Pregnancy Safe Immunity Hacks

Immune health is always a top priority in pregnancy, and it is especially important right now amid COVID-19. Getting the right nutrients, through the food you eat and supplements you take, gives your body the building blocks needed for a healthy immune response.

But, there is often confusion around what immune support is safe during pregnancy. Here we break down five of the top immunity supporting nutrients (plus 3 runners-up) that are safe for pregnancy, based on recommendations from our practitioner community. 

1. Vitamin A as Retinyl Palmitate

Many mamas avoid this “active” form of Vitamin A , Retinyl Palmitate, in pregnancy and instead just take Beta Carotene, a less “usable” form. Caution around Retinyl Palmitate exists because it is a fat soluble nutrient which means that it is not readily eliminated and can bioaccumulate. However, we think instructions to entirely avoid Retinyl Palmitate are misguided. Here’s why.

Though toxicity can occur at very high levels*, avoidance of Retinyl Palmitate has led to a high rate of Vitamin A deficiency in pregnancy and in newborns, which can be damaging as well. Among other benefits, Vitamin A supports fetal facial feature development including eyes and ears, adequate birth weight, full-term gestation, and normal thyroid function. 

Vitamin A is also especially important for the development and regulation of the immune response, providing enhanced defense against multiple infections. One of the ways vitamin A supports immune response is by increasing secretory IgA, an antibody that helps fight respiratory and gastrointestinal infections.

Beta Carotene is the form of Vitamin A found in plants, like carrots, sweet potatoes, and dark leafy greens. It is often poorly absorbed by the body and, once absorbed, it is inefficiently converted into the active (ready-to-be used) form your body needs. And, many women (potentially half) have a genetic variation that prevents the conversion of Beta Carotene completely. 

Retinyl Palmitate is found in organ meats like liver and in dairy products, but most of us do not get nearly enough from our diet.

For these reasons, we recommend choosing a prenatal vitamin that includes at least a portion of its Vitamin A in the active Retinyl Palmitate form. We generally like to see at least 1,090 IU or 600mcg. 

*The WHO says 10,000IU (equivalent to 3,000mcg) a day of the active form of Vitamin A is the upper limit. However, other research suggests that no risk has been observed at 30,000IU / 9.000mcg a day. Beta Carotene does not apply towards the upper limit, as there is no research to suggest that Beta Carotene can cause Vitamin A toxicity. 

2. Vitamin D3 with Vitamin K2

Your immune system cannot function without Vitamin D. Yet, research suggests over 50% of women are deficient in Vitamin D, including in one study of women in the Northern United States, despite the fact that 90% of women studied were taking a prenatal supplement. In this case, insufficiency was measured as serum 25-hydroxyvitamin D (circulating Vitamin D in the body and the best measure of Vitamin D supply) levels of 37.5 - 80 nmol/L or less. Many practitioners in our community prefer to see levels closer to 50 - 80 nmol/L and even in Southern California see deficiency rates upwards of 90% for women that do not appropriately supplement with Vitamin D. 

Your skin produces Vitamin D when it is exposed to sunlight, but for most of us direct sunlight exposure is limited by sunscreen, protective clothing, and spending a majority of our time indoors. And, it's difficult to get enough Vitamin D from diet alone. Moreover, many women have genetic variations that predispose them to lower levels of Vitamin D. 

We suggest supplementing with at least 4,000 IU of Vitamin D3. Additional supplementation on top of your prenatal is often necessary, as most prenatals contain at most 2,000 IUs.* D3 is recommended over D2, as it is the more effective form. One of the roles of Vitamin D3 is to increase calcium absorption from the gastrointestinal tract. Vitamin K2 should be consumed alongside of vitamin D3 in order to direct the calcium deposition into the bones and teeth, rather than in the arteries or kidneys.Vitamin K2 is found in organ meats, dairy products, and some animal products, but many aren't achieving the recommended daily amount of 90 mcg in diet alone.

*Most prenatal supplements will have 2,000 IU of Vitamin D3 at most due to caution around the fact that it is a fat soluble nutrient and therefore can be hard for your body to eliminate. Through research and clinical practice of our practitioner partners we do not think 2,000 IU is enough. 4,000 IU is a highly safe, and more effective, dosage. A 2011 well designed placebo and randomized controlled study on Vitamin D3 supplementation in pregnant women evaluated this dose. At 4,000 IU per day 82% of women reached proper blood levels of vitamin D and no participants had side effects of excessive blood levels of Vitamin D3. In addition, women taking 4,000 IU had far lower rates of pregnancy complications compared to those taking a lower dose. However, additional Vitamin D3 beyond 4,000 IU may be required for some mamas whose levels are especially low.   


3. Vitamin C with Bioflavinoids

Vitamin C gets a lot of attention for its role in supporting immunity--and for good reason. 

Supplementing with Vitamin C has been shown to help prevent and treat respiratory and other infections, as well as to support regulating overall immune response. Food is not always a reliable source of Vitamin C-- it degrades quickly after produce is picked and substantial amounts are lost in cooking.  

We suggest supplementing with 500mg of Vitamin C with Bioflavonoids, a highly supportive dose with helper antioxidants. Achieving this level will often require an additional supplement on top of your prenatal vitamin. (350mg of Vitamin C is the most we have seen in a prenatal supplement, but most have <100mg.) Ascorbic acid is the main form of Vitamin C found in supplements and naturally in fruit and other foods.

4. Omega-3 (DHA + EPA)

Omega-3 promotes a healthy immune response.Omega-3 is required for healthy cell membrane formation of all immune cells. Omega-3 enhances the function of many immune cells including B cells, a type of white blood cell, critical to fighting bacteria and viruses. And, Omega-3 helps reduce the synthesis of proinflammatory molecules, thereby supporting healthy inflammatory levels. (Inflammation is the response of your body's immune system to injuries and harmful things that enter your body.)*

Yet, up to 95% of women of childbearing age are failing to meet their needs for this fundamental nutrient.

We suggest supplementing with our Omega-3 tailored to a mama-to-be. It’s clinically proven to be 5x better absorbed and delivered with other needed nutrients like Choline. 

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. 

5. Zinc and Copper

Zinc plays a central role in your immune system. It is critical for everything from the normal development and function of cells that make up your innate immunity, your initial immune response, to the growth and development of T and B cells, the white blood cells that make up your adaptive, or secondary immune response. Zinc also functions as an antioxidant and supports the membrane structure of immune cells. 

It’s estimated that over 80% of pregnant women have insufficient Zinc intake. Zinc is found in meat, oysters and other seafood, eggs, and many seeds, nuts, and legumes. However many of the plant based sources have phytates that limit absorption. The body does not store Zinc, so you need to consume it daily.  

We recommend confirming that your prenatal supplement contains at least 15 mg of Zinc, yet more may provide further benefit. Supplementation with up to 50 mg of zinc during pregnancy has been studied and believed to be safe and effective in supporting the immune response in pregnancy. Taking higher doses of zinc can deplete copper, so it’s helpful to ensure you are getting both at a ratio of Zinc to Copper between 15:1 and 25:1.

Our 3 Runners-Up: As nutrition nerds, we can't help but mention our next 3 "runner-up" supplement recommendations for supporting prenatal immunity. 

Ginger

Ginger is the most well-studied herb used during pregnancy. Ginger is a strong antioxidant and promotes a healthy immune response. 

We suggest taking fresh ginger, ginger tea, and supplementing with up to 250mg of ginger concentrated ginger extract every 6 hours. 

Probiotics and Gut Health

It’s estimated that up to 80% of your immune system is actually located in your gut,  and the health of your immune function is directly related to the bacteria that reside inside. Your gut microbiome is directly affected by what you eat. Generally good bacteria thrive off complex starch plant-based foods and pathogenic bacteria thrive off high-sugar foods. Fermented and probiotic rich foods like yogurt, kimchi, sauerkraut and kombucha are great additions, but they are often not enough to give you the target strains needed to support immunity. 

We recommend supplementing with a probiotic that has multiple strains of Lactobacillus and Bifidobacterium, in a dose between 30-80 billion CFU (colony-forming units). (We’ll be launching a probiotic specifically tailored to pregnancy soon!)

Collagen Protein

Proper protein intake is critical in pregnancy. All proteins are made up of one or more chains of amino acids. Amino acids are involved in immune response including for the synthesis of antibodies. Amino acids have been delivered to hospital patients through feeding tubes for 50+ years to regenerate their immune systems by triggering new immune system cell growth. 

Different types of proteins have different amino acid compositions. Collagen contains the amino acids glycine, proline, and arginine which can be difficult to get enough of from other protein sources, and all are important components of properly supporting your immune system. 

To optimize your immunity, we recommend supplementing with 15g of hydrolyzed bovine collagen.