Notes By Stage : Preconception

Vitamin D is hard to get through food since there are limited options, so most women will need to supplement even with more than a prenatal vitamin has to offer. Read the vitamin D note for more information!

Nutrients for thyroid health 

Thyroid issues can often make getting pregnant and staying pregnant a challenge. One study found that increased TSH (thyroid-stimulating hormone) levels above normal increased the risk of miscarriage versus women who had normal TSH levels and had no increased risk of miscarriage (17).

Women who have tested positive for thyroid autoantibodies leading to thyroid inflammation also have an increased risk of miscarriage and preterm birth (18). People who are treated for thyroid dysfunction typically go on to have normal pregnancies (21). Getting a diagnosis for thyroid dysfunction is the first step to treatment. But below are three nutrients of importance when it comes to managing a thyroid condition.

Iodine: This micronutrient is important for thyroid hormone synthesis. However, researchers have found that too much iodine can have detrimental effects on maternal thyroid health (23). However, a study that examined many iodine supplementations while prenatal-perinatal and postpartum studies stated that more research is needed as the evidence is low quality and not strong (22). Fish, dairy products, and iodized salt have iodine, and iodine-intake-related problems when it comes to pregnancy are not common, although can be severe (23). The American Thyroid Association recommends pregnant women take 150 mcg of iodine daily, and most prenatal vitamins fail to meet this requirement. Learn more about iodine here. 

Selenium: Studies have shown that selenium intake was associated with reduced thyroid inflammatory activity during pregnancy and postpartum (24). Selenium can be found in meat, fish, eggs, and Brazil nuts. Learn more about selenium here. 

Iron is also crucial for proper thyroid function and is discussed in more detail below. View our note on iron as well for more detailed information. 

Are there certain foods I should avoid after a pregnancy loss?

It’s important to know that eating food itself is not linked to miscarriage, but some of the illnesses you can contract from consuming the food can. The CDC has data on current foods that have been linked to foodborne outbreaks here.

Alcohol

There is still research being conducted on this topic, but animal and human studies (25) have pointed to a direct physiological mechanism where alcohol has a negative effect on pregnancy outcomes, such as an increased risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome (SIDS). Learn more about alcohol consumption here. 

Mercury

Maternal exposure to mercury has been shown to have detrimental effects on a developing fetus. A handful of mother-child studies found neurodevelopmental delays in the children of women who consumed seafood high in mercury as their children got older (26). King mackerel, swordfish, shark, marlin, tilefish, ahi tuna, and bigeye tuna all have high mercury levels (27). 

However, it is important to note that consuming fish, like salmon, is safe and recommended while pregnant. Research shows that the benefits of consuming seafood outweigh the risks. Learn more about this research here.  See a list of low-mercury seafood options here. 

Listeria

Listeriosis is an infection caused by listeria monocytogenes, and is a mild illness for the pregnant woman but can be severe for your unborn baby. According to the CDC, listeria outbreaks have been linked to deli meats, dairy products, and produce. The best way to prevent an infection is to avoid unpasteurized dairy products, avoid raw sprouts, wash fruits and vegetables, and store food at an appropriate temperature. Keep in mind the amount of people who actually get infected from listeria per year is around 1600 in the United States, which is about 0.005% of the population. Learn more about important food safety tips here. And review our eating-out guide here. 

Vitamin A

Vitamin A is an important micronutrient for human health and fetal development. It helps your baby’s eyes, organs, and skeleton develop. Like with any nutrient, too little or too much is not good. Vitamin A supplementation in the form of retinoic acid (retinol) can increase the risk of miscarriage and congenital malformation in a growing baby when blood levels of vitamin A are high in the mom’s blood during the first quarter of pregnancy (28). That being said, a research study that took a look at the very high dosing of vitamin A during pregnancy did not find associations between miscarriage or abnormalities in babies (29). High doses of vitamin A are typically found when women use retinol products on their skin or take it as a medication or supplement. If you’re taking or using retinol/retinal, speak with your doctor before you try to get pregnant again.

Remember, much research is still being done regarding what causes miscarriage. And there is still no concrete way of knowing what exactly causes every single miscarriage that occurs. 

Depending on the nature of your losses, how many you have had, whether you have known risk factors, or whether your provider recommends it, you may wish to conduct investigative testing into possible root contributors, as outlined below. 

How do I plan for pregnancy after a previous one ended? 

As mentioned at the beginning, nutrition after a miscarriage isn’t entirely different from preparing your body for pregnancy and is similar to replenishing nutrients in a typical postpartum period. Although we are diving deep into recovery and pregnancy prep nutrition here, at the core, you want to eat a well-rounded diet focusing on including as many nutrient-dense foods that you enjoy eating each day. 

The Johns Hopkins Medicine blog, and we agree, recommends continuing to take your prenatal vitamins after your pregnancy has ended for nutrients like calcium, vitamin D, zinc, choline, vitamin B6, and folate (30, 31). This will help restore nutrients that may have been lost during pregnancy and prepare your body for another pregnancy.

Continuing to steer clear of smoking, alcohol intake (32), and excessive caffeine consumption are still being recommended to limit in the research (33) as of 2019 to aid female fertility. Maintaining a healthy weight and continuing your healthy eating habits are also recommended, as carrying excess weight outside of a healthy lab workup can put you at risk of pregnancy complications (34).

If your miscarriage was accompanied by blood loss, surgery, or anything else that requires extra healing on top of your loss, then certain nutrients will be imperative to help your bodily healing process.

Iron

Dietary iron recommendations for postpartum women return to non-pregnant level recommendations (35) unless you had blood loss during your miscarriage. Then your needs remain higher, closer to 27 mg per day. Regular iron intake recommendations for adult women are to consume 18 mg of iron per day (36). Red meat will have the most bioavailable iron, like beef, but iron can also be found in beans or tofu. If you have always had problems with anemia, check out this guide. 

Zinc

This mineral is essential to humans for general health but also for healing. Studies have shown that zinc plays a major role in cell repair, coagulation, and scar formation (37). If your miscarriage was accompanied by surgery, include foods high in zinc, like oysters, red meat, poultry, nuts, and whole grains.

Vitamin C

Vitamin C has antioxidant properties, aiding at the site of inflammation or damage, limiting free radical damage, and also helps in collagen synthesis (39). Though extra vitamin C is expelled from the body if it cannot be used, vitamin C is used in the healing process (38). Collagen is necessary for skin support and elasticity and to shrink the uterus back down after pregnancy (40). Citrus fruits and colorful vegetables will be your highest sources of vitamin C.  

Choline

This nutrient is important for the brain and is not commonly found in prenatal vitamins. A study from 2010 illustrated that pregnant women were not meeting their targeted choline levels (41) and recommended that women increase their intake of choline-rich foods. While you recover, try incorporating foods like chicken, beef, eggs, broccoli, and green peas to restore your choline levels. Learn more about choline here. 

Vitamin B12

This vitamin is important for making DNA and having healthy nerve and blood cells. A study from 2012 showed that vitamin B12 lowered during gestation but was adequately recovered in the postpartum period (42). Vitamin B12 (and B6) have been studied relating to depression in the postpartum period, but this different study from 2012 (43) found no significant differences between those who did display depressive symptoms and those who did not in relation to B12 (and folate and B6) intake during or before pregnancy in the postpartum period. Vitamin B12 is found naturally in animal products and is commonly fortified in almond milk, soy milk, and cereals. Learn more about B12 here. 

Magnesium

Magnesium is another important mineral to increase your intake during times of stress, as stress increases magnesium loss in the body and is worsened by magnesium deficiency (44). Since it is more difficult to source from food alone, using magnesium flakes (in a bath or shower once cleared to do so), magnesium lotion, magnesium deodorant, or taking in supplemental form (you can add this powder to a mineral mocktail, see below) is a good idea. Learn more about magnesium here. 

How can I incorporate all of these nutrients during this time??

The following are meals and recipes that are both comforting and nutrient-dense to support your time of healing:

Antioxidant probiotic gummies

Ingredients:

• 3 bags green tea (decaf or regular)
• 3 bags probiotic tea (there are many options for probiotic teas, but this dandelion chai blend is ideal as it contains dandelion for liver health, ginger for any nausea and taste, digestive support, plus cinnamon and cardamom are comforting, warming spices!) 
• 5 tbsp of grass-fed gelatin (discount code: RYANN18)
• ½ cup lemon or lime juice
• 1 ½  cups water
• 3-4 tbsp of honey 

Directions:

Add lemon to half a cup of water and heat in a small saucepan. Add honey and teabags. Steep for 5-10 minutes. While steeping, add gelatin to a separate bowl of remaining 1 cup water and let bloom before adding to the saucepan. Stir in on medium heat until fully incorporated. Add to glass dish and cut into small squares after chilling until firm or pour into gummy molds. Chill in the fridge until set. 

Liver dark chocolate bark

Ingredients:

• ½ cup dark chocolate chips (or any chocolate you like)
• Liver crisps/chips/crumbles (code PRENATAL)
• 1 tsp coarse sea salt 
• 1-2 tbsp dried tart cherries (or other dried fruit you like)
• Optional: 1 scoop of unflavored collagen (code TPNL) 
  • Further Food Collagen (code RYANN18)

Directions:

Melt ½ cup dark chocolate chips, stir in collagen powder scoop, and spread out on a plate or pan, and sprinkle crumbled liver chips on top, along with coarse sea salt and dried tart cherries (beef brisket is also delicious with chocolate if you want to crumble that on top with it too). Let harden on plate/pan and enjoy! 

Any other recipe with liver is ideal for supporting healing with comfort and nutrients. See our how to cook with liver guide for more ideas. 

Quick Daily Mineral Mocktail 

Support cellular hydration and increased mineral needs by either using a pre-made mineral blend mix such as LMNT, jigsaw adrenal cocktail blend, Needed hydration support, or by making your own with unrefined sodium, cream of tartar, and a source of vitamin C. 

Drink 1-2 mineral mocktails per day in the acute healing phase especially the week during and after your loss. 

Ingredients:

• 1 tbsp apple cider vinegar or 2 tbsp lemon or lime juice
• 1/8 tsp salt
• 1 tsp cream of tartar (for a potassium source) or 4 oz. coconut water
• 8 oz water (filtered or sparkling) or half coconut water

Mix all together and enjoy just before eating!

Other supportive meals for healing: 

• Slow cooker bone broth chicken soup
• Big Mac casserole
• Taco cauliflower rice skillet 
• Philly cheesesteak casserole
• Chili sweet potato fries
• Spaghetti squash lasagna
• Ham and broccoli casserole
• Taco soup
• Classic beef stew
• Oyster chowder
• 3 ingredient protein pancakes
• Bone broth hot cocoa and marshmallows
• Pre-made snacks to try: 7 Sundays cereal, Siete cookies, Simple Mills mixes (great for baking, cookies, or pancakes), Hu chocolate

How else can I support healing after a pregnancy loss? 

Besides supporting healing with nutrition, you can support your body in many other ways.

Continue taking all supplements you were taking prior to, including your prenatal. This can be mentally difficult after a loss, and if you need to take a break from it (or switch to another high-quality but non-pregnancy-specific multivitamin) for a bit, that is okay, too. 

Utilize red light therapy daily, long-term to support mitochondrial health (45, 46). In addition to supporting tissue repair as “powerhouses of the cell,” healthy mitochondria are critical for fertilization, implantation, and normal cell development, so red light therapy can be a helpful tool to not only recovering but potentially supporting healthy cells for a future pregnancy and reducing the risk for recurrent pregnancy loss as well (47, 48, 49).  I use and love Lumebox. 

Manage grief and get emotional support

Whether you lost your baby the day after you got a positive pregnancy test or well beyond, either loss is an incredible loss of life, hopes, and dreams for the future, and this warrants grief.

Know that you are not alone in your experience (at least 1 in every 4 women will experience pregnancy loss), and you deserve dedicated time to support healing physically and mentally (50). 

In addition to seeking support from those close to you, it may be helpful to seek formal support from a professional specializing in grief counseling. 

There are also organizations and resources available to you: 

• Bridget’s Cradles: An incredible resource for pregnancy loss full of ideas for memorializing your baby, books, and bible verses, support groups, keepsake ideas, and resources for stillbirth prevention and advocacy 
• Educational resources for health care professionals (nurses, midwives, chaplains)
• Rachel’s Gift: Support groups, community events, hospital memorial boxes
• Foreknown Ministries: Christ-centered non-profit organization that provides support and resources to grieving parents who have experienced stillbirth, pregnancy, or infant loss including weekend retreats, text support, and monthly digital support groups.
• Stillbirth resources
• There are also many pregnancy loss accounts on social media, such as @themiscarriagedoula, @miscarriageassociation, and if you are navigating pregnancy after loss, @pregnancyafterlosssupport

Prioritize rest and sleep

Besides nutrition, sleep is a cornerstone of supporting your mental and physical recovery after a pregnancy loss. 

• Aim to get 7.5-9 hours of sleep per night
• Avoid electronic devices 1 hour before bed. 
• Make your room as cool and dark as possible.
• Consider using a sleep mask and white noise machine. 
• Avoid consuming caffeine during the day past 2 pm.
• To help optimize sleep quality, try setting aside 30-60 minutes before bed to unwind.
• Minimize screens at night, wear blue light-blocking glasses if you watch TV, and consider putting a red light lamp in your bedroom and/or using a red night light and/or red bulbs in your bedroom.
• Prioritize getting sunlight in the morning and at dinner to support melatonin levels.
• Have a cup of tea (Traditional Medicinals Nighty Night extra or Celestial seasonings are perfect for promoting sleep)
• Do anything else that helps you relax: dim lights, prayer, reading or listening to an audiobook, drawing, puzzles, activity like knitting or crocheting, listening to soft music or white noise (the “white noise lite” app is free with lots of free white noise backgrounds), journaling, lavender scented neck wrap, or use a weighted blanket. 

Address your potential toxic burden

Are you currently or do you have a history of exposure to mold, heavy metals, or chemicals? Studies have found associations between these and pregnancy loss (51). 

The more environmental toxins you are exposed to regularly, the more difficult it becomes for your liver to do its job, in addition to having the potential to impact your thyroid and hormones (52). 

Addressing environmental toxins is a process, and we all start in different places. It can also be a costly one if done all at once, but as discussed in our Hashimoto’s note, there are many impactful changes you can make gradually over time and as your budget allows: 

10 ways to decrease your toxin exposure:

1. Support detox pathways to eliminate harmful endocrine disruptors: sweat (exercise or a walk on a sunny day), consume 30 grams of fiber daily, and staying well-hydrated.
2. Filter your water. Tap water contains fluoride that has been found to impact T3, T4, and TSH hormones. Filtering it is an easy way to avoid this source! One way to do this is by using a filter under your sink so it’s safer to wash produce and anything you use it for with food. AquaTru and Berkey are two reverse osmosis filters recommended!
3. Support your natural detox functions by increasing your antioxidant and cruciferous veggie intake to maximize your dietary phytonutrients and increase your body’s detoxification ability (53).
4. Shop for clean beauty at Credo (tons of brands ranging in prices!) and Crunchi. Start swapping the products you use most frequently when you run out of what you have.
5. Use Branch basic cleaning products or Aunt Fannie’s on Amazon. To learn more about clean beauty and household products, check out @toxinfreetay on Instagram!
6. If your toothpaste has fluoride, swap for hydroxyapatite toothpaste, which is a safe and effective alternative for fluoride for both children and adults (54, 55). Look for any “fluoride-free” toothpaste at the store!
7. Ditch any products that aren’t essential for you that you won’t miss, such as candles, scented plug-ins, body sprays, dryer beads, etc. 
8. Limit plastic wherever you can. For example, replace plastic food containers with glass, avoid plastic wrap for food, and use stainless steel or glass water bottles. 
9. Buy organic when possible and as you can afford— starting with following the Clean 15 and Dirty Dozen recommendations for produce! More on organic foods here. 
10. Limit your consumption of processed baked goods and sodas as much as possible, make homemade alternatives for store-bought baked goods whenever possible, and swap soda with sparkling water. 

You can also reduce your toxic burden by supporting detox with the recommendations for supporting detox pathways as well. 

Take a critical look at your stressors and mental well-being

Chronic and acute stress are common roots of all the above issues. It’s impossible to heal while in a state of stress. 

While pregnancy loss is (understandably) an immense stressor to handle, it’s important to get all the support you can to process your loss and other physical and emotional stressors in your life for full health going forward.

Besides stressors on your body (as discussed above, such as blood sugar dysregulation, undereating or nutrient deficiencies, high intake of inflammatory foods, infections, gut dysbiosis, poor sleep, over- or under-exercising, and environmental toxins), countless day-to-day emotional stressors impact each of us in different ways. 

Things to consider:

• How is your work-life balance?
• Do you have stable relationships? Close friends or family to confide in?
• Do you have hobbies and do things you enjoy each day?
• Do you take time for yourself? (Ideally, at least a small amount of time daily plus 1-2 full days off work each week.)
• Do you have unresolved past trauma?
• Are you generally satisfied and happy with yourself and your job/vocation in life? 

While it’s often a bidirectional relationship between anxiety and depression and pregnancy loss (and again, it’s understandable that you would not be completely yourself after such a loss and/or have anxiety going forward with conceiving or a future pregnancy), it is noted that anxiety and depression are risk factors for recurrent pregnancy loss (56). 

Even if you don’t have diagnosed anxiety or depression, nervous system regulation is an essential aspect of healing. Your body cannot dedicate energy to healing when in a sympathetic state (not to mention that reproductive functions aren’t deemed an essential process when in this state, so conception can be more difficult) (57). Not surprisingly, autonomic system dysregulation is thought to be an under-recognized cause of fertility issues (58). 

Stress isn’t going away anytime soon, so how can you increase your resilience to stress for more effective coping? Evidence-based recommendations include (59, 60):

• Cognitive behavioral therapy (CBT)
• Practice self-compassion
• Daily gratitude practice
• Daily relaxation practices
• Set goals
• Volunteer in your community
• Reframe negative situations 
• Focus your time and energy on what is under your control (vs what you cannot control)
• Positive thinking
• Surround yourself with positive people
• Build a strong support network 
• Work with a professional

How can I support healing if I had surgery to treat my pregnancy loss? 

If surgery is a part of your treatment in addressing a pregnancy loss, there are added considerations for recovery. In general, prioritize the same recommendations above and do anything below you can. 

Red light therapy 

Try it for at least 20 minutes daily to stimulate tissue repair and accelerate healing, reduce inflammation and pain, and support healing (61, 62, 63). (It can be any time of day or broken up into chunks; do it at least 10 minutes before bed to support melatonin and quality sleep). Look for a low EMF (electromagnetic field) light like this one.

Note: Studies have found red light therapy to support fertility by reducing inflammation, improving sperm quality, and improving conception rates. However, since it would be unethical to conduct studies on its safety during pregnancy, we do not have evidence guaranteeing it would be safe to use it (64, 65, 66). Therefore, it’s best to use it only when you are not pregnant. 

Glutathione

Glutathione supports immunity, liver detox, and antioxidant activity (67, 68). To increase glutathione production in your cells, consume sulfur-rich foods such as cruciferous vegetables (broccoli, brussels sprouts, cauliflower, kale, watercress, and mustard greens) and especially animal foods high in sulfur, including beef, fish, and poultry, since sulfur is needed to synthesize glutathione (69, 70). 

You could also take glutathione as a supplement alone or with another nutrient in a supplement, such as NAC. N-acetyl-cysteine/NAC is an amino acid that supports glutathione levels and promotes detox and antioxidant activity (71). You can take NAC in supplemental form and consume high-protein animal foods such as beef, chicken, and eggs. 

Other optional supplements to consider are arnica and bellis perennis to reduce pain, inflammation, swelling, and blood loss (75, 76). 

Emphasize healing your gut

If you underwent surgery, it’s also likely that you took antibiotics to prevent infection. It’s important to support gut health in an intentional way after taking antibiotics since they not only eradicate bad bacteria but also kill off good bacteria and deplete nutrients by reducing their absorption, including B vitamins, calcium, magnesium, potassium, and vitamin K (77, 78). 

Other ways to consider that support general healing AND gut health are humic fulvic minerals, collagen, and bone broth (which is also a source of collagen)

Humic fulvic minerals are minerals that also have the bonus of antimicrobial effects, are anti-inflammatory, contain antioxidants, and support gut health (72). You can add them to a mineral mocktail or any other drink (buy them here).  

Collagen is important to support tissue healing and regeneration (73). You can get collagen from meat skins, pork rinds, pulled pork, and bacon, or add it to coffee, tea, smoothies, or any other drink in supplemental powder form. We recommend either Needed (discount code TPNL) or Further Food (discount code RYANN18) collagen powders. 

Bone broth is a natural food source of l-glutamine, minerals such as calcium and phosphorus, amino acids, and collagen, and research has found it can reduce pain levels and pro-inflammatory proteins (74). You can make your own bone broth (with any carcass in a slow cooker) or buy it conveniently pre-packaged! 

Support natural detox in recovery.

“Detox” is often used as a buzzword, and a “diet culture” buzzword at that, but our bodies naturally detox through our skin (sweat), digestive tract (urine and feces), lymphatic system, kidneys and liver, and lungs (breathing). So, we aren’t at all talking about a tea or green juice detox here. In fact, it is not recommended to partake in any weight-loss-centric detoxes from your local juice shop. 

If you had surgery and antibiotics following a pregnancy loss, keeping detox pathways open and supporting natural detox (of anesthesia, antibiotics, and any other medications you may have been given) is an important piece of the recovery process. Yes, your body can and will do this naturally, but supporting it in doing so, especially considering everything you have been through in this healing journey, is important! 

Remember that the foundation of detox starts with diet! Focus on whole foods, quality animal protein and fat sources, hydration, and many different veggies. Additionally, cruciferous vegetables, berries, garlic, herbs, and spices such as turmeric can be helpful for detox systems and enzymes (79). 

Get a good sweat 

Every time you sweat, you remove waste products and toxins from the body (80). 

If you have access to a sauna, this can be a helpful additional tool to support natural detox after surgery and antibiotics (just clear this with your surgeon/medical team before using it again post-operatively) (81). An at-home sauna blanket is also effective as long as you’re sweating!

However, a sauna isn’t the only way to get in a good sweat-exercise (again, once you are cleared to do so); being outside in the sunshine in warmer months, or even doing housework, can be productive ways to work up a natural sweat to support this detox pathway. 

Digestion and elimination

Since toxins are excreted through feces and urine, staying hydrated and having daily bowel movements are key to elimination (82).

Between changing hormones following a pregnancy loss and especially if you undergo surgery, bowel movements may temporarily become less or more frequent (with either constipation, loose stools, or both). This is normal, but it doesn’t mean you can’t do anything about it. 

For constipation: 

• Add fiber to a drink/smoothie: psyllium husk fiber, chia, or flax seeds
• Add other higher fiber foods such as berries, nuts, and avocados 
• Move gently (even just getting out of bed) at least every hour 
• Stay hydrated and add lemon or apple cider vinegar to warm water each morning and as often as you’re able to 
• Ginger root or ginger root tea
• Magnesium citrate 
• Drink Traditional Medicinals smooth move tea

For loose stools/diarrhea (higher likelihood after surgery/antibiotics): 

• Keep foods bland: green bananas, unsweetened applesauce, bone broth, meats, soups, cooked veggies if tolerated (may need to temporarily limit or avoid veggies as well) 
• Stay hydrated and replenish electrolytes 
• If more severe, you can take a homeopathic remedy such as podophyllum peltatum  

Supporting blood flow and your lymphatic system

Your lymph system, or the network of organs, vessels, and tissues that move lymph fluid through the bloodstream, is also responsible for carrying waste products to be eliminated (83, 84).

To increase lymph flow, you can do any movement or form of exercise: walking, running, and especially jumping on a trampoline (just make sure if you are post-op that you wait until getting high-intensity exercise clearance) (85, 86). 

Respiration/breathing

Breathing stimulates lymph flow and reduces fluid accumulation (87).  Other ways to support respiration include exercising or any activity that gets your heart rate up, such as housework, brisk walking, or deep breathing. 

What are things I can do to advocate for myself to my medical provider(s) after a pregnancy loss? 

Whether you have had one loss or many, it is never wrong to want answers, look into potential contributors to the loss, and do everything in your power to try to reduce your chances of this happening again. 

While the exact cause of many pregnancy losses may never be known, especially if the loss was earlier on and did not require medical intervention, there are always things you can look into for any loss. You do not need to (nor do we recommend) wait until you have recurrent pregnancy losses to look into these. If your doctor/provider refuses to run any tests on you at all until you have had 3 consecutive losses (as is often standard practice), it might be a good idea to find another provider (88). 

Though miscarriages are not uncommon and do not always mean something can be addressed, there are sometimes things that can be done on a medical and/or lifestyle basis to reduce your chances of loss again. 

General things to inquire about and look into exploring after pregnancy loss include (some of these might include utilizing a functional health provider as standard providers might not have knowledge of these or be able to order/interpret them): 

• Blood sugar tests: HOMA-IR, fasting insulin, fasting glucose, A1C
• General health: CBC and CMP
• Thyroid tests: full thyroid panel + antibodies
• Infections and gut health (since as mentioned above, women with recurrent pregnancy loss have been found to have abnormal gut permeability (89): GI MAP, vaginal microbiome testing or vaginosis profile
• Nutrient status: Micronutrient panel
• Inflammation: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and plasma viscosity (PV)
• Toxins: Mycotox panel (if history of exposure to mold or symptomatic) 
• Recurrent pregnancy loss panel
• Hormone imbalances: prolactin, LH, FSH, progesterone, estrogen 

There are many more tests and even investigative surgeries to assess possible causes and root issues, but that goes beyond the scope of this note. Even so, the above information is a great place to start, especially if you are not definitively dealing with recurrent pregnancy loss or infertility. 

You do not need to explore all of these at once, but address what might be the most likely or probable factors for you based on your symptoms, environment, family history and other risk factors, health, and lifestyle. 

Also, don’t forget to explore possibilities with both spouses: semen analysis should be conducted, as well as any or all of the above labs as well.  

How can I, as a friend, support my friend who went through a pregnancy loss? 

Maybe you’re reading this note and haven’t experienced a loss yourself and are wondering how you can help support your friend through a loss. You are already being a good friend by caring and wanting to be helpful to them in this!

Here are some ways you can support them through this difficult time:

• Be present and listen: your time and attention are one of, if not the most helpful and valuable gifts you can give anyone suffering from a loss. If your friend needs space or wants to be alone, they can always decline your invites, but always reach out to them to at least offer ways to spend time together (or if they live far away, offer phone calls/video calls). Check up on them, especially if you notice them going radio silent or MIA for a while. 
• Ask them specific ways you can support and be there for them and offer suggestions and ideas, such as inviting them over/offering to visit them, bringing over meals, doing any activity the friend enjoys, doing something distracting like watching a comedy movie or reality TV night, or just going on a walk to process everything together 
• If the baby was given a name: refer to the baby by name
• Say: “I am so sorry for your loss.” It is important to articulate these words in some form, and this phrase is also adequate if you don’t know what to say. 
• If the loss mom is religious, prayer intention/service/mass cards, saint cards/medals/key chains/mini statues (if the baby is named after a saint) are always appreciated
• Recognize the loss mom and father especially during holidays that are difficult: send cards for mother’s day and father’s day (especially if this baby was their first and the parents might not otherwise be recognized), give them a special ornament for christmas with the baby’s name/sonogram picture, or an egg/mini Easter basket at Easter, card at Thanksgiving letting them know you are thankful for their family. 
• Do something special in memory of and honor of the baby: plant a tree, any kind acts of community service, organize a local walk/run with friends for the baby (optional: if a specific cause of death was known, have each person donate $5 and donate the money to a charity for that condition), donate to a charity the loss parents love 
• If you are looking for a gift for the loss mom, Etsy has many gifts and gift baskets, keepsakes, and other personalized tributes for pregnancy losses 
• Let them know their baby will never be forgotten and is always a special member of their family
• Recognize how no matter how short the life, their little one was created with a purpose and mission in this life and beyond
• Check in on them in the weeks and months (and years) following their loss: Grief over the loss of a life never completely goes away. Though it often becomes less acute and more bearable in time, it will always exist in some form and to some degree. Keep in mind, this holds true even if the couple goes on to give birth to more children, and is never a replacement for those lost! Sometimes, grief can become even lonelier in time when it is no longer acknowledged, as often people may be showered with love and support in the immediate days following the loss, but in time, others move on, while they never do. Simply acknowledging them by asking how they are doing regarding their little one, or even the occasional text or card letting them know you are thinking of them and the little one they lost, goes a long way in letting them know they are not forgotten, and you will be continually supporting them in this journey. 
• Follow their lead: everyone is unique, and each person grieves and copes with loss differently. Tune into the way your friend articulates their feelings and perspective on the situation, and support them by sharing their perspective and views on the situation. There is no one way or wrong way to grieve. 

For example, if they share how angry they feel or how unfair the situation feels, commiserate with them. Or perhaps they sometimes want to share about the joy that their baby brought them in a short time, or the good things that came of pregnancy, then join them in sharing how the little one’s short life touched you as well. 

Remember, grief is often multifaceted and might bring many different emotions on different days and times, so there can often be both joy and gratitude along with tears, anger, sadness, or disappointment—all are valid, and being a true friend is supporting and joining in all of the above in your friend’s healing journey. 

Other ideas for ways to support your friend during this time, depending on the nature of your relationship:

• Offer to drop by for a meal or organize a meal train (especially if they are undergoing surgery for a pregnancy loss) and/or make them one of the recipes to support healing above in the recipe section. If you live far away, you can send a gift card for a meal delivery service, a fast food delivery company, or their favorite restaurant gift card. 
• Send them a personalized wellness/goodie basket: this can be full of their favorite foods, comfort foods, a specific theme of a hobby or activity, pampering/spa themed, or a movie they love (this basket can also be funny, helpful, serious, sentimental, or a combo of the above). You can also send a healing basket if you know them well enough to know they would want the supplements and recommendations for products, foods, and supplements above in their healing journey (see above healing section for ideas. Things like fuzzy socks, a cozy blanket, lotion, teas, or other care products can also be comforting.
• Give the loss mom a gift card to some kind of pampering/spa/wellness service (e.g., mani/pedi, facial, wash and blowout, massage) if they would enjoy it. Self-care can become more difficult in grief, and having others take care of these things can be both soothing and a peaceful welcome distraction (as well as a relaxing excuse to get out of the house). 
• Write them a thoughtful card/note expressing your condolences, appreciation for them, or the impact their baby/pregnancy had on you, and letting them know you are in solidarity with them in these challenging times 
• Offer to host an event to recognize their baby, such as a mass or service followed by a luncheon, a celebration of life with other friends, or even just a day with the two of you doing things you love together, or any fun things in honor of their baby.
• Give (or make your own) memorial box.
• In the long run, let them know how their little one(s) are not ever forgotten, even if they go on to have future children on earth (even in the little ways, like acknowledging the total number of children/pregnancies they have, rather than just those that were to term or children born). One way to do this is by noting the important dates associated with the pregnancy loss in your calendar with annual reminder notifications (these might include days such as the date of loss, baby’s birthday for a stillbirth, or any other form of miscarriage which involved your friend giving birth/what she classified as giving birth, a D&C surgery date, due date, etc.). Recognize these days annually with verbal recognition, a text, a card, a phone call, or other check-in to let your friend know you are always remembering her loss, her little one, and allow her to talk about her little one or the events surrounding those days again if she would like.

Things to AVOID doing after someone experiences a pregnancy loss

Though everyone is unique and each person copes with loss in their own way, these are general phrases and actions that are often not helpful and even hurtful for those undergoing loss.  

• Saying nothing at all about the loss or avoiding the topic of the loss: it is often awkward and uncomfortable for those who have suffered a loss to bring up the subject themselves. If you avoid the subject, even if they want to process it out loud and talk about it. Ignoring the subject can also be hurtful (even if you are just trying to spare their feelings). Instead, ask directly about how your friend is coping/feeling/doing in the days and months following the loss. Don’t assume, just because a certain amount of time has passed, that they no longer want to discuss it or are no longer mourning. If you are worried they may not want to discuss it, you can always ask: “Would you like to talk about your baby/baby’s name? Or would you prefer some distraction right now?” 
• All phrases starting with the phrase “at least…” 
• Alluding to this event being “part of God’s plan” (even if you and your friend are religious, people might not agree that it is part of His plan, or agree that it is a good one, often have difficulty understanding it, and/or might find it patronizing for anyone to say that to them). 
• Being philosophical, bringing theology into the situation (unless they do so first), or trying to make it a teaching moment for them/offering wisdom in a patronizing way. Remember: saying “I am so sorry” is never wrong if you are at a loss for words! 
• Trying to find the good in the loss, unless the loss mom herself first talks about things she finds good in the situation 
• Avoid giving unsolicited advice unless your friend specifically asks for your opinion or advice on the situation. Avoid giving advice on grieving, managing the loss, healing, or ideas for trying to conceive or stay pregnant/prevent loss in the future. If they do not ask for advice, it’s safest to assume it would not be helpful at this time. 
• Vague phrases such as “Let me know how I can help.” Many people in grief do not have the mental capacity to come up with ways to help, which puts the burden on them to brainstorm ideas for your involvement. Instead, be creative and offer specific, concrete ideas and ways you can help, such as: “Would it be helpful if I did XYZ on this day?”
• Never allude to the loss being in any way within the person’s control, having been preventable (even if you feel it was, it is not appropriate to suggest it was this way between them and their medical providers), or somehow influenced by the person’s actions. If the loss mother wants to explore possible risk factors, this is her decision to make and a separate conversation to have at a different time, and only if she initiates it. 
• Asking when they will “try again” or if they have started trying to conceive again. Even if their TTC journey was something you discussed together in the past, it might be something they prefer to keep private following a loss or could be a sore subject (especially if a longer healing period that requires abstinence from TTC is warranted), so it’s safest to avoid asking unless your friend initiates the conversation. 

The Bottom Line

1. Pregnancy loss is devastating, with many physical and emotional complexities to address as you heal. There is no way to know exactly what caused your miscarriage, so it is important to understand it is not your fault. 
2. Though it can be difficult to find the motivation to optimize nutrition after a pregnancy loss, enlisting support with cooking can help you meet your nutrient needs. In general, focus on eating for blood sugar balance, foods that support both your physical and emotional healing, and foods for your gut health. If you had surgery to address your pregnancy loss, you can utilize red light therapy, drink bone broth, eat foods high in collagen, glutathione, NAC, and humic fulvic minerals to support healing and replenish nutrients lost through taking antibiotics, including B vitamins, calcium, magnesium, potassium, and vitamin K. 
3. Certain foods, as well as micronutrients, have mixed results when it comes to assessing if any of them are related to miscarriage, and research is still ongoing. However, testing your vitamin D levels and thyroid levels is an absolute must. 
4. Continue to take care of yourself, eat foods that make you feel good, have someone else cook for you, and stay hydrated. Other areas to potentially address after a pregnancy loss include managing grief and getting emotional support, prioritizing rest and sleep, reducing your toxin exposure, and reducing stress.
5. Find a doctor who listens to your needs; it is okay to ask questions and request more from your provider, whether that is in a deeper explanation or running more tests, including blood sugar tests, a full thyroid panel, infection, gut, and vaginal microbiome tests, a micronutrient panel, inflammation tests, toxin tests, hormone assessments, or a pregnancy loss panel.  
6. If you are a friend of someone who has recently experienced a loss, support them by being present to them, recognizing the immensity of the loss, offering specific ideas to support them during this time, and avoiding potentially hurtful comments or actions that could come across as minimizing the loss or making it seem less tragic than it is even if it is common. 

Written by: Claire Gilmore, MSCN, CNS, LDN and Alessandra D’Orazio, MS, RD

Reviewed/edited by: Ryann Kipping, MPH, RDN, LDN