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An Expanded View of Prenatal Care: 11 Points to Consider

Posted By John Gannage, MD, Saturday, November 19, 2011
Updated: Thursday, January 30, 2014
Prenatal care from a conventional medicine perspective follows a standard that is an excellent starting point. Tobacco and alcohol restriction, measuring iron levels, checking fetal structural development, BP and urine measurements, and other aspects of primary care prenatally are important pillars. With more funding, and if asked to direct a higher standard of care, these are the additional recommendations I would make:

1. Disseminate information to would-be parents,prior to conception, that a pre-pregnancy session with a trained professional is advisable.

2. During the pre-pregnancy session, an individualized treatment plan would be outlined by a holistic professional, with the intention of optimizing mom's health. This session could be used to understand Mom's lifetime habits and exposures, address nutrition imbalances, optimize liver function, provide support for digestive and intestinal health, and detoxify tissues following the principles of functional medicine. Setting the target date for conception based on a measurable change in Mom's health would be advised. (The same process can be used for Dad based on research indicating the importance of sperm health.

3. During the pre-pregnancy session, a discussion would take place emphasizing the importance of: a balanced diet; the avoidance of dietary chemicals like high fructose corn syrup, MSG and aspartame; assessment and avoidance of food allergies, intolerances or sensitivities; organic food choices with direction on avoiding "the dirty dozen"; the best fish choices; and the basics of hydration including the healthiest water sources.

4. A home survey would be conducted, with education about: the importance of avoiding home renovation projects during, and perhaps prior to, pregnancy; cleaning up indoor air quality; the common sources of household lead; and the strict avoidance of chemicals like pesticides. Scanning the home for EMF's and geopathic stress could be included.

5. Aworkplace survey would be included as well, again with the purpose of identifying and avoiding sources of poor air quality, excessive radiation, and oxidative stressors.

6. Provide sound advice about dental procedures and cleaning during pregnancy where amalgam fillings are involved.

7. Check Mom for an Omega 3 score, and optimize Essential Fatty Acid balance. EFA's are vital to fetal nervous system development.

8. Measure Vitamin D blood levels, and supplement into a healthy range, while also avoiding calcium deficiency.

9. Aggressively treat iron deficiency, which along with point 8. helps to avoid/lessen the impact of stored bone lead mobilized during pregnancy.

10. Measure and ensure normalcy of Mom's glutathione and/or homocysteine levels.

11. Instruction on appropriate physical activity, air travel, emotional stress and other impactful daily activities that are often taken for granted.

This is a list that can be expanded as research develops regarding how to best protect a developing fetus from any negative influence of environmental and nutrition factors. It is based on personal experience in my medical practice where taking detailed case histories, including pregnancy exposures, of a tremendous number of families has been part of my daily routine for over 10 years.

The goal is ensuring the healthiest newborns and children possible, understanding that studies have shown that at birth 287 chemicals have been found in cord blood For some children, perhaps the ones with susceptibilities or compromised nutrition, a chemicalized start to life inside, and then outside, the uterus is a contributing factor in developmental disorders.

Parents are advised to bear in mind that fetal tissue concentrates many chemicals to a much higher level than what exists in Mom's tissues, that many chemicals move to the baby from Mom during pregnancy, and that the blood-brain barrier is not fully developed until at least 6 weeks after birth. A little education in this area can go a long way, which in my mind should begin prior to conception. Because the question needs to be asked: are we as a society, in the 21st century, doing all we can to ensure a healthier start for our newborns?

(Dedicated to my kids)

Tags:  integrative medicine  nutrition  prenatal 

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New Thyroid Guideliens for Pregnancy (and Fertility!)

Posted By ona McCulloch, BSc, ND, Wednesday, August 3, 2011
Updated: Tuesday, February 4, 2014

The American Thyroid Association has updated their guidelines for the management of thyroid concerns in pregnancy, the details of which were published in the journal Thyroid this past month. Many of us who work in the field of fertility have long been aware of research suggesting that ranges for TSH should be lower in pregnancy. It is truly great to see that this has been formally recognized. Although these guidelines were written for pregnancy, I also apply these to women with fertility concerns who are preparing for pregnancy. Prevention is always best when it comes to avoiding miscarriage.

Thyroid disease is very common in pregnancy. One of the reasons is thatone of the main thyroid hormones (free T4) decreases in pregnancy.Another reason is that TBG (thyroxine binding globulin) increases during pregnancy – TBG is a hormone that binds to the circulating thyroid hormone, making it unavailable to act on receptors. This aggravates cases of hypothyroidism by binding up the thyroid hormone that would normally be available to work in the body.

hCG, the pregnancy hormone, has a profound effect on thyroid function too. Normally in pregnancy, hCG causes TSH (Thyroid stimulating hormone) to decrease. TSH is produced by the pituitary gland and causes the thyroid gland to make thyroid hormones. So in a healthy pregnancy, we expect a woman to have a lower TSH than she usually would . This makes high levels of TSH in pregnancy to be of even more concern and gives us a lower "normal” reference range for pregnancy. When TSH levels are high, this indicates that the thyroid function is low, as the pituitary is attempting to stimulate more thyroid hormone production from the thyroid gland.

Autoimmune thyroiditisis very common in pregnancy as well. 1 in 10 pregnant women will develop antibodies to the thyroid. Hypothyroidism develops in 16% of women with thyroid antibodies. Thyroid antibodies are also associated with lower success rates in IVF cycles, and increased miscarriage rates, even if there is no hypothyroidism in the patient. Postpartum thyroiditis can occur in around 50% of women who develop antibodies during pregnancy.

As you can see, thyroid conditions are a very common health problem, and have great impact on pregnancies and fertility. Not only is thyroid disease related to miscarriage, but subclinical hypothyroidism or positive thyroid antibodies can impact the brain development of the fetus and have been linked to poor intellectual development in the baby. Hyperthyroidism is related to miscarriage and a host of problems such as intrauterine growth restriction. So this is an issue we must take seriously!

The new guidelines suggest the following:

  1. Trimester specific tighter ranges for TSH:
    First trimester normal range 0.1 to 2.5 mIU/L
    Second trimester 0.2 to 3.0 mIU/L
    Third trimester 0.3 to 3.0 mIU/L
  2. Women who are already receiving thyroid replacement therapy should increase their dose by 25% to 30% when they become pregnant.
  3. The total amount of iodine should be 250 ug from all dietary and supplemental sources.
  4. Monitoring is important to ensure that women with hypothyroidism or subclinical hypothyroidism are not at risk. TSH should be measured once every 4 weeks until 16 to 20 weeks’ gestation and at least once between 26 and 32 weeks’ gestation.

Basic nutrition for thyroid in pregnancy

Of note,although our salt is iodized in developed countries, there is a growing deficiency of iodine.This is because the iodine in our salt supply is not well absorbed and utilized. In pregnancy, there is a 50% increase in iodine requirements. So, choose a prenatal with some iodine content, usually around 150-200ug per day. Do not exceed 500mcg total intake daily, as this can pose an increased risk for hypothyroidism.

Selenium should be part of a prenatal vitamin. Several studies have shown that selenium decreases the levels of thyroid antibodies (anti thyroglobulin (anti TG) and anti thyroidperosidase (anti TPO). A randomized controlled trial found that supplementing with 200mcg of selenium daily during pregnancy and the post partum period reduced the incidence of postpartum thyroiditis in women who were positive for thyroid antibodies. 55 mcg should suffice as prevention in healthy women.

Perinatal thyroid disease is very common and new research is rapidly emerging on this topic. Thyroid disease affects fertility, pregnancy, maternal and fetal health. Women should optimally try to establish healthy thyroid function before conceiving: this way many concerns can be prevented, and the health of both moms and babies will be protected.


  • Selenium Supplementation in Patients with Autoimmune Thyroiditis Decreases Thyroid Peroxidase Antibodies Concentrations JCEM 2002 87: 1687-1691
  • Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. THYROID Volume 21, Number 10, 2011
  • Dietary Iodine: Why Are So Many Mothers Not Getting Enough? Renner R 2010. Environ Health Perspect 118:a438-a442.
    Increased prevalence of thyroid antibodies in euthyroid women with a history of recurrent in-vitro fertilization failure Hum. Reprod. (2000) 15(3): 545-548

Tags:  Infertility  prenatal 

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