The Case:  Katherine is 37years old and 20 weeks pregnant Since early in her pregnancy, she’s had stiff joints and been exhausted and extremely nauseous. Prenatal vitamins made her morning sickness worse and time wasn’t making anything better.  Katherine was having trouble keeping food down and was worried about getting sufficient nutrients to the fetus.  The Investigation During the first trimester of pregnancy, it’s common to experience nausea and fatigue. For most women, the body finds it’s new equilibrium by the second trimester. When Katherine came to me with continued issues, I knew we had to dig a bit deeper into her diet and look at what she’d done to prepare her body for pregnancy.  Kristin Mallon is a Registered Nurse (Certified in Inpatient Obstetric) and a midwife. She’s a pregnancy expert, published author and co-founder of Vibrant Beginning Pregnaceuticals. She’s delivered thousands of healthy babies. Her focus is on helping women prepare their bodies optimally before, during and after pregnancy through high-quality nutrients.   The First Trimester Kristin explains that the body experiences an influx of hormones (specifically estrogen, progesterone, and human chorionic gonadotropin or hGC) when fertilization occurs. This is why so many women experience symptoms like morning sickness, nausea, and fatigue in the first few months of pregnancy - their bodies are reacting to the change in hormones. Some women may also experience breast tenderness, low-grade headaches, gastro-intestinal upset, and change in appetite (which may be caused by an aversion to food or smells). When Things Don’t Get Better in the Second Trimester For most women, the body learns to deal with the increased hormones and the symptoms dissipate after three months of pregnancy. However, for some women the symptoms persist. This may have to do with genetics - some women are predisposed (based on how fast their body metabolized hormones) to experience a more difficult pregnancy. However, these symptoms may have nothing to do with the increased hormones, they may, in fact, have more to do with nutritional status.  Metabolic vs. Nutrition It’s important for a woman to know if her persistent symptoms are related to nutritional status or a metabolic issue. If it is nutrition, than the course of action would be to adjust the diet and increase supplements to support nutritional needs. This is often the traditional approach. However, if it is a metabolic issue, this approach won’t help and may in fact be fruitless since the additional nutrients won’t be metabolized and absorbed.  Preconception Nutrition Many women shift their focus to nutrition after they get pregnant. Kristin recommends starting to focus on nutrition at least twelve weeks before attempting to get pregnant. This includes focusing on nutrition and taking prenatal vitamins. However, not all prenatal vitamins are formulated optimally.  Selecting a Prenatal Vitamin For most women, a single prenatal vitamin is not going to do the trick. Most prenatal vitamins are not formulated correctly and may include unnecessary elements like dyes, fillers and non-natural ingredients.  Prenatal Iron Many prenatal vitamins contain iron and this is something that Kristin does NOT recommend. Iron slows down your gastrointestinal tract and can cause constipation. Your digestive system will also slow down due to pregnancy so having too much iron in your system when you become pregnant can exacerbate the nausea and vomiting common in the first trimester. In addition, iron binds with calcium which decreases the body’s ability to absorb both minerals. Only 9 - 10% of women actually need to supplement their iron during pregnancy so it should not be the default.  Unclear Pregnancy Nutritional Needs The only official recommendations Americans have (from the Food Nutrition Board, Institute of Medicine, or the CDC) for nutritional needs during pregnancy is 400 - 800 micrograms of folic acid and 100 - 150 micrograms of i