Table of Contents
Table of Contents
Planning for pregnancy is a crucial time in a woman's life because it is truly an investment in the health of her fetus, her child, and the next generation. But surprisingly, about fifty percent of pregnancies are unplanned. That means women's health at all times, across their lifespan, should be optimized.
How do we succeed? A woman needs exercise, a healthy diet, optimization of both physical and mental well-being, control of any underlying diseases, vaccinations, PLUS a prenatal vitamin supplement containing the correct amount of folic acid, taken daily so that if and when she conceives, she is prepared for pregnancy.
Science shows us that taking folic acid before conception decreases the risk of severe neural tube (spinal) and cardiac defects and can protect against neurodevelopmental disorders.1
The Preconception to Infancy (P2I™) Program equips healthcare providers with innovative tools and knowledge to address pregnancy complications and chronic childhood diseases, creating lasting benefits for families and communities.
P2I™ highlights the importance of reducing toxin exposure as a vital yet often overlooked step in pregnancy preparation, alongside optimizing women's health and prioritizing maternity care.
Potential toxicants are found in the air we breathe, the water we drink, the food we consume, and the products we use. They include:
Some CMR examples include phthalates, PFAS, and flame retardants—products in our daily lives.
Phthalates are synthetic chemicals widely used to increase the flexibility of plastics, dissolve chemicals, and stabilize fragrances in personal care products. They are in most of our personal care products, such as hair products, face creams, and makeup. They are even found in medical tubing and devices, shower curtains, and upholstery! Phthalates are associated with preterm birth, hypertension in pregnancy, disruption of reproductive organ development like hypospadias and cryptorchidism, or early puberty, behavioral disorders like ADHD, and poor language development.
Pesticides are linked to miscarriages, stillbirths, severe neurodevelopmental disorders in children, and reproductive dysfunction in adults. They are endocrine disruptors that can impact ovulation and sperm, interfering with conception. Unless you conscientiously follow an organic diet, you are exposed to pesticides.
Per- and polyfluoroalkyl substances (PFAS), commonly called "forever chemicals," are synthetic compounds widely used in consumer products because of their water- and grease-resistant properties. They are found everywhere, and reducing exposure is difficult. PFAS are found in nonstick cookware, food packaging, water-resistant clothing, and industrial waste. They can cause reduced fertility, preterm birth, hypertension in pregnancy, and both neurodevelopmental and immune system disorders in the fetus and children.
We recommend taking a prenatal supplement with folic acid at least three months before conception for optimal effect. A good prenatal supplement should include essential vitamins and minerals to support fetal development.
For instance, iodine is crucial for thyroid function and neurodevelopment; iron is necessary for normal fetal and postnatal neurodevelopment and a wide range of physiological processes, in addition to reducing maternal anemia and the risks of pregnancy complications. Choline is a nutrient essential for cell membrane structure, neurotransmission, and muscle function, while omega-3 fatty acids are fundamental for fetal brain and retinal development.
Prenatal Supplements will vary in the amount and type of vitamins and minerals they contain. Our medical organizations provide recommendations on the optimum content of prenatal vitamins.3
However, the most serious concern is that there is no regulatory requirement for post-production testing to assure the consumer that prenatal vitamins are safe and contain the listed ingredients in the stated dose: every vitamin specifies what they contain and the amount of each ingredient purportedly in them.
The United States Government Accounting Office (GAO) explains, "Unlike medications, dietary supplements—including those for prenatal care—don't have to be evaluated for safety or effectiveness by the Food and Drug Administration before reaching stores."4
Research has shown that many vitamins do not contain the listed ingredients, with some even lacking the essential folic acid so strongly recommended. A sampling of 26 commonly used prenatal vitamins, including one prescription brand, found that 40% exceeded the established level of lead toxicity. Toxic elements like aluminum, titanium, thallium, and nickel were detected in every sample.5
Equally concerning is that testing of prenatal vitamins shows contamination with toxic chemicals-- like lead, mercury, cadmium, arsenic, uranium, pesticides, and phthalates. The United States GAO, in 2024, went so far as to state that current prenatal vitamins could result in women taking too much or too few supplements or being exposed to unnecessary toxicants. Their conclusion stated: "The limited reach of FDA's oversight over dietary supplements—including prenatal supplements—could lead to unfavorable health outcomes for vulnerable populations (i.e., pregnant individuals and fetuses)."
The International Federation of Gynecology and Obstetrics (FIGO) reviewed these concerns about prenatal vitamins. FIGO recognizes that prenatal vitamins are prescribed routinely for women before, during, and after pregnancy to improve the mother's nutritional status and the fetus's health. They gathered a global group of scientists and identified which chemicals should NOT be found in products used by pregnant women, particularly prenatal vitamins.6 In October 2023, they issued a statement calling for the certification of all prenatal vitamins that included testing for twenty-four heavy metals, 120 pesticides, microbials, allergens, and other toxicants. This list also has the potential to cover exposure to personal care products, food, and packaging!
Isn't vitamin certification already happening? No, certification of prenatal vitamins is not required. As the GAO stated, the FDA lacks the oversight to perform post-production assessments of vitamins. This means "Third-Party Testing" is a necessity!
Currently, there are standards set by the United States Pharmacopeia (USP) where supplements are verified through testing and evaluation. USP Dietary Supplement Verification Program ("DSVP") requires compliance with and awards the use of the "USP Verified" Mark on their label to indicate that USP has tested and verified that the product complies with USP public quality standards.7 USP conducts annual surveillance where products are pulled from store shelves and tested to help ensure they continue to meet quality standards, but they do not test every lot. Only four metals and a few chemicals on the FIGO list are assessed with USP.
NSF International (formerly the National Sanitation Foundation) began in 1994 as an independent and accredited organization that develops public health standards and certification programs to test and certify products and systems designed to protect the world's food, water, consumer products, and the environment.8
The NSF offers product and ingredient certifications for supplements. The USP-verified mark means a product has been tested for ingredients and contaminants. USP and NSF certify products for safety, which is a crucial regulatory step.
However, they are not looking at specific concerns regarding safety for pregnancy and fetal development, and that is where P2i™, based on the FIGO standard, is the highest safety standard recommended and one that we believe should be followed.
The FIGO standard for prenatal vitamins is that NO level of a toxicant can be considered safe, particularly when women have many sources of exposure over any given day! Neither USP nor NSF requires 24 heavy metals, 120 pesticides. Nor do they require the zero (de minimus) measurable level required by the FIGO standard. They are good—BUT not good enough for women's and children's health!
The FIGO list is much more comprehensive than either USP or NSF.
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This Wellness Hub does not intend to provide diagnosis, treatment, or medical advice. Read more. The content provided on this Wellness Hub is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health-related diagnosis or treatment options. Information on this Wellness Hub should not be considered as a substitute for advice from a healthcare professional. The claims made about specific products throughout this Wellness Hub are not approved to diagnose, treat, cure, or prevent disease.
