#03: Needed

When I was in college studying nutrition and dietetics, I remember being fascinated by a lesson on the nutritional demands of pregnancy.

"Eating for two" is a phrase often used to describe the food habits of expecting mothers, but this often makes us think of the quantity, rather than the quality, of food being eaten. And yes, while pregnant women do require more calories to sustain a healthy pregnancy, they also need more nutrients.

Specific nutrients, such as folate, are absolutely critical during pregnancy.

Folate deficiency in pregnant women has been shown to cause severe birth defects, most notably neural tube defects, and can even lead to miscarriage. Women who are planning to become pregnant are advised to consume no less than 400 micrograms of folate per day, and ideally more, up to 1000. We're talking about a nutrient on the order of micrograms that can make the difference between a healthy baby, and one with life-altering birth defects.

Luckily, the importance of folate in pregnancy has been recognized for some time now.

Food and ingredients such as bread, pasta, and flour are fortified with folate in the US, and have been since the FDA mandated that food manufacturers do so in 1998 as a public health measure.

Still, pregnancy is highly metabolically demanding, and if pregnant women don't consume adequate amounts of certain vitamins and minerals, both they and the baby are at risk of deficiency.

This is where prenatal supplements come in.

Prenatal supplements help women who are, or are expecting to become pregnant, ensure that they get enough essential nutrients for the best chance at a healthy pregnancy, outside of what they consume in their diet. But the problem is that we're talking about supplements, which are not regulated by the FDA, resulting in a wide variation in quality between brands. A women can take a prenatal supplement with the expectation that she's getting total coverage of all the nutrients she needs, all the while the supplement is in fact lacking in one more critical areas.

This is why when I found Needed, I had to write about them

Needed is a prenatal supplement company that recognized the problem of subpar prenatal supplements, and decided to do something about it.

Today, we'll learn about how Needed has expertly developed prenatal supplements that meet the needs women throughout their pregnancy journey.

We'll also talk about:

• The state of prenatal supplements

• Needed’s products and resources for men's preconception health

• How Needed is creating educated consumers

• The market for maternal care and other startups in the space

Prenatal Supplements: It's hit or miss

"FDA Approved" is not a claim that any nutritional supplement can make.

This is why in the US, the quality and claims of supplements should always be studied carefully. This isn't to say that supplements don't work, or that that bottle of vitamin B you just bought from Amazon is nothing but sawdust; Supplementation is part of the health routines of many people, and often to their benefit. But the Food and Drug Administration, the organization tasked with protecting public health by regulating drugs and subjecting them to years of testing, doesn't oversee them, leaving manufacturers and private companies to regulate themselves.

This can lead to a wide variation in the quality of products, and nowhere is this more pronounced than the prenatal supplement market.

In April of this year, research out of the University of Colorado School of Medicine found that 99% of affordable commercial dietary supplements do not contain appropriate doses of key vitamins and nutrients necessary to provide healthy supplementation for pregnancy.

Just last year, in the Maternal Health, Neonatal, and Perinatology journal, researchers published a meta analysis that looked at how the contents of 180 commercially available supplements stacked up to current evidence-based recommendations for eleven vitamins and nutrients that are important to a healthy pregnancy. The study looked at mostly single-vitamin supplements, and found that depending on the vitamin or nutrient, only 10% - 60% of supplements tested met or exceeded the recommendations found in the literature. The only category of supplement who's contents exceeded 90% of the recommendation was folate, due to it's paramount importance in pregnancy.

In a follow up study that assessed the mineral content of over 100 prenatal supplements, the authors again found that they, "varied widely in mineral content, often contained only a subset of essential minerals, and the levels were often below our recommendation."

To be clear, supplementation alone is not enough for a healthy pregnancy. First and foremost, pregnant women need to consume a diet that gets them as close as possible to their micronutrient and caloric needs, in a way that is healthy and sustainable. Supplements are meant to fill in the gaps, providing added insurance and making up for any dietary deficiencies.

Still, it's been shown that many pregnant women struggle to get all the nutrients they need, even with supplementation. In 2019, a paper published in JAMA Network looked at a sample of 1003 pregnant women, nearly 70% of which reported using a prenatal supplement. Using data from the National Health and Nutrition Examination Survey (NHANES), they sought to determine the proportion of women at risk of inadequate dietary intake. They found that over 10% of women in the study we're likely not meeting the recommendations for vitamins D, E, K, A, C, and B6, as well as folate, zinc, choline, iron, calcium, potassium, and magnesium, despite using a prenatal supplement.

Depending on socioeconomic status, education, and food environment, a woman's access to food and supplements that meet the needs of her pregnancy can vary widely. There's a need in the market for quality supplements that address all aspects of prenatal nutrition, in a way that is accessible and affordable.

Enter, Needed.

The Founding of Needed

Needed was founded in 2020 by Julie Sawaya and Ryan Woodbury, who met during their time in business school at Stanford.

Both are trained nutritionists and mothers, who discovered through diagnostic testing that they were both deficient in key nutrients needed for a healthy pregnancy. Taking their health, and that of their children, into their own hands, the two delved into the research on prenatal supplements and found that over 95% of women taking a prenatal supplement were still deficient in key nutrients. Over the course of three years, Julie and Ryan worked on designing a prenatal supplement that provided the nutrients pregnant women need, and then some. Looking at the problem holistically, they developed a host of other supplements to support a healthy pregnancy, creating a complete nutritional system for expecting mothers.

Today, needed has over 50 employees, and has built a network of over 3,000 health experts, including physicians, dietitians, and midwives, who help to develop new products, provide pregnancy education, and set a new standard for prenatal nutrition.

Needed's Product Lineup

Needed's product lineup supports women's health at each stage of pregnancy, including prenatal, pregnancy, and postpartum. They also have a line of men's supplements, designed to support overall health, as well as sperm health.

Supplements are sold in pill and powder form, and can be bought individually or as part of a subscription package. As of January 2023, Needed had about 5,500 subscribers. Many of Needed's products are also sold as bundles, consisting of multiple products that complement one another.

Needed has six plan options, each designed for women at different stages of their pregnancy journey.

Assessing Needed's Products

Looking at Needed’s prenatal multi supplement, it contains 24 vitamins and minerals shown to support a healthy pregnancy.

Notably, many of the vitamins and minerals have been incorporated in their most bioavailable forms, such as magnesium bisglycinate, methylated folate, and vitamin D as cholecalciferol.

Most nutrients in the prenatal supplement are well over the recommended Daily Value, which is a reference amount for how much of a nutrient to consume daily, provided by the FDA. This isn't necessarily cause for worry, however, as the Daily Value references are for pregnant and lactating women, who have higher nutrient demands than non-pregnant women. Many of the vitamins included in high amounts are also water soluble, meaning most of the excess will be excreted in the urine.

Alongside their prenatal multi, Needed also offers supplements that support a healthy gut microbiome, promote relaxation and aid in sleep, immune support, and hydration.

For both men and women, Needed has developed omega-3 supplements, which are essential fatty acids that we must get from our diet and are crucial to fetal development.

Omega-3 fatty acids are a type of polyunsaturated fatty acid.

They play an important role anti-inflammatory processes, and are used to make up the cell membranes of the eyes and brain, among other parts of the body. Adequate omega-3 intake is important during pregnancy, as these fats are used intensively for fetal brain development and have been shown to help prevent premature birth.

Studies have shown that a majority of people in the United States consume less omega-3 than is recommended for optimal health, and pregnant women are at even greater risk, since omega-3's are used by both the baby in the womb and in breast milk.

Omega-3's can be found in foods such as fish and nuts, but for women without easy access to these foods, or who have difficulty eating these foods before, during, or after pregnancy, supplements are a great option.

Customers can test their omega-3 levels before making a purchase, using a test provided by Needed. The test provides a measure of a person's omega-3 index, which is a measure of the ratio of DHA and EPA, two constituent fatty acids of omega-3.

How Needed is Addressing Men's Preconception Health

Men's role in preconception matters, and Needed has addressed this through a guide on preconception health for men on their site, alongside their men's supplements.

The guide focuses on illustrating why men's preconception health matters, and helps empower men to learn about their role in fertility. For example, sperm count and quality have a major impact on fertility, and are both impacted by lifestyle factors such as nutrition, exercise, and sleep.

The Standard American Diet, a sedentary lifestyle, and environmental toxins have all been shown to do a number on testosterone, which negatively impacts sperm. Shifting to a diet rich in plants, lean meats, and high quality fats are a great way to improve testosterone and sperm health, as is getting regular exercise, managing stress, and avoiding endocrine disruptors such as bisphenol-A, commonly found in plastics.

The guide details foods, supplements, and exercises that can all be used to help support optimal testosterone and sperm health, as well as additional resources on all of these topics.

To support men's fertility, Needed has created a fertility-promoting multi-vitamin, which contains many of the same nutrients found in the women's multi, although at different quantities. They also make a supplement meant to support healthy sperm, featuring a host of pre- and probiotics, antioxidants, and botanical extracts.

Creating educated consumers

Needed provides education on every vitamin, mineral, and nutrient included in their supplements for anyone seeking to understand more about the importance of each to a healthy pregnancy.

For example, when looking at choline, prospective buyers of the prenatal multi supplement can learn more about its role in fetal development, how Needed's prenatal choline content stacks up against competitor brands, and why choline was used in the form and dose listed on the nutrition label.

Listed below each nutrient are several research papers pertaining to it, good resources for anyone interested in diving deeper into the science behind a particular nutrients role in a healthy pregnancy.

Creating educated consumers is, in my opinion, vitally important to any brand selling health products.

By helping consumers understand why a product is beneficial to their health, and not just telling them that it is, brands are able to create more trust and loyalty, while also helping consumers make more informed decisions.

Consumer education is a core part of Needed's business. Their blog features dozens of articles on topics such as pre-conception health for men and women, postpartum and breastfeeding, nutrient testing, and in-depth guides on nutrition.

Much of the education on Needed's site was created in partnership with practitioners from their Changemaker's program.

Needed Changemaker's is a collective of over two dozen women's health practitioners, including midwives, registered dietitians, and medical doctors. The collective focuses on providing education, community, and advocacy for perinatal care, as well as contributing to product development at Needed.

Practitioners interested in joining the collective and bringing awareness of Needed products to their patients and clients can join through Needed's site.

Being part of the program includes benefits such as discounted Needed products for patients and clients, opportunities to contribute to educational material, and input on new product developments.

Third-Party Testing

All of Needed's supplements are third-party tested by independent labs that verify the quantity and quality of the nutrients contained in them.

Third-party testing is an important factor to consider for anyone purchasing a nutritional supplement. As we covered earlier, the FDA doesn't regulate or test supplements for quality, so third-party testing provides an important function of accountability for otherwise unregulated supplement companies.

Helping women in need

To help women who can't afford high-quality supplements, Needed donates products to give-back programs for pregnant and breast-feeding women in need.

They've also partnered with healthcare clinics focused on serving pregnant women, and contribute money and products to research partnerships focused on nutrition research on fertility, pregnancy, and postpartum health.

Funding

Needed has raised $8 million in Seed funding.

Their Seed round was co-led by Seae Ventures and Sekhmet Ventures, with participation form Peterson Partners and Crescent Ridge Venture Partners.

Other innovators in maternal care

Needed is doing great work to help women and men get the nutritional support and education they need for optimal fertility and pregnancy.

Their supplements support a wide range of physiologic processes vital to a successful pregnancy, are backed by the latest research and third-party tested, and have been influenced by practitioners who play many different roles in pregnancy care.

Researching Needed led me to discover a whole lot of other startups who's mission it is to make pregnancy safer, healthier, and more successful for women and their babies. The market for maternity and newborn care is massive, valued at $504 billion in 2020 and expected to grow to $1.7 trillion by 2030.

Here are just a few of the companies I learned about, some of which I may cover in future newsletters:

• ByHeart: A baby nutrition company that makes formula clinically-proven to be closest to real breast milk in terms of nutrient composition.

• Oula: A modern maternity-care clinic that combines clinical obstetrics and midwifery to bring compassionate, evidence-backed, and insurance-reimbursed maternity care to more pregnant women than can be cared for by a OBGYN alone.

• Bloomlife: A remote maternity-care company that provides low-cost, high-quality care to women with at-risk pregnancies.

• Pots for Tots: A healthy meal delivery service for baby and toddler food.

Job Board

Open roles at Needed as of August 14, 2023

Needed does not currently have any open roles listed on their website or LinkedIn, however in their FAQ section they encourage anyone who thinks they would be a good fit to email [email protected] with their resume and why they think they'd be a good fit.