Why a Better Prenatal is Needed: An Integrative Pediatrician’s Perspective

It's rare to run your prenatal vitamin choice by your future child's pediatrician. And yet, pediatricians are responsible for your child's health and wellbeing, so it makes sense to seek their input before baby is here. We know nutrition and health of mama directly influences baby's for a lifetime.

So today, we’re talking with Dr. Sarabenet Sequeira, an integrative pediatrician and a founding medical advisor to Needed, about why a better prenatal is needed for children's health. 

Sarabenet Sequeira is an MD, Board Certified pediatrician currently in practice in Marin, California. Graduating in 2000 from George Washington University School of Medicine in Washington, DC, Dr. Sequeira completed her residency at the University of California, San Francisco, where she was selected Chief Resident in Pediatrics. She also has completed her certification in Primary Care Homeopathy from the American Board of Homeotherapeutics, and from the European CEDH.   

Why does a better prenatal matter for children's health?

Ensuring that mama is well nourished has a great impact on her baby’s health. We know that there is a well-researched connection between mama’s gut health and baby’s gut health, immunity, and allergy risk. There is also a strong link between mama’s intake of Omega-3s and baby’s brain and cognitive development, and it has been shown that women who are depleted in Vitamin D have higher rates of preterm delivery.

Many mamas I see are really working hard to eat well and nourish themselves through food. It’s a hard thing to tell them that during pregnancy and postpartum, they unfortunately just cannot rely on food alone. A high quality prenatal is absolutely essential to ensuring all nutrient needs are met.

I have found, anecdotally, in my practice that mothers who are taking higher doses of Omega-3s and who have adequate Vitamin D levels postpartum, seem to be less prone to postpartum depression and anxiety.

Related Reading: Postpartum Vitamin D Deficiency Symptoms

I also see differences in an infant’s skin, growth, and iron stores that are directly related to the nutritional status of the mother.

Plus, a mama who is nourished and well in body and mind is often more equipped - more confident and balanced - to care for her child. 

As a physician yourself, where do you see the gaps in nutritional education among physicians and how have you overcome this in your own practice? 

Medical school covers a tremendous amount of information, and the amount of that time dedicated to nutrition education is very limited (as little as 1 4-hour course in many medical schools). As a result, physicians generally rely on nutritionists, dietitians, and other specialists like naturopathic doctors to work with patients on specific nutrition-related needs.

In my own practice, I have learned a tremendous amount about nutritional biochemistry and appropriate supplementation from my naturopathic doctor colleague, Dr. Hillary Frederickson. In addition, I chose to pursue integrative training in addition to the rigorous demands of a medical degree and residency to supplement my own nutritional knowledge. I am a bit of an outlier in my profession, though the number of physicians pursuing functional or integrative trainings after residency and fellowship is growing.

Growing up in Marin, outside San Francisco, my mother used everything from homeopathy to Bach flower remedies to Ayurvedic dietary principles to keep us well. I discovered early on the healing powers of many alternative systems of medicine from firsthand experience, so I always knew that I wanted to practice in an integrated medical model. I chose to go to medical school so that I would have a broad knowledge base with which to evaluate and utilize other forms of medicine. I love having so many tools at my disposal to help the families I care for

Many of your patient families come to you for nutritional advice. What are the key challenges that you see women face when it comes to getting trusted prenatal nutrition advice?  

For most women, an OBGYN is their sole practitioner before, during, and after pregnancy, and so a lot of nutrition questions fall to them. 

OBs have a lot to cover-both in their medical training, and in their patient visits. Their training covers not just routine pregnancy and gynecologic care, but also surgery and obstetrical emergencies. OBs can only dig deep on so many topics as part of their studies, and unfortunately, nutrition isn’t typically one of them. OBs are certainly trained in some key nutrition concepts but because that is not the focus of their training, they may not be able to advise on some nuances. For example, I learned in obstetric studies that Folate is important for pregnant women, but I was not taught anything about the difference between Folate and Folic Acid and how genetic differences can determine how a woman processes Folate in the body. 

Many women also only seek obstetrical care when they are already 2-3 months pregnant and don’t think to start prenatal nutrition conversations before conception planning starts. We know that a healthy lifestyle and good prenatal supplement are important prior to pregnancy but many women begin asking OBs these questions at a time when diet and lifestyle changes are less likely to occur. It’s also much harder to eat well and take supplements when you have nausea of pregnancy. The first trimester is a challenging time to eat well. For my own pregnancies I tried to be as well nourished as possible before I got pregnant.

And like many areas of health and medicine, the field of prenatal nutrition is changing all the time. For example, even in medical school just 20 years ago, I was taught that just 15 minutes of sun on the backs of the hands would give women what they needed for Vitamin D. I also learned that prenatal levels of Vitamin D had no bearing on the health of an infant. It wasn’t incorrect information given what we knew at the time, but plenty of research has since emerged that suggests neither of these things are true. 

There is also a difference between awareness and deep practical knowledge and it takes time for these new learnings to become standard practice. For example, in most practices, it is still not standard to check Vitamin D in pregnant and postpartum women, yet most women are at insufficient levels. Even in my practice in sunny California, most women and children I test are either insufficient or deficient. This includes some women who are currently taking a prenatal vitamin!

This is why I love that trusted resources like Needed exist to inform and empower women with the information they need to help manage their prenatal and postpartum health alongside their providers.

What advice would you give to women who want to know what to look for in a prenatal vitamin that is optimal for both themselves and their babies?

I always tell mamas that pregnancy is one of the most nutritionally-demanding phases of life for a woman. You are developing a baby from scratch - every organ and system must be created by your own body. It’s an incredible thing and it requires a high amount of a variety of nutrients. 

I see a lot of women who are very nutritionally-conscious and eat a fairly balanced diet, but it often surprises them that even if you eat well, a solid prenatal supplement routine is essential. A few critical items I look for, all of which I’m thrilled to see in Needed’s prenatal plan, include the following:

• Methylfolate - It is important that you are not taking Folic Acid as 40-60% of women cannot process this form. Folate is critical for baby’s development so it is essential that you take a form that your body can actually use.
• Vitamin D - Most prenatals include 2000 IU or less of Vitamin D but I like seeing around 4000 IU to support baby’s development and mama’s emotional health and immunity. This increases to 6000IU for breastfeeding mamas.
• Vitamin B12 - Vitamin B12 is essential for mama’s energy and metabolism and baby’s cognitive and neurological development but is often found in amounts that are far less than optimal. 
• Choline - Choline is one that is shockingly absent or included in incredibly low doses given how essential it is for baby’s brain and neurological development. Folate seems to get all of the attention, but at least 550mg of Choline is needed for optimal development.
• Omega-3 fatty acids - Omega 3s are essential for baby’s brain development and mamas brain health, but should be taken separately from your prenatal as they have a tendency to oxidize. Whether plant (algae) or animal (fish)-based, be sure yours is from a trusted source. 
• Iron - Iron is a tricky one, as your needs increase during pregnancy but too much can be unsafe. I always suggested testing the Iron levels of the families I work with to determine whether we need to supplement, and with how much. I suggest taking a prenatal without Iron and then layering on a separate supplement as needed. This is also ideal as your needs may change as you move through pregnancy. Sometimes mamas cannot stomach natural sources of Iron in the early stages of pregnancy but have no trouble meeting their Iron needs through diet later on.
• Pre/probiotic - There are thousands of probiotics available but not all of them are created equal. Don’t just grab one off the grocery shelf, seek one out that has strains targeted to pregnancy (like Needed’s Pre/Probiotic) as probiotic supplementation in mama has been shown to support a healthy gut and reduce allergies in baby.

What advice do you have for new or expecting mamas to support mood during the postpartum phase?

Women need wraparound social, physical, and emotional support during the postpartum phase.

My supportive regimen for physical well being includes the following:

• A daily nap - even if you can't sleep just lie down when your baby naps in the early afternoon. Make this a family thing, every day.
• Time outside - we need sunlight exposure to help maintain day/night cycles. More time outside helps with sleep quality.
• Omega 3 fatty acids - a higher amount of Omegas through diet and supplementation in postpartum is both safe and effective for mood and emotional wellbeing 
• Vitamin D - Vitamin D has been shown to support mood in postpartum women. Women need to consume 6000 IU daily while breastfeeding to have enough for both themselves and to pass into the breast milk for their infant. Needed’s prenatal offers 4000 IU which is sufficient for pregnancy and for mama if not breastfeeding, but if you choose not to supplement your baby with infant Vitamin D drops (just add a drop to your nipple before nursing, or a bottle if you’re certain baby will take it all), you should add an additional 2000 IU dose of Vitamin D on top of your Needed prenatal. Many brands offer Vitamin D drops in 500-1000 IU doses per drop that can be easily added to any drink in whatever increment you need.
• Supportive home help - for generations, women were not expected to mother alone. Even today, many cultures still gather family and community members to care for a mother so she can care for her baby. Ask for help from your partner, family members, a postpartum doula, or friends. Accepting food deliveries and help with laundry and cleaning will make this phase much more manageable and less overwhelming. This can be done safely even in the pandemic, and is especially important now as we are so much more isolated.
• Sleep - five hours of consecutive sleep has been shown to be protective against postpartum depression. Once milk supply is established, work with a pediatrician to get your infant one longer stretch of sleep early in the night if possible. Of course, this means you must go to sleep as soon as baby does!

What advice do you have for mamas looking to prepare for the journey that is mamahood?

I think it all boils down to five key items:

1. Get key nutrient and hormone (e.g. thyroid) levels tested prior to pregnancy so that you have a baseline and so that you know where more supplementation or attention might be needed. I like to get a look at Vitamin D, Omegas, Iron, Folate, Calcium, and Vitamin B12. 
2. Supplement wisely beginning before you start trying. Nutrients are needed from the moment of conception, and this happens at least two weeks before you get a positive test. It’s wise to start a comprehensive prenatal supplement routine at least as soon as you start trying (a few months before is ideal!). I am so excited about the protocol that Needed has developed. It really accounts for all of the key needs, and is designed for optimal nutrition--not simply meeting bare minimums like with most prenatal vitamins.
3. Eat a diet rich in whole foods - while diet may not cover all your bases thanks to nutrient variation, soil depletion, seasonality and access, taste preferences, food aversions, and more, focusing on a diet full of good sources of all macro- and micronutrients will help support baby’s growth and development. Research has shown it can also impact taste preferences by impacting the flavors present in the amniotic fluid.
4. Avoid environmental toxins as much as possible. Check your cleaning and personal care products and avoid known endocrine disrupting chemicals. These can impact mama’s hormones and health and have even been shown to appear in the umbilical cords of babies, suggesting that harmful chemicals cross the placenta to and transfer to baby. I suggest removing sources of chemicals prior to conception, or whenever you read this. It’s not too late to reduce your exposure by considering what chemicals you consume, put on your skin, or use in your home. For more on this, check out a short series by another physician about pregnancy-safe detox.
5. Prepare for postpartum beyond baby by preparing meals ahead, stocking your pantry, lining up support from family and friends, and discussing family dynamics, expectations, and responsibilities with your partner and other children.

Thank you so much Dr. Sequeira!