Evidence-based nutrition for conception, pregnancy and foetal development — folate, iron, omega-3s and key nutrients, contextualised for South African mothers and reviewed by HPCSA-registered dietitians. Evidence-based content with peer-reviewed sources cited in each section.
Folate prevents up to 72% of neural tube defects when taken pre-conception
~27% of SA pregnant women have iron-deficiency anaemia
SA DOH provides free iron-folate supplements at antenatal clinics
Avoid high-mercury fish: swordfish, shark, king mackerel
Click any section below to expand the full content — nutrition targets, SA-adapted guidance and cited peer-reviewed sources.
The “eating for two” myth is just that — a myth. The UK NICE guidelines (NG3) and ACOG (2020) confirm energy needs rise modestly: ~340 kcal/day in the second trimester and ~450 kcal/day in the third, with no extra calories needed in the first trimester. Protein needs increase to ~71 g/day (1.1 g/kg). The focus is nutrient density, not quantity.
Critical nutrients include folate (600 µg), iron (27 mg), calcium (1,000 mg), iodine (220 µg), choline (450 mg) and DHA omega-3 (200 mg). Avoid listeria-risk foods (soft cheeses, deli meats, unpasteurised dairy, raw fish), high-mercury fish (swordfish, shark, king mackerel), alcohol, and limit caffeine to <200 mg/day. In South Africa, iron-deficiency anaemia affects ~27% of pregnant women — supplementation per DOH antenatal guidelines is important.
Protein71 g/day (1.1 g/kg) — quality protein at each meal
Folate600 µg/day — prevents neural tube defects
Iron27 mg/day — SA anaemia rates high; supplement per DOH
DHA200 mg/day from low-mercury fish or algae
AvoidAlcohol, raw fish, soft cheeses, high-mercury fish, <200 mg caffeine
SA antenatal iron-folate programme
The SA Department of Health provides free iron-folic acid supplementation at antenatal clinics. Attend antenatal care early and consistently to access this and screen for anaemia, gestational diabetes and hypertension.
1NICE. Diabetes in pregnancy: management from preconception to the postnatal period (NG3). London: NICE; 2025.
2ACOG Committee Opinion. Nutrition During Pregnancy. Obstet Gynecol. 2020;135(e1):e1-e13.
3Lancet Series on Maternal and Child Nutrition. 2018;391(10117).
4Vorster HH, et al. SA food-based dietary guidelines. S Afr J Clin Nutr. 2013;26(3):S1-S164.
Nutrition affects fertility in both partners. For women, folate (400 µg/day) should begin at least 3 months before conception to prevent neural tube defects. Adequate iron, iodine, omega-3 and vitamin D support ovulation and early pregnancy. The Mediterranean diet pattern is associated with improved fertility outcomes (ESHRE 2018; Alesi 2019).
For men, antioxidants (zinc, selenium, vitamins C and E) and omega-3 improve sperm quality and motility. Both partners should avoid trans fats, excess alcohol and smoking — all impair fertility. BMI matters: both underweight and obesity reduce fertility. In South Africa, ~68% of women are overweight or obese, a significant fertility risk that also increases pregnancy complications.
Folate400 µg/day, 3 months pre-conception (women)
Diet patternMediterranean — associated with higher fertility
MenZinc 11 mg, selenium, vit C/E, omega-3 for sperm quality
BMI18.5–24.9 — both underweight and obesity impair fertility
Fertility is a shared journey
Male factors contribute to ~50% of infertility cases. Both partners should optimise nutrition, limit alcohol and stop smoking. If conception hasn't occurred after 12 months (6 months if over 35), see a fertility specialist.
1ESHRE Guideline Group. Nutrition and fertility. Hum Reprod Open. 2018;2018(2).
2Alesi S, et al. Nutrition and female fertility. Hum Reprod Update. 2019;25(6):703-730.
3Vorster HH, et al. SA food-based dietary guidelines. S Afr J Clin Nutr. 2013.
“Prenatal” covers the pre-conception window and first trimester — the period when nutrient stores are built before demands peak. Pre-conception priorities: folate, iron, iodine, vitamin D and choline. The first trimester usually needs no extra calories; nausea and aversions are common, so focus on nutrient density and folate intake.
Managing nausea: small frequent meals, ginger (proven effective), vitamin B6, bland carbohydrates (crackers, toast), and hydration. Weight gain should follow IOM guidelines based on pre-pregnancy BMI (11.5–16 kg for normal BMI; 7–11.5 kg for overweight; 5–9 kg for obese; 12.5–18 kg for underweight). In SA, pre-conception folic acid is in DOH guidelines but adherence is low — plan pregnancy nutrition before conception whenever possible.
Pre-conceptionFolate 400 µg, build iron/iodine/vit D stores
Weight gainIOM guidelines by pre-pregnancy BMI
NauseaGinger + B6 + small frequent bland meals
1st trimesterNo extra calories — nutrient density over quantity
Hydration2–3 L/day, especially with nausea/vomiting
Avoid retinol (vitamin A) supplements
High-dose preformed vitamin A (retinol) is teratogenic. Avoid cod liver oil, retinol-containing multivitamins and vitamin A-rich liver supplements in pregnancy. Beta-carotene (plant vitamin A) is safe.
1IOM. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington DC: National Academies Press; 2009.
2NICE. Antenatal care (NG201). 2021.
3Viljoen JL, et al. Folic acid fortification and awareness in South Africa. S Afr Med J. 2015;105(7):582-586.
Universal supplements: folic acid (400–600 µg) from pre-conception to 12 weeks; iodine (150 µg); vitamin D (600–1,000 IU) if sun exposure is limited. DHA (200–300 mg) from low-mercury fish or algae supports foetal brain/eye development. Iron (30–60 mg) if deficient or per SA DOH antenatal protocol. Calcium (1,000 mg) if dairy intake is low (also reduces pre-eclampsia risk).
Avoid: high-dose retinol/vitamin A (>10,000 IU — teratogenic), herbal supplements without obstetrician approval, and excess iron if not deficient (causes constipation and may be harmful). In South Africa, the DOH provides iron-folic acid free at antenatal clinics. Always clear every supplement with your obstetrician or midwife — even “natural” products can be unsafe in pregnancy.
UniversalFolic acid 400–600 µg (to 12 weeks)
Iron30–60 mg if deficient or per DOH protocol
Iodine150 µg/day
Vitamin D600–1,000 IU if limited sun
DHA200–300 mg (low-mercury fish or algae)
AvoidRetinol, unapproved herbals, excess iron
Clear every supplement with your obstetrician
Even natural/herbal supplements (including "pregnancy teas") can be unsafe. Bring all supplements to your antenatal visits. Never self-prescribe iron or vitamin A in pregnancy.
1WHO. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016.
2ACOG. Nutrition During Pregnancy. Obstet Gynecol. 2020;135(4):e1-e13.
3SA Department of Health. Guidelines for Maternal Care in South Africa. 2015.
From pre-conception folate to third-trimester iron, pregnancy and fertility nutrition demands are precise and evidence-based. South Africa faces high rates of maternal iron-deficiency anaemia and obesity, both of which affect fertility and pregnancy outcomes. HealthLab’s Pregnancy & Fertility Nutrition guide translates NICE, ACOG, WHO and SA DOH guidelines into practical South African eating patterns — covering folate, iron, DHA, calcium and iodine needs, the supplements that matter, what to avoid, and when to seek professional care. Every section cites peer-reviewed sources and is reviewed by HPCSA-registered dietitians and obstetric professionals.
