While you are not eating for two when pregnant, you are certainly nourishing for two. During pregnancy, certain nutrient needs increase significantly from the pre-pregnancy time. Prenatal vitamins are incredibly important to help fill in the nutrient gaps from your diet. However, the supplements available on the market can vary quite a bit. Different prenatal vitamins can contain different forms of nutrients and different quantities of nutrients. Furthermore, certain prenatal vitamins contain more or less nutrients than other brands. Choosing a high-quality prenatal vitamin can be confusing, which is why I will highlight what to look for in a prenatal vitamin as well as share some of my top choices.
When to start taking a prenatal
Certain nutrients are especially important during early pregnancy. For example, folate is critical for the development of the neural tube, which occurs within the first four weeks of pregnancy. Insufficient maternal intake of folate can result in neural tube defects, which are defects of the baby’s brain and spinal cord (1). Because of this, it is important for the mother to consume adequate folate before conception and throughout pregnancy. In addition to folate, prenatal vitamins contain several other important nutrients. Taking a prenatal vitamin at least three months prior to becoming pregnant can help you start off pregnancy with adequate nutrient stores.
What to look for in a prenatal vitamin
Supplements aren’t regulated by the FDA. Because of this, it’s important to choose a prenatal vitamin that has been third-party tested to ensure that it only contains what it’s supposed to contain. Third-party testing is particularly important during pregnancy as there is concern for contaminants, like heavy metals, in supplements. Check the vitamin label or look on the company website for information on whether their products are third-party tested.
NSF, USP, or ConsumerLab are reputable third-party agencies. If a supplement is tested by one of these three companies, it should be included on the supplement label.
To search for NSF certified supplements, click the following link https://info.nsf.org/Certified/Dietary/
To search for USP certified supplements, click the following link https://www.quality-supplements.org/verified-products/verified-products-listings
Unfortunately, certifications by these top third-party agencies can be expensive. As a result, supplement companies may use other third-party testing agencies. If you want to learn more about the third-party testing for a particular supplement, the supplement company should be able to provide more information.
Don’t purchase prenatal vitamins on Amazon
Many of the items listed on Amazon are sold by third-party sellers and not the actual brand manufacturer. In the past, Amazon has had issues with counterfeit and fake supplements sold by third-party sellers (2). To be safe, purchase prenatal vitamins directly from the brand’s website, and not on Amazon.
Folate and Vitamin B12
You may have heard the terms folate and folic acid interchangeably, but they are slightly different. Folic acid is the synthetic form of the vitamin that is found in dietary supplements and in fortified foods. Folate is the form of the vitamin that naturally occurs in non-fortified foods. Both folate and folic acid need to convert to the active form, 5-methyltetrahydrofolate (5-MTHF) in order to be used by the body.
Some prenatal vitamins contain the active form of folate, 5-MTHF, instead of folic acid. Unlike folic acid, 5-MTHF is already reduced and does not need to go through any conversions in order to be used by the body. 5-MTHF in supplements has been found to have the same or greater bioavailability than folic acid. Furthermore, some women have a MTHFR gene mutation, which prevents folic acid from being converted to 5-MTHF. For those women with the MTHFR mutation, supplementing with the active form of folate, 5-MTHF, may be important so folate can be properly metabolized by the body (3).
Similarly, methylcobalamin is the biologically active form of vitamin B12. This form of vitamin B12 is used in many prenatal supplements.
Sufficient Vitamin D
Vitamin D is a unique nutrient in that it is primarily obtained from the sun. It can, however, also be found in certain foods, like fatty fish and fortified dairy products (1).
The current recommended amount of vitamin D is 600 IU. However, this recommendation may not provide sufficient vitamin D during pregnancy. Those who have insufficient vitamin D levels prior to conception, may require higher vitamin D intake. It’s important for women to get their vitamin D levels checked prior to conception to know if they are vitamin D deficient and if so, may require higher supplementation.
Look for a prenatal vitamin containing vitamin D3 (cholecalciferol) instead of vitamin D2. This is because vitamin D3 can more effectively increase serum vitamin D levels and keep levels higher longer that vitamin D2 (4).
Iron or Calcium, not both
Consuming iron and calcium at the same time can decrease the absorption of iron (5). Many prenatal vitamins contain either iron or calcium, but not both. To know which nutrient to prioritize in a prenatal vitamin, work with a registered dietitian to understand your dietary intake of both nutrients. Additionally, getting your iron levels checked prior to conception can inform you if you are deficient and may need iron supplementation.
Some women may require additional supplementation on top of their prenatal vitamin. If taking a separate iron or calcium supplement, it should be taken at a different time than a prenatal vitamin to avoid consuming iron and calcium at the same time.
Choline and Iodine
Choline and iodine are key nutrients for pregnancy, but aren’t included in every prenatal vitamin. Look for a prenatal vitamin that contains these important nutrients.
Eggs are one of the best dietary sources of choline (6). If you’re not eating eggs and your prenatal vitamin does not contain choline, you may want to consider taking a choline supplement.
DHA is an added bonus in a prenatal supplement, but not necessary if you’re consuming low-mercury, fatty fish rich in DHA. However, those who are not consuming fish may want to consider taking a DHA supplement or choosing a prenatal vitamin that contains DHA.
Talk to your healthcare provider
It’s important to review the supplement ingredients list, which nutrients are included in the supplement as well as the quantity of each ingredient compared to the daily recommended value. Certain nutrients can be toxic if taken in excess, so be sure to consult your professional healthcare provider before adding any supplements to your routine. Show your prenatal vitamin to your professional healthcare provider to ensure that it doesn’t contain ingredients or nutrient quantities that could interfere with any medications or supplements you are taking.
Every pregnant woman has different needs based on factors, including her health history, nutritional status, and current dietary intake. Specific supplement recommendations will vary from person to person based on these factors and additional factors like budget and pill tolerance. Furthermore, certain women may need additional supplementation on top of a prenatal vitamin. Talk to your professional healthcare provider to ensure you are choosing the supplementation protocol that is right for you and your specific needs.
Since men are half of the equation, it’s also important for the male partner to supplement with folate prior to conception. The male partner can take a daily men’s multivitamin, containing folate. Men have different needs than pregnant women, so it’s important for the male partner to take a multivitamin that is specifically catered to men. Evidence suggests that consumption of antioxidants and omega 3 fatty acids may improve sperm quality (7). I will also share some of my favorite men’s multivitamins in my prenatal vitamins handout. As always, men should consult their professional healthcare providing before adding any supplements to their routine.
My Top Prenatal Vitamin Choices