Choosing Your Prenatal Vitamin: Building A Healthy Pregnancy 

There are many choices when preparing for a healthy pregnancy.  Everything from what you eat, your prenatal vitamin, and environmental exposures may impact your pregnancy and your growing baby.  You can start by optimizing your fertility and starting with a prenatal vitamin is the easiest step.   

Why do You Need to Take a Prenatal Vitamin?

In an ideal world, it is easy to have access to quality food from quality sources all year long. The reality is that modern agriculture has depleted the soil and global warming has affected our growing times. Our bodies are further stressed by busy lifestyles, jobs, social injustice, pandemics, and medications like birth control.  This means many people enter pregnancy already nutrient-depleted and then there is the natural increase of nutrients needed for pregnancy and breastfeeding.  

Of course, food should always be our first source of nutrition whenever possible. Eating a healthy, colorful, and diverse diet will help you get most of the vitamins and minerals you need. Of course, prenatal vitamins do not take the place of a healthy diet in creating a strong nutrition foundation for you and your baby. But they do offer a buffer, an extra insurance policy, to help bridge the gaps in what’s missing in your diet.   

Numerous studies show that taking a prenatal vitamin not only improves the baby’s health, but also the health of the birthing person. Benefits include improved fertility and a reduced risk of miscarriage. During pregnancy, benefits include a reduction in complications such as gestational hypertension, preeclampsia, preterm birth, low birth weight babies, birth defects, and stillbirth.  As you can imagine, all of these can have major impacts on the physical and mental health of the family. Long-term, there is a decrease in chronic problems for the children including diabetes, obesity, and cardiovascular disease, to name a few. 

When Should You Take Prenatal Vitamins?

Pregnancy nutrition is critical from just before the moment of conception. And yet, the reality is that half of the pregnancies in the US are unplanned.  This means that we need to optimize our nutrition intentionally before pregnancy. 

Many providers recommend anyone in their childbearing years who are sexually active take a prenatal at best that contains at least 800 mcg/day of methylfolate and 2000 units of Vitamin D. Methylfolate is particularly important (see below) because it is essential for the healthy development of the baby’s nervous system which mostly takes place before most people even have a positive pregnancy test! 

If you are planning on becoming pregnant in the next year, consider starting your prenatal vitamins at least 3-6  months in advance. It is never too late, so start them as soon as possible.  

It is common to continue your prenatal vitamins for at least 3 months postpartum if you are formula feeding, and at least 12 months if you are breastfeeding. Even after you have weaned you will want to continue your prenatal vitamins to replenish lost nutrients from pregnancy and recovery.   Depending on your family plans, you may choose to stay on the prenatal vitamin as a daily nutrient supplement as your next pregnancy is not that far out.  

Which Prenatal Vitamin Should I Take?

All prenatal vitamins are not created equal. Many fall short and others are filled with additives, fillers, and artificial colors. What is most important is their bioavailability- or their ability to be absorbed and used by the body. 

Instead of recommending specific brands or products, I want to address the ingredients. You may find all or most of these in a single supplement or you may choose the spread out. You may prefer chewable or pill form.    

Tips for taking your supplement: 

• Avoid taking your supplements on an empty stomach. Always take your prenatal supplements with food, ideally in the middle of a meal so that there is food buffering the supplement.  
• Try taking your supplements at different times of the day, especially if you get nauseous in the morning.   
• Heartburn can be from a lack of acid in the stomach.  So try taking your prenatal supplements with something that’s slightly acidic, like lemon or citrus water. 

 

Here are the nutrients I look for when evaluating prenatal vitamin quality and why: 

• Methylfolate:  Prior to pregnancy, it improves egg quality,  preventing miscarriage, as well as other pregnancy complications including preeclampsia. During pregnancy, folate plays a special role in the formation of a baby’s chromosomes, neural tube, and nervous system. It also can affect prenatal and postpartum anxiety and depression. However, if you are part of the 30-50% of the population that has the MTHFR gene, you can not absorb and use regular folic acid from your diet. This test is expensive and not typically covered by insurance companies. Dose: Use a prenatal with 400–800 mcg methylfolate. 
• Vitamin B6: Supports healthy levels of progesterone which creates a healthy uterine lining for implantation. Many women enter pregnancy low in B6, especially if they’ve been using hormonal contraceptives. Dose: 5-10 mg of Pyridoxal-5-phosphate (P5P) a day.  If you are experiencing morning sickness, speak to your provider about increasing the dose to 50-100 mcg/day.
• Iron: Anemia, low iron, is associated with many poor outcomes. Anemia can be a reason for infertility. In pregnancy, it can hinder immunity which in turn increases infection rates and is associated with infections. Iron supplementation also helps the baby to get a full gestational period.  Dose: To avoid constipation from iron, take 27 mg of iron chelate, which is the non-constipating form. 
• Iodine: Critical to your healthy thyroid function and therefore your menstrual cycles and fertility, iodine also prevents miscarriage and stillbirth. Pregnancy, it’s also critical to your baby’s thyroid, brain development, and central nervous system development. Even mild iodine insufficiency can affect your thyroid health and fertility, and deficiency is associated with reduced IQ and cognitive development in a baby. Dose: Your prenatal vitamin should contain a daily dose of 200 to 250 mcg of iodine.

• Choline: Essential for baby’s neurologic development and cognitive function, especially memory, focus, and attention. Adequate intake may prevent birth defects and provides your child with stress resilience and protection from anxiety. While choline can be obtained from the diet, many of our diets fall short, as eggs are one of the primary sources aside from beef and calf liver. Dose: Your prenatal should contain 400 mg. 
• Zinc: Plays a role in ovulation, supports healthy estrogen and progesterone levels, and is important for optimal immune function. It protects the developing egg against oxidative damage and is important for fetal brain development and function. Dose: Your prenatal should contain between 15- 45 mg of zinc daily. 
• Omega-3 Fatty Acids (DHA/EPA): Play an essential role in the conception and the formation and development of the oocyte and embryo. Higher intake is associated with a better ovarian reserve and higher rates of conception. DHA is also critical for the baby’s brain and neurological development may prevent preterm labor. Interestingly, a couple of studies have shown that it can improve stress resilience and maybe prevent prenatal and postpartum depression. Dose: I recommend a combined DHA/EPA, either from fish oil or a vegan source. 
• Vitamin D:  Is associated with improving fertility. It promotes healthy follicle formation, and in studies of women undergoing IVF, people with higher vitamin D levels have not only pregnancy rates 35% higher, but higher quality embryos compared to those who are deficient. It also appears to prevent preterm labor. Natural food sources include fatty fish, eggs, and mushrooms. Natural sunlight is also an important source, but dietary sources and sunshine aren’t usually enough to meet fertility and pregnancy needs. Dose: For most people, 2000 iu daily will take care of deficiency, but it’s ideal to have your level checked and supplement accordingly. 
• A probiotic: Taking a probiotic may assist with fertility, conception, and healthy pregnancy in a variety of different ways. A disruption in the vaginal microbiome can favor the growth of organisms that interfere with fertility and increase pregnancy risk including miscarriage and preterm birth. Women undergoing IVF often have higher levels of BV and abnormal vaginal flora, which is now suspected to be a cause of infertility that led them to treatment and may also interfere with IVF success. Probiotics can also help reduce inflammation and regulate blood sugar. Taking a probiotic containing a broad spectrum of Lactobacillus species may provide you with a fertility advantage. It can also help prevent urinary tract infections, gestational diabetes, preeclampsia, as well as prenatal or postpartum anxiety and depression. Probiotics throughout pregnancy may help to prevent eczema, allergies, and asthma in their babies. Look for probiotics in the refrigerated section instead of shelf-stable ones. 

Choosing What’s Best for You

Once we know the quality is there, the decision of which to take becomes a matter of your personal preference and tolerance – dose, cost, form, and a little bit of trial and error to find what works all come into play. What one person loves, another may get nauseated at the smell of.  If you have trouble taking a prenatal, you’re not alone- so consider different options like a gummy or take them in the middle of lunch instead of the first thing in the morning. 

Remember to always speak with your health care team prior to starting any supplements.