All the way through (as well as beyond) pregnancy, nutrition matters. That’s in large part because our bodies’ nutrient needs change when we’re pregnant. For one, blood volume nearly doubles in pregnancy. (1) Hitting daily iron needs is important during pregnancy to help support the growing baby and placenta.*

Nutrition in pregnancy also matters because pregnant women are the one-and-only nutritional source for their growing fetuses. Babies-to-be don’t get to ask for substitutions or make requests—they get what their birthing parent gets. Adequate pregnancy nutrition supports healthy fetal growth and development.*

These two factors are why prenatal multivitamins can be so helpful before, during, and after pregnancy. Nutritional perfection is an impossible standard but prenatals help you meet the recommended nutrient levels for pregnancy on top of what you’re getting from food.*

Nutritional Needs During Pregnancy

The American College of Obstetricians and Gynecologists (ACOG)—aka the leading organization of OB/GYNs—recommends these 10 nutrients (in these amounts) during all three trimesters of pregnancy (2):

• Calcium (1,000 mg)
• Iron (27 mg)
• Iodine (220 mcg)
• Choline (450 mg)
• Omega-3 DHA (200 mg) (3)
• Vitamin A (750 mcg from 14-18, 770 mcg from 19-50)
• Vitamin B6 (1.9 mg)
• Vitamin B12 (2.6 mcg)
• Vitamin C (80 mg from 14-18, 85 mg from 19-50)
• Vitamin D (600 IU)
• Folate (600 mcg)

In addition to ACOG’s recs, there are other nutrients that are important for pregnancy but not always easy to get enough of from food alone, including Biotin, Boron, Vitamin E, Vitamin K2, and Magnesium.

Ingredient-wise, it can be important to limit how much white albacore tuna and caffeine you have. The avoid list is, maybe unsurprisingly, quite a bit longer. During pregnancy, experts suggest to avoid:

• Hot dogs and deli meat
• Raw fish
• Fish with high levels of mercury
• Raw or undercooked eggs/foods made with raw or undercooked eggs
• Unpasteurized juice, milk, soft cheese, or foods made with unpasteurized juice, milk, or soft cheese
• Raw sprouts or unwashed fruits and veggies
• Store-bought salads like chicken salad, egg salad, or tuna salad
• Most herbal pills and teas
• Alcohol (there’s no known safe amount in pregnancy)

Do You Really Need to “Eat for Two” When You’re Pregnant? Everyone’s needs are different, but the standard guidelines are no extra calories in the first trimester, about 340 extra calories per day in the second trimester, and about 450 extra calories per day in the third trimester. (4)

First Trimester (Week 1-Week 12)

Three of the leading players in first trimester nutrition are Folate, Choline, Omega-3 DHA, and Iodine.

Very early in the first trimester, the fetal neural tube (brain and spine) develops. Folate and Choline support neural tube development.* The two nutrients, along with Omega-3 DHA, promote fetal brain development overall.*

During early pregnancy, the fetus also depends on maternal Iodine intake. In fact, the American Academy of Pediatrics, the Endocrine Society, and the American Thyroid Association recommend that pregnant and lactating women receive a daily prenatal multivitamin that contains 150 mcg of iodine.* (5-7)

What foods are good sources of these nutrients?:
• Choline can be found in foods like beef liver, hard-boiled eggs, beef top round, soybeans, chicken breast, and Atlantic codfish. We’re also really into a Choline-rich shake, featuring our Essential Protein.

• Folate can be found in dark leafy greens, beans, avocados, lentils, and peas. We also love this Folate-rich recipe for a delicious mashed-potato substitute: mashed cauliflower.

• Omega-3 DHA can be found in foods like shellfish, salmon, tuna, mackerel, and anchovies. We also recommend smoothies with almond butter, which includes Omega-3 fatty acids that the body can convert into DHA.

• Iodine can be found in foods like cod, seaweed, oysters, iodized table salt, fish sticks, and hard-boiled eggs. Eggs with avocado toast has iodine that’ll bring a nutritious start to your mornings.

Second Trimester (Week 13-Week 28)

One standout in second trimester nutrition is Iron.

Over 90% of pregnant people are not getting enough Iron from their diet. (9) By the third trimester of pregnancy, almost 30% of pregnant people have low levels of Iron.

Iron during pregnancy is super important starting very early—we’re talking days into embryo development (10)—because it supports red blood cell formation, hemoglobin formation, and oxygen transport.*

In pregnancy, the Recommended Dietary Allowance (RDA) is 27 mg. (9) While meeting that RDA is critical throughout pregnancy, people are more likely not to as pregnancy progresses. That makes the second trimester a good time to make sure you're squared away, Iron-wise.

What are good food sources of iron?
• Leafy vegetables such as spinach
• Organ meats
• Lentils
• Pumpkin seeds
• Kidney beans

This curried lentil salad recipe is a great food prep option that has iron in it for the work week ahead.

Third Trimester (Week 29-Birth)

Calcium and Vitamin D become even more critical for third trimester nutrition.

In the third trimester, calcium is especially involved with fetal bone health.* (11) Vitamin D, a calcium-helper nutrient, promotes normal calcium absorption in the gut. In order to have enough calcium stores to do their thing by the third trimester, getting enough calcium and Vitamin D from food, and supplementation as needed, should start in early pregnancy.*

Calcium may also support healthy blood pressure in the second and third trimesters.* (12)

The RDA of calcium in pregnancy is 1,000 mg, and it’s 15 mcg (600 IU) for Vitamin D. Based on national data, about 97% of women don’t get enough Vitamin D from what they eat. (13)

What foods are good sources of these nutrients?:
• Calcium can be found in foods like low-fat yogurt, part-skim mozzarella, canned sardines, milk, calcium-fortified soymilk, tofu, and salmon. Try this vegan creamed greens recipe for a side dish with calcium.

• Vitamin D can be found in foods like cod liver oil, rainbow trout, sockeye salmon, and raw white mushrooms. Consider this umami-filled vegan stuffing recipe.

Bottom line: Nutrition is a major part of pregnancy health. Eating balanced, nutritious meals and supplementing with a prenatal multivitamin can help support nutrient levels to support a growing pregnancy throughout each trimester.*

Ritual can help you stay on top of your body’s changing nutritional requirements before, during, and after pregnancy:

• Our Essential Prenatal is your next-generation prenatal, with 12 key nutrients for before and during pregnancy.*

• Got Choline on the brain for fetal brain development? Complement what you’re already getting from what you eat and the Essential Prenatal with our Natal Choline and Essential Protein.*

• Support new nutrient demands on your body for 6 months postpartum and throughout lactation with our Postnatal Multivitamin.

References:

1. Artal-Mittelmark, R. (2021). Healthy Living: Physical Changes During Pregnancy. Merck Manual. Retrieved November 12, 2023.

2. American College of Obstetricians and Gynecologists. (2021). FAQs: Nutrition During Pregnancy. American College of Obstetricians and Gynecologists. Retrieved November 12, 2023.

3. Coletta, J. M., Bell, S. J., & Roman, A. S. (2010). Omega-3 Fatty acids and pregnancy. Reviews in obstetrics & gynecology, 3(4), 163–171.

4. Office of Disease Prevention and Health Promotion. Eat Healthy During Pregnancy: Quick Tips. Health.gov. Retrieved November 12, 2023.

5. Leung, A.M., E. N., Pearce, E. N., Braverman, L. E., & Stagnaro-Green, S. (2014). AAP Recommendations on Iodine Nutrition During Pregnancy and Lactation. Pediatrics, 134(4).

6. De Groot, L., et al. (2012). Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, 97(8), 2543–2565.

7. Public Health Committee of the American Thyroid Association. (2006). Iodine supplementation for pregnancy and lactation-United States and Canada: recommendations of the American Thyroid Association. Thyroid, 16(10):949-51.

8. Office of Dietary Supplements. (2023). Fact Sheet for Health Professionals: Omega-3 Fatty Acids. National Institutes of Health. Retrieved November 12, 2023.

9. Office of Dietary Supplements. (2023). Fact Sheet for Health Professionals: Iron. National Institutes of Health. Retrieved November 12, 2023.

10. Singh, R., Soman-Faulkner, K., & Sugumar, K. (2023). Embryology, Hematopoiesis. In: StatPearls [Internet]. StatPearls Publishing. Retrieved November 12, 2023.

11. Jouanne, M., Oddoux, S., Noël, A., & Voisin-Chiret, A. S. (2021). Nutrient Requirements during Pregnancy and Lactation. Nutrients, 13(2), 692.

12. Hofmeyr, G. J., et al. (2019). Prepregnancy and early pregnancy calcium supplementation among women at high risk of pre-eclampsia: a multicentre, double-blind, randomised, placebo-controlled trial. Lancet (London, England), 393(10169), 330–339. doi:10.1016/S0140-6736(18)31818-X

13. Office of Dietary Supplements. (2023). Fact Sheet for Health Professionals: Vitamin D. National Institutes of Health. Retrieved November 12, 2023.