Victor L. Fulgoni III, Kathleen C. Reidy, and Patrick M. Catalano. “Estimation of Total Usual Dietary Intakes of Pregnant Women in the United States.” JAMA Network Open 2, no. 6 (June 21, 2019): e195967. https://doi.org/10.1001/jamanetworkopen.2019.5967.

[8] Ota, E., Mori, R., Middleton, P., Tobe-Gai, R., Mahomed, K., Miyazaki, C., & Bhutta, Z. A. (2015). Zinc supplementation for improving pregnancy and infant outcome. The Cochrane database of systematic reviews, 2015(2), CD000230. https://doi.org/10.1002/14651858.CD000230.pub5

[9] Grieger, Jessica A., Luke E. Grzeskowiak, Rebecca L. Wilson, Tina Bianco-Miotto, Shalem Y. Leemaqz, Tanja Jankovic-Karasoulos, Anthony V. Perkins, Robert J. Norman, Gus A. Dekker, and Claire T. Roberts. “Maternal Selenium, Copper and Zinc Concentrations in Early Pregnancy, and the Association with Fertility.” Nutrients 11, no. 7 (July 16, 2019): 1609. https://doi.org/10.3390/nu11071609.

[10] Bisht, Shilpa, Muneeb Faiq, Madhuri Tolahunase, and Rima Dada. “Oxidative Stress and Male Infertility.” Nature Reviews. Urology 14, no. 8 (August 2017): 470–85. https://doi.org/10.1038/nrurol.2017.69.

[11] Agarwal, Ashok, Anamar Aponte-Mellado, Beena J Premkumar, Amani Shaman, and Sajal Gupta. “The Effects of Oxidative Stress on Female Reproduction: A Review.” Reproductive Biology and Endocrinology : RB&E 10 (June 29, 2012): 49. https://doi.org/10.1186/1477-7827-10-49.

[12] Fallah, Ali, Azadeh Mohammad-Hasani, and Abasalt Hosseinzadeh Colagar. “Zinc Is an Essential Element for Male Fertility: A Review of Zn Roles in Men’s Health, Germination, Sperm Quality, and Fertilization.” Journal of Reproduction & Infertility 19, no. 2 (2018): 69–81.

[13] Schisterman, Enrique F., Lindsey A. Sjaarda, Traci Clemons, Douglas T. Carrell, Neil J. Perkins, Erica Johnstone, Denise Lamb, et al. “Effect of Folic Acid and Zinc Supplementation in Men on Semen Quality and Live Birth Among Couples Undergoing Infertility Treatment.” JAMA 323, no. 1 (January 7, 2020): 35–48. https://doi.org/10.1001/jama.2019.18714.

[14] Coletta, Jaclyn M, Stacey J Bell, and Ashley S Roman. “Omega-3 Fatty Acids and Pregnancy.” Reviews in Obstetrics and Gynecology 3, no. 4 (2010): 163–71.

[15] Basak, Sanjay, Rahul Mallick, and Asim K. Duttaroy. “Maternal Docosahexaenoic Acid Status during Pregnancy and Its Impact on Infant Neurodevelopment.” Nutrients 12, no. 12 (November 25, 2020): 3615. https://doi.org/10.3390/nu12123615.

[16] Middleton, Philippa, Judith C Gomersall, Jacqueline F Gould, Emily Shepherd, Sjurdur F Olsen, and Maria Makrides. “Omega‐3 Fatty Acid Addition during Pregnancy.” The Cochrane Database of Systematic Reviews 2018, no. 11 (November 15, 2018): CD003402. https://doi.org/10.1002/14651858.CD003402.pub3.

[17] Gaskins, Audrey J, Rajeshwari Sundaram, Germaine M Buck Louis, and Jorge E Chavarro. “Seafood Intake, Sexual Activity, and Time to Pregnancy.” The Journal of Clinical Endocrinology & Metabolism 103, no. 7 (July 1, 2018): 2680–88. https://doi.org/10.1210/jc.2018-00385.

[18] Safarinejad, M. R. “Effect of Omega-3 Polyunsaturated Fatty Acid Supplementation on Semen Profile and Enzymatic Anti-Oxidant Capacity of Seminal Plasma in Infertile Men with Idiopathic Oligoasthenoteratospermia: A Double-Blind, Placebo-Controlled, Randomised Study.” Andrologia 43, no. 1 (February 2011): 38–47. https://doi.org/10.1111/j.1439-0272.2009.01013.x.

[19] Ruder, Elizabeth H., Terryl J. Hartman, and Marlene B. Goldman. “Impact of Oxidative Stress on Female Fertility.” Current Opinion in Obstetrics & Gynecology 21, no. 3 (June 2009): 219–22.

[20] Alahmar, Ahmed T. “Role of Oxidative Stress in Male Infertility: An Updated Review.” Journal of Human Reproductive Sciences 12, no. 1 (2019): 4–18. https://doi.org/10.4103/jhrs.JHRS_150_18.

[21] Xu, Yangying, Victoria Nisenblat, Cuiling Lu, Rong Li, Jie Qiao, Xiumei Zhen, and Shuyu Wang. “Pretreatment with Coenzyme Q10 Improves Ovarian Response and Embryo Quality in Low-Prognosis Young Women with Decreased Ovarian Reserve: A Randomized Controlled Trial.” Reproductive Biology and Endocrinology : RB&E 16 (March 27, 2018): 29. https://doi.org/10.1186/s12958-018-0343-0.

[22] Alahmar, Ahmed T., Aldo E. Calogero, Pallav Sengupta, and Sulagna Dutta. “Coenzyme Q10 Improves Sperm Parameters, Oxidative Stress Markers and Sperm DNA Fragmentation in Infertile Patients with Idiopathic Oligoasthenozoospermia.” The World Journal of Men’s Health 39, no. 2 (April 2021): 346–51. https://doi.org/10.5534/wjmh.190145.

[23] Langsjoen, Peter H., and Alena M. Langsjoen. “Comparison Study of Plasma Coenzyme Q10 Levels in Healthy Subjects Supplemented with Ubiquinol versus Ubiquinone.” Clinical Pharmacology in Drug Development 3, no. 1 (January 2014): 13–17. https://doi.org/10.1002/cpdd.73.

[24] Bates CJ, 2005. Selenium. In: Caballero B, Allen L, Prentice A (eds). Encyclopedia of Human Nutrition. 2nd ed. Elsevier Academic Press, 118-125.