10 Tips for Picking the Best Prenatal Vitamin
So are prenatal vitamins really that good for you during pregnancy? In a nutshell: Yes. Our experts are here to answer your questions when it comes to making sure you're getting the nutrients you and baby need.
If you've got baby on the brain, you should start taking a prenatal vitamin three months before you begin trying to get pregnant, if possible. "The egg starts maturing about three months before it's released, and it's critical that the proper nutrients are present during the earliest stages," says OB-GYN and reproductive endocrinologist Robert Greene, M.D., F.A.C.O.G., a fertility specialist at cny Fertility center in Syracuse, N.Y.
If you think you're pregnant and are not taking a supplement, don't wait until your first appointment for a prescription because you will have missed a crucial developmental period for your baby:
"Neural-tube defects [such as spina bifida] happen in the first four to six weeks of pregnancy," says Sudeep Kukreja, M.D., associate director of the neonatal intensive care unit at Children's Hospital of Orange County in Orange, Calif. So start taking an over-the-counter folic acid supplement with 600 micrograms right away.
Still have questions when it comes to taking prenatal vitamins? You're not alone. We tackled the most common questions expecting moms have about prenatal vitamins to get you guidance from the experts.
#1 Which vitamins and minerals are most important and why?
"The three most important nutrients, based on very good research, are folic acid, iron and calcium," says Kukreja. Folic acid helps prevent neural-tube defects; iron is important for the delivery of oxygen to the baby and prevents anemia in the mom; and calcium helps build your baby's bones and prevents bone loss in the mother.
#2 Are all prenatal vitamins pretty much the same?
No. Prescription vitamins are regulated by the Food and Drug administration, but they're not required to contain certain nutrients. "There are many different formulations available, with different concentrations of each nutrient," says Kukreja. Some have a little of everything; others contain only a handful of nutrients. If you have special health considerations, your OB may suggest a supplement with added nutrients to meet your needs.
#3 Can I take an over-the-counter or organic prenatal vitamin?
There's nothing wrong with taking over-the-counter vitamins as long as they have a USP (U.S. Pharmacopeia) seal or NSF International certification; these organizations monitor supplement quality. "We do have concerns about pills that contain certain herbs and those that may contain too much of a certain nutrient, like vitamin A, which can adversely affect the fetus' development," says Ashlesha Dayal, M.D., an associate professor of obstetrics and gynecology at the Montefiore Medical Center in Bronx, N.Y. "Take the bottle to your obstetrician to make sure that all the ingredients are safe," Kukreja adds.
#4 What should I do if I have morning sickness and am throwing up?
"Try to take the vitamin before you go to bed at night, so you can sleep through the nausea," says Bronx, N.Y.-based OB-GYN Ashlesha Dayal, M.D.
#5 Do I need to take anything in addition to my prenatal vitamin?
"Supplement with calcium if your prenatal doesn't contain enough," says Kukreja. Most don't because adding too much calcium to a multivitamin makes it unstable. Pregnant women need 1,000 milligrams a day; many supplements only contain 150 milligrams to 250 milligrams. You can take a tums tablet daily to supplement it.
In addition, many pregnant women don't get the institute of medicine's recommendation for 600 IUs of vitamin D per day. But most prenatal vitamin formulations contain 400 IU, and this should be adequate when combined with a healthy diet, Dayal says. The March of Dimes also recommends that pregnant women get at least 200 milligrams of DHA daily. Found in fish and some plant-based, vegetarian sources, DHA is an omega-3 fatty acid that's essential to fetal brain and eye development, Dayal says. Many prenatals contain DHA, but you also can take fish oil capsules; they're mercury-free.
#6 I'm a vegetarian. Should I be taking any additional supplements?
"Because [strict] vegetarians are not consuming animal products, the nutrients they tend to need are vitamin B12, zinc, iron and omega-3 fatty acids like DHA," says greene. "Look for supplements that contain these vitamins plus DHA from algae, a vegetarian source, rather than from fish."
#7 Is it bad if you don’t take your prenatal vitamins during your pregnancy?
The best way to stay healthy during your pregnancy is to eat right and maintain a healthy weight gain. Yes prenatal vitamins are an important part of your pregnancy nutrition, but they are never a subtitute for a healty well balanced diet. If you forget your vitamins once in a while do not panic...and do not "double up" because they may make you feel sick or increase constipation. I usually recommend that my patients put any "daily medicine" in a place they go every day...such as next to their toothbrushes, hairdryers, car keys, etc. Sometimes you can even set a daily reminder or alarm on your cell phone so you can remember to take your vitamins.
#8 Can I take regular vitamins until I get my prenatal vitamins refilled?
It is fine to take a regular, over-the-counter multivitamin for a short time until you get your prescription refilled. This would not be advisable for long periods of time because prenatal vitamins have different amounts of certain vitamins and minerals that are specially formulated for pregnancy. For example, there is more iron in a prenatal vitamin than in a regular multivitamin. And, most prescription prenatals have DHA, a fatty acid thought to be important in fetal eye and brain growth, whereas many over the counter formulations do not. You can also ask your practitioner to give you some samples to help you temporarily.
10 Tips for Picking the Best Prenatal Vitamin
What are the most important things to keep in mind when researching prenatal vitamins? And which nutrients are most essential for preconception and prenatal health? Keep reading to find out.
1. Start now
Instead of waiting until you're pregnant to start taking prenatal vitamins, get ahead of the game and start taking one today. A daily prenatal is beneficial three months (or more) prior to conception, fertility treatments, and/or pregnancy. It helps set the stage for healthy development and supports healthy growth through pregnancy and beyond. So don't wait - start early! (And grab our 90-Day Preconception Checklist!)
2. Consider your personal preferences
For example, do you have any allergies? What about any medical or religious restrictions? Do you need a kosher or vegetarian supplement? What about allergen-free? Or do you require special dosing or additional supplements (for example, as is the case for people with the genetic mutation MTHFR)? Do you have a history of bariatric surgery or anemia? All of these factors should be taken into account when choosing a prenatal vitamin.
3. Note the daily serving size
The number of daily pills or capsules required to get the nutrients listed on the bottle’s nutrition label will be listed as the "serving size." Believe it or not, this serving size can range from one to up to six pills daily, depending on the brand. Is the recommended serving size realistic for you?
Keep in mind, taking less than the recommended dose may increase risk of birth defects and nutrient deficiency. Additionally, taking more than what's recommended on the bottle is neither better nor safe for you and the baby, and it can even mask other nutrient deficiencies.
4. Compare costs
While some prenatal vitamins may seem more costly at first glance, they may actually provide a 2-3 month supply, making them the more cost-effective option. Along the same lines, some may include DHA, and therefore may not require additional supplementation. Read the labels carefully to fully understand what each prenatal vitamin provides. There are lots of options out there at various price points.
5. More doesn't mean better
There are a lot of important vitamins and minerals needed for pregnancy. Getting them all in an individual pill, in addition to eating a well-balanced diet, could be a lot to swallow (pun intended). I generally recommend taking a prenatal that meets all or most of your recommended nutrient needs.
While you may not find an all-inclusive prenatal that suits your specific needs, you may only have one or two extras to add, rather than remembering to take several pills during the day. Additionally, this can help reduce the risk of nutrient deficiencies and overdoing it (if nutrients are excluded, doses are often missed or accidentally repeated).
6. Avoid gummies
Yes, they are colorful, sweet, and make taking vitamins a lot easier for some. Unfortunately, with a gummy multivitamin or prenatal vitamin, some essential nutrients are usually missing or present only in lower doses. This is especially true for iron.
7. Watch out for added herbs
Many herbal supplements are contraindicated in pregnancy, and may interact with medications you might be taking for fertility. Check with your doctor if you have more questions about an ingredient in a specific prenatal.
8. Look for these noteworthy nutrients
Including at least 600 mcg folic acid (the synthetic form of the B vitamin, folate) is beneficial for anyone thinking about trying to conceive (at Illume Fertility, we recommend 800-1000 mcg for pregnancy). Why? During the first 28 days of conception, the neural tube develops, ultimately becoming the baby’s spinal cord, spine, skull, and brain later in pregnancy.
A birth defect (called a neural tube defect) can occur without adequate folic acid, reiterating the importance of taking a quality prenatal several weeks or months before conception. In addition, folic acid plays a role in DNA synthesis of red blood cells, the nervous system, and proteins, and helps to support the placenta and prevent miscarriage, preterm delivery, and maternal anemia.
Checking this level is a regular part of your bloodwork in our practice. With regard to fertility and reproduction, vitamin D assists with ovulatory regulation and healthy egg formation. Normal levels have been associated with higher IVF success in some studies and are essential for a healthy pregnancy.
In contrast, vitamin D deficiency is associated with an increased risk of pre-eclampsia, gestational diabetes, poor bone growth, and low birth weight in newborns. Most prenatal vitamins contain some vitamin D, but your healthcare provider may suggest additional supplementation to help keep your levels within the optimal range.
Higher maternal intake of choline during pregnancy can improve pregnancy outcomes and baby’s health (i.e. lower risk of pre-eclampsia, reduce risk of neural tube defects, ease the baby’s response to stress, improve aspects of brain function, and has benefits that continue while breastfeeding).
Despite the scientific evidence on choline's benefits, most prenatal vitamins haven’t caught up yet and may only have small amounts of choline, if any. A good way to make up the difference is through a well-balanced diet.
Iron is essential! It is needed to make the hemoglobin protein that carries oxygen to tissues. The need for iron doubles in pregnancy to accommodate maternal and fetal blood supplies. Ensuring adequate iron intake can help prevent anemia, fatigue, preterm delivery, and low birth weight in babies.
DHA is an essential omega-3 fatty acid beneficial for the development of your baby’s brain, vision, and nervous system. Some prenatal vitamins include this, but getting enough of this nutrient often requires additional supplementation.
Bonus Supplement: CoQ10
This naturally occurring antioxidant produced in our bodies is essential for cellular energy production. Supplementing with CoQ10 (in addition to a good prenatal vitamin) has many health benefits, especially for fertility. It has been shown to improve sperm motility, density, and morphology, as well as improve egg quality.
Your doctor may recommend supplementing with CoQ10, particularly if you are undergoing IVF or want to try to improve egg quality. There are different forms of this nutrient, some more readily absorbed than others. Talk to your practitioner to determine what dosing and form are best for you.
9. Keep it up
Continuing your prenatal for 6-12+ months after you have delivered your baby can help restore and replenish your body and help meet your and your baby’s needs, especially if you are breastfeeding.
10. Remember your needs are unique
While these nutrients are important, many others are as well, and a regimen is not necessarily a "one size fits all" kind of deal. The question "What nutrients do I need?" can ultimately best be answered after your fertility specialist has evaluated all of your bloodwork. Always check with your healthcare provider before starting a vitamin regimen, and ask which additional supplements may suit your individual needs.
The Bottom Line: Be Proactive
With these 10 takeaways in mind, I hope you feel a bit more confident in choosing your prenatal vitamin.
At Illume Fertility, we offer a premium selection of vitamins and supplements we trust. If you’re a patient at Illume and are interested in purchasing supplements through us, please contact your nutritionist or Care Team. Good luck on your path to parenthood - you’re already taking a big first step by ensuring you get all the right nutrients!
Writer: Jill Hickey
Jill is a Registered Dietitian Nutritionist who has been providing nutrition guidance to children and adults for over 20 years. She currently supports both PCOS and fertility patients at Illume Fertility with her broad experience and unique perspective. Jill is passionate about helping people work towards their healthiest selves by providing evidence-based, sustainable, personalized diet and lifestyle guidance.
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