The Who, What, When of Prenatal Vitamins
If your experience is anything like mine, I heard of prenatal vitamins, knew I needed to take them when I was pregnant and my knowledge ended there. A quick search in the grocery store or online, and just like anything in life these days, I quickly became overwhelmed with all of the options. One-a-days, three-a-days, raw, organic, gummies, powders. Not to mention every option had different amounts in each vitamin. I just wanted someone to tell me - why am I taking a prenatal? When should I begin taking a prenatal? And what is most important to have in my prenatal? From there, I wanted to make the decision which prenatal was best for me.
So, why do we take prenatal vitamins?
As we are all aware, the American lifestyle is not known for being the healthiest. Whether it’s the overabundance of processed foods, restaurant-style preparation of food, agricultural standards, nutrient-depleted soil, or our modern busy lifestyles and use of medication, including birth control. Studies have found that American women are deficient in many vitamins and on top of heading into pregnancy already low on essential vitamins and minerals, researchers at Duke University concluded pregnant women “expend the same amount of energy as the high-level athletes competing in the 4,800 km race from California to Washington, D.C.”
“I already take a daily multivitamin. Is that enough?” While any multivitamin is better than no multivitamin, there are a few key vitamins pregnant women need at a higher level. For example, folate, iron and choline are greater in prenatal vitamins because they are key nutrients in the development of baby and mom’s health. Additional benefits of taking a prenatal for mom include improved likelihood of conceiving and staying pregnant, reduced risk of prenatal and postpartum anxiety and depression and lower pregnancy complications like gestational hypertension and preeclampsia. Additional benefits for baby include reduced risk of preterm birth, low birth weight and birth defects, possible reduction of autism, and lower rates of long-term chronic problems like diabetes and cardiovascular disease.
In addition to taking prenatal vitamins to build up the vitamins we are missing, a healthy diet is really the building block of any good foundation. A simple way to ensure a well-balanced diet is to make sure each meal has one serving of good fat, protein, fiber, and leafy green.
When should I start taking a prenatal vitamin?
Over half of the pregnancies in America are unplanned, so generally if you’re sexually active, it is best to be on a prenatal vitamin. If you’re beginning to plan for a family, it is recommended to be on a prenatal vitamin for at least 3 months before conception because that is how long it takes for your eggs to mature. Ideally, you would be on a prenatal vitamin for 6 months, long enough for healthy eggs and to build up your vitamin and mineral levels. However, if you’re reading this and already pregnant, begin today. As mentioned earlier, any prenatal multivitamin is better than none.
As a quick aside, it is recommended to stay on your prenatal during your postpartum season for at least 3 months. If you’re breastfeeding, the recommendation is to stay on for at least 12 months. If you’re considering conceiving again in the future, you may want to stay on your prenatal the whole time (there is nothing wrong with this).
What’s important to have in a prenatal vitamin?
This is where I struggled the most in selecting a prenatal because there are so many different brands, types, frequencies and vitamin levels.
Let’s begin with what type of prenatal to take. It does not matter if your prenatal is in the form of a capsule, gummy, or powder. This is a personal choice and should be based on what you know you’ll take most consistently.
Some vitamins are one-a-days, two-a-days, or three-a-days. A few things to consider here. One-a-days tend to have higher levels because you’re taking it once a day, which might not sit well if you have a sensitive stomach or are struggling with prenatal nausea. The idea behind taking a multivitamin multiple times throughout the day, aside from being inconvenient to our aforementioned busy lives, is the concept of bioavailability. Meaning, your body can only absorb a certain amount of vitamins and minerals at a time, and taking them in smaller doses, more frequently throughout the day, allows your body to absorb more over time. However, again, what is most important here is you make the choice that is best for you and will take consistently over time (notice a theme here?)
And finally, suggested vitamins and their levels:
Methylfolate: Commonly referred to as folate (not to be confused with the synthetic version, folic acid - I discuss the difference below). Your prenatal should contain 800 mcg of folate. Benefits of folate include:
Baby: Plays a special role in the formation of baby’s chromosomes and nervous system, prevents neural tube and other defects and may protect against autism
Mama: Improve egg quality, prevent miscarriage, prevents pregnancy complications including preeclampsia and placental abruption, and protect against prenatal and postpartum depression
Iron: Your prenatal should contain 27 mg of iron bisgylcinate chelate, which is a non-constipating form. Avoid sulfate forms which can cause digestive upset, constipation and isn’t well absorbed. Benefits of iron include:
Baby: Decrease in many adverse fetal outcomes, longer gestation and improved birth weight
Mama: Decrease in many adverse maternal outcomes, increase in maternal immunity which reduces infection rates, including intrauterine infection, reduces ovulatory infertility
Choline: Choline is an essential nutrient that your liver produces, but most of the choline your body needs comes from the food you eat. Pregnant women need even more to support the development of baby. Your prenatal should contain 400 mg. Benefits include:
Baby: Neurologic and spinal cord development and signaling, and cognitive function, especially memory, focus and attention, stress resilience and protection from anxiety, preventing neural tube defects, cleft lip, hypospadias and cardiac defects
Mama: Support for brain and central nervous system improving memory and mood, support the liver and muscles work correctly and cells to form and repair their membranes
Iodine: Your prenatal vitamin should contain a daily dose of 200 to 250 mcg of iodine, unless you’re taking an iodine supplement for thyroid or breast health in which case, decrease the recommended dose. Benefits include:
Baby: Thyroid, brain development, central nervous system development, improved IQ and cognitive development
Mama: Critical for thyroid health, as well as healthy menstrual cycles and fertitily, prevention of miscarriage and still birth
Zinc: Your prenatal should contain between 15- 45 mg zinc daily. Benefits of zinc include:
Baby: supports a healthy oocyte development and important for fetal brain development and function
Mama: supports ovulation and immune functions, supports healthy estrogen and progesterone levels, protects eggs against environmental stress
Additional vitamins to consider either in your prenatal multivitamin or in addition to your multivitamin include:
Vitamin A: Aim for 770-1,300 mcg RAE/ day of mixed betacarotene and retinyl plamitate. Taken together beta carotene and retinyl palmitate support immune function, fetal growth, gene transcription, and lung development.
Vitamin B6: It’s best to take the active form, Pyridoxal-5-phosphate (P5P), in a range of 5-10 mg per day. Supports healthy levels of progesterone which creates a healthy uterine lining for implantation and may also prevent morning sickness.
Vitamin C: 200-2,000 mg to aid in tissue formation, including collagen, protection from free radicals, and neurotransmitter synthesis. You might need an additional vitamin C supplement to achieve levels of 500 mg or more.
Vitamin D3 + K2: Up to 4,000 IU to support immune function, bone formation, and healthy fetal development and decrease risk of preeclampsia, bacterial vaginosis and gestational diabetes. K2 improves the bioavailability of D3 for your body.
Calcium: 300-600 mg for the formation of healthy bones. As much as 350 mg per day are transferred to the baby in the third trimester.
Magnesium: 100-300 mg. You may need an additional magnesium supplement in addition to a prenatal.
Selenium: 200 mcg to provide antioxidant protection and support thyroid health
Folate vs. Folic Acid
You may come across discussions about folate versus folic acid. Once again, both versions are essential for the healthy development of a baby’s nervous system, so it is vital one of them is included in your prenatal vitamin. If you’re interested in the difference between the two, please continue reading.
Folate, also known as Vitamin B9, is the natural version of the essential nutrient that is critical for the growth of healthy cells and DNA creation and is protective against cardiovascular disease, cancer and Alzheimer’s. It is found in many foods like leafy green vegetables, asparagus, and broccoli. Folic acid is the synthetic version and the FDA requires manufacturers to add folic acid to many foods.
Your body takes the folate you consume and converts it within the digestive tract to the active form your body will use. Unfortunately, your body cannot do the same with folic acid. Between the folic acid added to processed foods and what is included in a prenatal vitamin, your body cannot convert it all to the active form and relies on other organs to create a form the body can use. Aside from this being a slow and inefficient process, you can also end up with elevated levels of folic acid in your blood. The natural version, folate, is much more easily processed by the body.
So, what now?
As mentioned several times during this article, taking any prenatal vitamin is better than no prenatal vitamin. So choose one that works best for your lifestyle, digestion, and overall preference instead of taking none because you couldn’t find the “perfect one”. Spoiler alert - there is no perfect prenatal vitamin.
What I took between conception, pregnancy and postpartum looked different every time. In 2020, I discovered Needed., a perinatal nutrition company created by women. I started to compare their vitamin design to recommendations I followed by other trusted female practitioners and was pleasantly surprised to see how it checked off so many of the boxes. It was also the first time I saw a prenatal offered in the form of a powder, which I was doing a lot of smoothies at the time. I have since switched to their capsules because I’m not in a season where I was taking the powder form consistently enough. And over the past two years, I have transitioned the rest of my supplements, like collagen, probiotic, electrolytes and sleep support, over to their brand, as well. If you’d like to try a sample of their supplements, using the code DISSINGERSAMPLE will save you $10 at checkout. I currently subscribe to one of their plans so that it’s one less thing I need to think about right now. If this option fits your current lifestyle or you’re just interested in one of their products, using code DISSINGER will save you 20% at checkout.
Some other prenatal vitamins to consider are:
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