Taking prenatal vitamins is vital to a healthy pregnancy. An integral part of prenatal care, they can significantly prevent major birth defects such as spina bifida, anencephaly, heart defects, and cleft palates and lips. They also help ensure that mothers-to-be have the essential nutrients they need throughout the entirety of their pregnancy. But figuring out which prenatal vitamin to take can seem overwhelming. Before trying to conceive, women should talk with their doctors about what supplements they recommend and why.
In addition, many commonly asked questions about prenatal vitamins are answered in the below guide, created by ConsumersAdvocate.org. What nutrients need to be included and at what amounts? Is a gummy or capsule more effective? Is organic better than synthetic? Are over-the-counter vitamins regulated by the U.S. Food and Drug Administration? For women and for health care providers, this piece is a great starting point for a discussion on the best ways to promote a healthy pregnancy.
Prenatal Vitamins Reviews
See which six prenatal vitamins are ConsumersAdvocate.org’s top picks and why.
Helpful Information About Prenatal Vitamins
Find out what points should be considered when choosing a supplement. You’ll also get information on key nutrients, including recommended daily amounts, the difference between folic acid and folate, and why women with the MTFHR gene need a specific form of folate. (You can also read more about folic acid and folate in the “Prenatal Vitamins” section in our prenatal care article.)
What to Watch Out For
Learn which three vitamins vegan women should pay special attention to and whether it really matters if a vitamin is made from natural or manufactured components.
FAQs About Prenatal Vitamins
Get answers to some commonly asked questions about prenatal vitamins.
OUR TOP PICKS: PRENATAL VITAMINS REVIEWS
The art of reading vitamin labels is a tricky one. For starters, vitamins aren’t regulated by the FDA and companies often litter their bottles with attractive claims such as “organic”, “Non-GMO,” or “Gluten-Free.” While these labels are important, it’s perhaps even more important for expecting or lactating women to be aware of what supplement labels claim they include and in what dosages. Equally important is knowing if the pills have been tested by an independent third party that can verify if these claims are accurate.
Finally, no matter how fancy a supplement may sound, it’s important to consider if you can actually stomach a particular pill, since you’ll most likely be swallowing these more than once a day, every day, for at least nine months. So, without further ado, here are our picks for best prenatal supplements based on third party verification, ingredient contents, and pill type.
NATURE MADE MULTI +DHA REVIEW
Best Value Supplement
Screenshot Naturemade.com, December 2019.
How Many Pills a Day: 1
Cost: $11.75/ 60 count on Amazon
With over 40 years of experience in the vitamin industry, Nature Made is one of the most recognizable brand names in the market, a comforting thought given how vast and varied the supplement world is. Nature Made also counts with the United States Pharmacopeia label (USP), meaning the ingredients have been thoroughly vetted and have been found to be not only safe, but also accurate in chemical composition and quantity.
With 27 mg of iron, 800 mcg of folic acid, and 1000 IU of vitamin D, Nature Made’s prenatal supplement checks off almost every box for required nutrients, at an affordable price. Additionally, the supplement includes 200 mg of DHA which is essential for the baby’s neurological development. Most companies don’t include DHA in their formula, much less have the added benefit of including all of their nutrients in a single convenient soft gel pill.
As with most prenatal vitamins on the market, these supplements include a reduced dose of calcium, so it’s important to get the required amount from other sources.
BEST NEST WELLNESS MAMA BIRD AM/PM REVIEW
Best for Vegans
Screenshot bestnest.com, December 2019.
How Many Pills a Day: 2
The Best Wellness Company’s Mama Bird Prenatal AM/PM Multi + is our pick for best vegan supplement. Although they don’t specify the lab they use, the Denver-based company assured us that their vitamins undergo third-party lab verification, and that their “manufacturing facilities are supplement GMP-certified in the USA and forms are provided to the FDA.”
Mama Bird vitamins, which are also gluten- and soy-free, come with a hefty dose of folate at 800 mcg, excellent for those with the MTFHR gene mutation. The vitamins also provide 10 mcg of B12 which compensates perfectly for the lack of B12 in some vegan mothers’ diet.
Additionally, Mama Bird supplements come with 50 mg of choline, a necessary nutrient that aids in several bioprocesses during pregnancy, and that has been connected to the neurological development of the baby. Few supplements include choline in their ingredients, making these vitamins especially beneficial for pregnant and lactating women.
The company also offers a monthly subscription service where you can get 7% off the original price if you sign up.
One downside to these supplements is that they don’t contain enough vitamin D, with only 10 (400 IU) of the recommended 15 mcg. However, one positive element is that the company uses lichen to extract cholecalciferol, meaning you get the recommended D3 instead of the usual vegan-friendly pills which contain D2 and aren’t as readily absorbed by the body.
SMARTYPANTS ORGANIC REVIEW
Best Gummy Supplement
Screenshot smartypantsvitamins.com, December 2019.
How Many Gummies a Day: 4
Cost: $36.95/30-day supply
Because women are hypersensitive to taste during pregnancy, gummies can be a welcome alternative to the so-called “horse pills” most prenatal vitamins are considered to be. Due to how organic and nutrient-packed their supplements seem to be, Smarty Pants’ Organic gummies are our top pick for best gummy prenatal supplement.
Smarty Pants organic gummies provide the nutrition needed for a healthy pregnancy including 600 mcg of folate, 17.5 mcg of B12, and 1200 IU of vitamin D.
One big downside to Smarty Pants is that, like most gummies, it doesn’t contain iron. And, since it doesn’t have calcium either, you’ll need to find alternative sources for both of these essential minerals.
Another thing to keep in mind when considering this or any other gummy is that their sugar levels are usually much higher than traditional pills, a problem for women with blood sugar issues or those at risk of gestational diabetes. Smarty Pants Organic Gummies include 7 g of added sugar per serving size (4 gummies), so it’s important to check with your doctor or nutritionist before choosing this type of prenatal supplement.
These gummies are certified by both the USDA and the American Vegetarian Association making them verifiably organic. Smarty Pants also assured us their products are third-party verified by “nationally-recognized, Good Manufacturing Practice laboratories that are ISO 17025 certified.”
MEGAFOOD BABY & ME 2 REVIEW
Best Whole-Food Based Supplement
Screenshot Megafood.com, December 2019.
How Many Pills a Day: 2
Cost: $31.77/30-day count
MegaFood’s Baby & Me 2 is not exclusively made with whole foods, as they also include yeast in their processing. They obtain their nutrients from foods such as carrots, oranges, brown rice, and cabbage, which could help in the better absorption of nutrients due to the different phytonutrients interacting in the process.
The herb-less Baby & Me 2 formula includes 600 mcg of methylated folate, 18 mg of iron, and 600 IU of vitamin D. Although these vitamins don’t include calcium or magnesium because they inhibit iron absorption, they contain 300 mg of choline, which is much more than most pills provide.
We found this Certified B corporation to be one of the most transparent companies, not only providing the name of all their third-party test labs, but also the name of their in-house test lab. Their supplements are Non-GMO and NSF-gluten free certified. The company also offers a monthly subscription service where you can save up to 10% off the original price.
One important thing to note is that, when choosing whole food or yeast-based supplements it’s important to keep in mind the reaction these may have on your body. Occasionally, food-based supplements will include foods or nutrients that could cause allergies to flare up in people who may have not even known they had them in the first place. The same goes for people who may be susceptible to bacterial overgrowth, which the ingestion of yeast might exacerbate. As always, it’s important to always check the label to verify it doesn’t contain foods you might be sensitive to.
Most Complete Supplement
Screenshot Theralogix.com, December 2019
How Many Pills a Day: 2 tablets, one soft gel 1
Cost: $75/91-day supply without prescription or $58/91-day supply with prescription
TheraNatal is our pick for overall best prenatal because of how complete and encompassing its formula is. While it does require taking three pills a day, the supplement provides every essential nutrient—in the optimal dosage required—you will need for a healthy pregnancy.
TheraNatal includes 1000 mcg of methylated folate, 12 mcg of B12, 27 mg of iron, and 3000 IU of vitamin D—five times the RDA dosage, but an amount that is still considered safe, and even necessary for pregnant women. In addition to this, TheraNatal also includes 300 mg DHA, the proper RDA for pregnant women, and 150 mg of choline.
Although $75 may seem like a hefty price to pay all at once, its 91-day count really places these vitamins at around $25 a month, a more affordable option than many prenatal supplements out there. Additionally, the price is even lower if a physician prescribes it. TheraNatal is also third-party tested and “certified by NSF & IFOS, in a cGMP registered facility.”
A potential downside to this supplement is that, as we mentioned above, it comes in the form of three pills—2 tablets and one soft gel—which might be a burden to women who are especially sensitive to swallowing pills.
RITUAL ESSENTIAL REVIEW
Best for Sensitive Stomachs
Screenshot Ritual.com, December 2019.
How Many Pills a Day: 2
Cost: $35 per month
If you’ve heard of Ritual Vitamins, it’s probably through their glossy Instagram campaigns. However, Ritual is more than just a pretty brand. The company has made an effort to come across as one of the most transparent in the industry. On their website, the company has made a point to describe each of their ingredients as well as their source of origin, so you know exactly what you’re getting in each bottle. Additionally, when we asked, the company willingly provided the names of their third-party laboratories and affirmed that their products undergo ongoing testing. They even offered to connect us with someone from their in-house testing team to answer any questions we could have.
Ritual’s Essential prenatal supplements aren’t the most comprehensive in terms of ingredients. But although many of the vitamins and minerals included in most prenatal supplements are missing from this supplement, they do provide the essential nutrients: 1000 mcg of methylated folate, 18 mg of iron, 2000 IU of vitamin D3 from lichen extraction, and 8 mcg of B12. The vitamins also include 350 mg of DHA and 55 mg of choline. The supplements do not contain any calcium, though.
One peculiar element about these vitamins, which are also vegan-friendly, is that they’re made with a “no-nausea capsule design” which is supposed to minimize discomfort while taking the pill. According to the company, this specially designed capsule works by dissolving in the “less sensitive, more absorptive areas of your gut that can be easier on your stomach.” Additionally, the pills are citrus-infused to make the experience of taking them that much more pleasant.
Ritual works solely through a monthly subscription, but you can cancel at any moment.
MORE INSIGHT INTO OUR METHODOLOGY
The world of vitamin supplements is a vast and unregulated space that can seem daunting and even scary at times. Taking prenatal supplements is an absolutely essential part of pregnancy that ensures your baby grows healthy and strong enough to thrive in the outside world. But they’re equally important to keep the mother healthy and strong enough to carry another being.
For this reason, we identified three different factors to keep in mind when selecting a prenatal supplement: whether the supplements are verified by independent third parties; the pill type available (gummies, tablets, or capsules); how many you need to take and how often; and, of course, its ingredients.
Additionally, although we initially considered organic or synthetic as a factor, we found that the topic is too nuanced to make any conclusions as to which type is better. In the end, both synthetic- and organic-based supplements can work equally well, depending on the person.
The most important thing to consider when buying a prenatal supplement is whether or not they contain all the essential nutrients and minerals necessary for a healthy pregnancy. Thus, we evaluated how comprehensive each company’s formula is, and whether they contained at the very least folate or folic acid, iron, calcium, and vitamin D.
We also checked whether the vitamin’s dosages aligned with the American College of Obstetricians and Gynecologists’ recommended daily intake for pregnant women.
Additionally, we looked at the components of certain vitamins, such as vitamin D. Due to the varying degrees of bioavailability, the body uses these vitamins better depending on whether they’re synthetic- or whole food-based. Most of the time, there are no major differences between synthetic vitamins, but certain vitamins are better absorbed by the body depending on their chemical composition.
Since vitamins are not regulated by the FDA, the accuracy of ingredients advertised by companies may vary. One of the few ways you can rest a little easier knowing your vitamins are actually what you’ve purchased is by making sure the company carries out third-party testing. A third-party verification guarantee demonstrates a company’s willingness to have external labs check the ingredients and dosages in their products.
Labels like NSF-certified (National Sanitation Foundation) or USP-certified (U.S. Pharmacopeia Convention) are generally considered to be reliable seals of approval for product verification. Both organizations serve as non-profits that, among other things, aim to verify the potency and accuracy of product contents.
We contacted the companies on our list to check whether they conducted third-party testing. Although the majority of the companies we contacted declined to share the name of these labs for what they described as legal reasons, some were very forthcoming with the names of both their third-party verifiers and their in-house testing labs. We made sure to pick companies that confirmed their use of third-party labs.
Pregnancy can be one of the most hormonally challenging times for women. Taste buds can be distinctly hypersensitive during this period and tolerance to ingesting anything might be particularly low.
For this reason, we considered the type of pill—whether tablet, capsule or gummy—as well as how many you’ll have to take daily.
It’s important to note that some types of vitamins, such as gummies, don’t necessarily include all the essential nutrients critical during pregnancy, meaning you’ll have to take additional supplements.
HELPFUL INFORMATION ABOUT PRENATAL VITAMINS
Whether you’re pregnant, thinking about getting pregnant, or have just completed a pregnancy, there are certain nutrients and minerals your body needs to compensate for having to produce doubly for you and your baby. This is where prenatal vitamins come in. They work not only for your baby’s development, but to ensure you get all the required nutrients necessary to carry out a pregnancy, and to replenish your depleted stocks postpartum.
Ideally, mommies-to-be would be getting all the necessary nutrients from a balanced diet. However, it’s not exactly a secret that women are at their queasiest during pregnancy, and hormonal fluctuations may make eating that extra plate of spinach particularly off-putting.
Xaimar Sánchez, a registered nutritionist working for Head Start and who tends to a large population of young expectant mothers echoed this, “the truth is that many women find it difficult to ingest all the essential nutrients they need during pregnancy. Whether it’s because they can’t physically stomach ingesting the required foods, or because they simply don’t make the best nutritional choices when it comes to their diet, many women don’t receive all the minerals and vitamins necessary to cover their nutritional requirements. That’s where prenatal vitamins come in.” Prenatal vitamins try to even out the dietary playing field, so you can have as many of the essential nutrients you need for a healthy, uncomplicated pregnancy.
Regardless of this, the importance of a balanced diet during pregnancy is crucial. “In theory, if a pregnant woman has a proper and balanced diet, she should be able to cover all her nutritional needs since she’ll be ingesting all the vitamins, minerals, and macronutrients she needs. But the reality is that most of the time this doesn’t happen,” added Sánchez.
Despite the important role prenatal supplements play during pregnancy, it’s a well-known fact that the vitamin world is a vast and sometimes messy place. The lack of regulation and oversight in the vitamin industry, coupled with the multitude of companies claiming to have the best, most natural products, can make the process of picking the right prenatal especially daunting.
Because vitamins in general aren’t FDA-regulated, it’s important to know what to look for when choosing the best prenatal vitamins.
Here are some points to consider:
- Know the Recommended Dietary Allowance (RDA) for each essential mineral or vitamin. The American College of Obstetric Gynecologists (ACOG) has established specific RDAs for each essential pre- and post-natal nutrient. This is the dosage that should be met unless you have special dietary needs, or your doctor recommends otherwise.
- Source material, and how much bioavailability these sources have. Bioavailability refers to how much of a particular mineral or nutrient your body can absorb and effectively use. Not all vitamins are created equal—while some supplements can include whole-food-based ingredients, others may be entirely synthetic. The type of ingredient used can influence how easily a specific nutrient will be absorbed by your body, as well as to what degree. This is especially important because some fat-soluble nutrients, such as vitamins A, E, K, and D can be harmful at higher dosages (because they accumulate in your body), but how much of that dosage your body will actually absorb varies if the vitamin is made synthetically, or derived from organic sources.
- The amount of nutrients you regularly intake from your current diet. The first place you should always look to get your essential nutrients is your diet. If you know you’re a big salmon eater, for example, the amount of DHA (an important omega-3 which aids in the development of the baby’s nervous system) you’ll need in your prenatal supplements may not be as copious as for a vegan mom-to-be who may be much more lacking in this nutrient. How much necessary foods you regularly include in your diet will directly affect how much of a particular nutrient you need in a prenatal supplement.
- Supplement third-party verification. Third-party verification is an important factor to keep in mind when choosing prenatal supplements, since vitamins as a whole aren’t regulated by the FDA. When vitamins get third-party tested, companies are assuring customers they’ve verified that the contents of their product matches that of the supplement labels.
WHAT YOU REALLY NEED WHEN YOU’RE EXPECTING
Prenatal vitamins were created so that women could have the proper intake of minerals and vitamins necessary during pre-, peri- (during), and post-conception. Many vitamins today include these nutrients, while also adding on other minerals that help throughout the many phases of childbearing.
Dr. David Aguirre, an ob-gyn with more than 20 years of experience, told us that: “The most important thing is to have a balanced diet because prenatal vitamins can’t replace healthy food. There are many other nutritional factors to consider during pregnancy, it’s not all just about minerals and vitamins.You also need proper amounts of calories, proteins, and fats for a healthy pregnancy. Gestational diabetes, constipation, and overall malnutrition are all at risk of occurring during pregnancy and all depend on how balanced your diet is.”
In other words, the best way to obtain the essential nutrients you need is through a complete and balanced diet. But acquiring the necessary nutrients—and in the adequate amounts—is so essential for childbearing, that prenatal vitamins could be indispensable for many women.
No matter how many sophisticated or “all-natural” additives some companies like to include, there’s only a handful of nutrients that should absolutely be part of any prenatal supplement you choose, in part because of how difficult it is to meet their necessary dosages. These are folate, or folic acid, iron, calcium, and vitamin D.
Folate or Folic Acid (RDA by ACOG: 400-600 mcg)
Folic acid is perhaps the one absolutely indispensable nutrient a prenatal vitamin must have.
While often used interchangeably, it’s important to note that folate and folic acid are not the same thing. Folic acid is the synthetic form of Folate (or Folacin), a B vitamin essential to the development of healthy red blood cells, as well as for the division of cells and the development of genetic material in your body.
Although naturally occurring folate is commonly found in leafy green foods, such as spinach or kale, women need elevated amounts of folate during pregnancy or they can run the risk of becoming anemic through what’s known as folate-deficiency anemia. Folate is a necessary component for the formation of hemoglobin, which carries oxygen to the essential parts of the body, such as the heart and brain. Without the proper amounts of it, women run the risk of becoming anemic.
Moreover, research has demonstrated that at least 85% of folic acid is estimated to be bioavailable when taken with food, whereas only about 50% of folate naturally present in food is bioavailable. While you should always prioritize getting folate from your diet, prenatal vitamins are a vital aid in supplying the proper quantity of folate needed for a healthy pregnancy.
Aside from what we’ve mentioned, the main reason it’s so important to consume this nutrient before and during pregnancy is that folic acid is essential for the development of the baby’s neurological system, as it helps the baby’s neural tube properly develop into its brain and spinal cord. Pregnant women or those who want to get pregnant must be sure to get the recommended dosages of folate or folic acid because it protects growing fetuses from developing Neural Tube Defects (NTDs). In fact, several studies have shown that pre-pregnancy use of prenatal vitamins containing folic acid can prevent 50 to 70 percent of NTDs.
These defects, which can result in life altering consequences, or even death, usually occur within the first 28 days after conception—before most women are even aware of their pregnancy. For this reason, it’s widely recommended that all women of childbearing age consume folic acid even if they are not planning on becoming pregnant.
“Depending on how severe the condition is, spina bifida can cause partial or full body paralysis, lack of bladder control (meaning the baby will most likely have to be catheterized the rest of its life), or even death.” says Ingrid Ancalle, a neonatologist who often sees newborn complications related to NTD’s. She added that: “This is why, ideally, all women of reproductive age should take folic acid, to minimize this risk.”
Unfortunately, many women still lack access to essential health information such as this. One study published in 2018 found that fewer than 5 percent of poor, urban women use prenatal vitamins.
Because of how essential folate is, many prenatal vitamins will often include higher doses of folic acid or folate in their products, which may be beneficial for women with folate deficiencies. Although this nutrient is water-soluble, meaning your body will get rid of excess amounts, it’s important to bear in mind its tolerated upper intake level (UI), which is 1000 mcg daily. According to the CDC, higher doses than these should not be taken unless recommended by a doctor, not because it can cause harm, but because it provides no added benefit. Excess amounts of folic acid have also been shown to hide symptoms of B12 deficiencies.
Folic acid vs Folate: What’s in a name?
Whereas folic acid is the man-made form of folacin, folate is the naturally occurring form that can be found in whole foods such as dark green leafy foods, certain vegetables, and nuts.
The difference between the two types matters largely because of a genetic mutation in a gene called the MTFHR gene. This mutation is estimated to affect about 25% of Hispanic women and 10-15% of Caucasian women. The MTFHR gene, which is supposed to properly break down the folic acid found in many fortified foods and vitamins, is unable to do so in women that have this mutation, meaning these women are also at a higher risk for having children with NTD’s.
Moreover, individuals with this mutation often aren’t aware they have it unless they undergo genetic testing or begin to show symptoms of the conditions often associated with it.
For this reason, women that carry this mutation need the metabolically active form of folate that their bodies can properly process. Many prenatal vitamins today contain the natural active form of folate, often appearing as 5-MTHF, methylfolate, or 5-methyl tetrahydrafolate.
The most common brands of this metabolically active form of folate are Quatrofolic, Extrafolate, and Metafolin. Prenatal vitamins will usually name which brand of folate they’re using.
- Beef liver
- Cooked broccoli
- Leafy greens (such as spinach and kale)
- Cooked lentils
Iron (RDA by the ACOG: 27mg for women 19–50 years old)
Iron is another essential nutrient that becomes even more relevant during pregnancy. Without sufficient iron your body can’t make enough red blood cells or hemoglobin to carry oxygen to the rest of your body’s tissues, which can result in anemia. “One of the most common problems during pregnancy is anemia because women often don’t get enough iron.” says Dr. Aguirre. “In severe cases, anemia could also prevent enough oxygen from reaching the fetus, causing Small for Gestational Age babies or intrauterine growth restrictions.”
Sánchez also commented on the frequency of iron deficiency in pregnant women, signaling improper nutrition as a big culprit. “The most common thing I see in pregnant women is iron deficiency, and it’s often because women don’t follow a balanced diet (they don’t snack properly or have their three meals), they’re missing certain foods from their diets, or they simply forget to take folic acid. This is all reflected in their decreased iron levels.”
Pregnant women are at a higher risk of becoming anemic because their bodies are producing 30-50% more blood, but there isn’t enough iron stocked up to produce hemoglobin. Vegetarian and vegan women are oftentimes at an even higher risk because plant-sourced iron is usually not as properly absorbed by the body as the kind that comes from meat.
Because mild anemia is fairly common during pregnancy, it’s important to make sure you get the recommended amounts of iron either through your diet, or through prenatal vitamins that include the necessary and adequate doses. It’s also important to regularly consult with your doctor if you feel any of the symptoms associated with anemia.
- Red meat
- Organ meats (such as beef liver)
- Dark chocolate
How you take iron matters. There are two caveats you should keep in mind when it comes to the proper consumption of iron and choosing a prenatal supplement. One is iron’s interaction with calcium, the other is its interaction with vitamin C.
Calcium and Iron
When scouting for prenatal supplements you’ll often notice that calcium and iron dosages are much lower than their RDAs. This is because, as a general rule, calcium inhibits the absorption of iron in the body. Many prenatal vitamins will often eliminate calcium altogether in order to supply higher levels of iron, since calcium is much more readily available to eat in foods.
In the event that you choose to ingest the nutrient separately, it’s recommended that you take each one several hours apart, so as to increase the absorption of each one in the body.
If choosing a prenatal supplement with both calcium and iron, eating foods high in calcium in the morning, while having iron-rich nutrients at night, for example, could help in the absorption of each.
Vitamin C and Iron
If calcium inhibits the absorption of iron, vitamin C has been shown to do the exact opposite. Vitamin C increases the absorption of non-heme iron (iron found in plant-based foods which is harder for our bodies to absorb), allowing for greater overall absorption of iron in the body. Studies have shown that eating foods high in vitamin C—such as oranges, strawberries, and kiwis—along with your daily intake of iron can help to greatly increase the latter’s absorption. Taking a vitamin C supplement when consuming your favorite iron-rich foods could also speed up the absorption process.
Calcium (RDA by the ACOG: 1000 mg for women 19-50 years old)
Calcium is another essential nutrient for both you and your baby. Calcium aids in the development of your baby’s musculoskeletal system, as well in the development of her heart and nerves.
A proper intake of calcium during pregnancy can also reduce the risk of pre-eclampsia, which affects approximately 4 percent of pregnancies in the U.S. and can cause serious health complications for both the baby and the mother.
Because calcium is not produced by the body, it’s essential to get the necessary amounts in your diet or supplements so that you don’t run out of your own supply. If you don’t consume enough calcium to sustain both you and your baby, your body could start depleting its own stocks, putting you at risk of osteoporosis.
One thing to keep in mind when selecting a prenatal supplement is that they’ll often include a much lower percentage of calcium than the established RDA, due to their interaction with iron. For this reason, it’s highly recommended to take a calcium supplement along with your prenatal vitamins and include calcium-rich foods in your diet.
- Parmesan cheese
- Canned sardines/salmon
- Cooked winged beans
- Calcium-fortified tofu
- Cooked collard greens
Vitamin D (RDA by the ACOG: 600 IU for women 19-50 years old)
It’s estimated that almost 42 percent of Americans are vitamin D-deficient. This number is important when talking about pregnant women, since vitamin D is vital for a healthy pregnancy.
First, vitamin D is crucial for the absorption of calcium, which is necessary for the development of bones in fetuses and for the overall health of the mother’s musculoskeletal system. As so, vitamin D deficiency can not only affect bone growth, but could even result in preterm birth.
An important aspect to keep in mind about vitamin D is that recent studies point to the benefits of increased dosages of the vitamin in pregnant women. Amongst other things, this research shows vitamin D supplementation reducing the risks of preeclampsia, preterm birth, and infections during labor when taking at least 2000-4000 UI. Fortunately, many prenatal supplements include higher dosages than the established RDA.
Vitamin D3 vs D2
Vitamin D—which is not strictly speaking a vitamin but a fat-soluble steroid—is available for ingestion in two different forms: vitamin D2 and vitamin D3.
D3 is derived from animal products and is the most bioavailable form of the vitamin, while D2 is derived from plants and is not considered as effective at being metabolized by the body.
This difference is important to women who are vegan or vegetarian since not all prenatal vitamins include the D2 form (ergocalciferol) of the nutrient. However, there are ways to obtain D3 or cholecalciferol through lichen, a cross between fungi and algae which is considered vegan. Regardless of the source, prenatal vitamins will always specify whether it’s cholecalciferol (animal-based), ergocalciferol (plant-based), or lichen derived (algae-based)—next to vitamin D in the product label.
- Wild salmon
- Canned tuna
- Soy and cow milk
- Orange juice
- Fortified cereals
Although this list only comprises a few of the many recommended nutrients the ACOG recommends, these are the most essential to have in your daily prenatal supplements, primarily because the rest of nutrients can be more easily ingested through your diet. As so, we recommend checking the labels of each product to verify that they include the necessary amount of nutrients recommended by the ACOG, and that simultaneously best fit your needs.
The most important takeaway, though, is that you eat healthy and be consistent in taking your prenatal vitamins. We know this is often easier said than done, what with unruly hormones and a hypersensitive belly taking over your life. But the truth is, just by consuming the adequate nutrients, you can minimize the dangers or risks of complications for you and your baby. As Dr. Aguirre told us: “The best prenatal pill is going to be the one with the proper amounts of iron and folic acid, but also one the mother tolerates. If you can tolerate a particular [prenatal] pill, you should take that one.”
WHAT TO WATCH OUT FOR
A Word for Vegans
Vegan and vegetarian mothers have dietary restrictions that call for special considerations when purchasing prenatal supplements. Specifically, vegan and vegetarian women who are expecting should watch out for three nutrients that may not be readily available in their regular diets: DHA, B12, and iron.
1. DHA (docosahexaenoic acid). An important omega-3 fatty acid found in some seafood, DHA has been shown to help in the baby’s visual and neurological development, amongst other things. The ACOG recommends pregnant and lactating women take at least 200 mg of DHA daily. However, because vegan and vegetarian women lack seafood in their diets, it might be difficult for them to get the proper amount recommended for a healthy pregnancy. Fortunately, many DHA supplements are now made from algae and so are safe for vegan and vegetarian women.
2. B12. To date, B12 that can be properly used by our bodies is only available from animal sources such as beef, eggs, and shellfish. Vegans need supplements or special foods that have been fortified with yeast grown in B12 cultures. This is a critical vitamin for vegan and vegetarian women whose diets are often high in folate. Folate, which is part of the B complex (B9), is known to hide symptoms of anemia, one of the first signs of B12 deficiency. So, while mothers could be consuming abundant folate through their diet and supplements, they might unknowingly be B12-deficient. Moreover, B12 deficiency can have severe health consequences during pregnancy, such as significantly increasing the risk of NTD’s.
In addition to certain fortified foods like some cereals, there are two forms of B12 vegans and vegetarians could opt for: methylcobalamin and cyanocobalamin. Most prenatal vitamins purporting to be vegan or vegetarian include methylcobalamin as their choice for B12. However, some research indicates that cyanocobalamin (which has trace amounts of cyanide considered to be safe) may be better absorbed by the body than the natural form of methylcobalamin. Whichever form you choose, the most important thing is to always consume B12 in the recommended amounts.
3. Iron. Although many plant-based foods are rich in iron, pregnant vegan and vegetarian women often need to get much more than what’s available in their diets. Moreover, prenatal vitamins often lack the required amount of iron in their ingredients, which is why some doctors might recommend vegan and vegetarian pregnant women supplement their diets with iron supplements, depending on their iron levels.
ORGANIC VS SYNTHETIC PRENATAL VITAMINS
One of the first things you’ll notice when choosing a prenatal supplement is the vast variety of types on the market. The vitamin industry is generally split into organic, or whole-food vitamins, and so called “synthetic” vitamins. What each company may interpret as organic can vary, but generally vitamins that are advertised this way are purported to be made with whole foods or natural components, instead of the chemical equivalents manufactured in a lab. Many of these products are also Non-GMO certified, but this isn’t always the case. Incidentally, many companies will boast about their pure organic ingredients, trying to differentiate themselves from other “synthetic” products.
In reality, the difference between the two is not as black and white as many companies try to make it. No vitamin supplement is 100% natural, or organic, and none is 100% synthetic. Rather, many times companies will combine processes.
Research regarding whether organic vitamins are more beneficial than synthetic ones is highly split. Food-based vitamins are often touted as best because their phytonutrients—the natural chemicals found in some fruit and vegetables—are thought to make overall absorption of minerals and nutrients more effective. Similarly, some writing on the subject indicates that synthetic nutrients may not be processed in a way that can be effectively be absorbed by your body.
However, a potential downside to food or yeast-based supplements is that sometimes consumers could get allergic reactions—such as hives— they weren’t even aware they had because of all the different foods being used as ingredients. The one thing everyone can agree on regardless of whether you choose organically or synthetically processed supplements, is that it should be free of excessive fillers and additives that could cause potential harm to you or your developing baby.
FAQS ABOUT PRENATAL VITAMINS
Isn’t good nutrition good enough?
As we said above, prenatal supplements are in no way a replacement for a healthy diet and many of the essential nutrients pregnant or lactating women need can—and should be—primarily ingested through dietary means.
But these supplements still play an essential role in the prenatal process for a couple of reasons: first, because it’s difficult to get the required amounts for each nutrient solely through food (especially considering how particular taste buds can get during pregnancy); and second, because enough nutrients have to reach at least two targets—mom and baby—which makes getting the required quantities even more important.
Can I take more than the recommended amount of folic acid?
Folic acid is a water-soluble nutrient, meaning that…well, you’ll pee out whatever excess you consume.
In theory, this means there isn’t any harm to consuming more than the established RDA’s of folic acid. However, an abundance of folic acid can mask B12-deficiency by hiding its symptoms, and this can be increasingly harmful in the long run. For this reason health organizations like the World Health Organization, advise against taking more than the established Upper Intake levels of folic acid, which is 1000 mcg a day.
Are prescriptions prenatal vitamins superior to over-the-counter supplements?
Short answer: Not really. Both prescription and over-the-counter (OTC) prenatal supplements can be effective, as long as the required amounts for essential nutrients are included. Of course, third-party verification aids in trusting that each brand actually includes the necessary amounts of minerals and nutrients. One study in 2017 which compared the two types, found that prescription supplements tended to have higher amounts of folic acid than OTC vitamins. However, generally, both types of supplements were shown to have the required amount of ingredients for pregnant women.