How to choose the right prenatal supplements

pregnancy

If you are thinking about getting pregnant within the next year, or are pregnant, this post is for you! I’m going to break down how to find the best prenatal supplements in a sea of options. But first, let’s start with the why.

I’m sure you’ve already heard this from multiple sources so just to drive it home, know that pregnancy is a critical time for optimal nutrition for both mom and baby. Lots of nutrients are required to build the placenta, nourish a growing baby, help you in labor, delivery and healing, and while breastfeeding. Today, many of us are just not getting everything we need from our food. Even those with a pretty fantastic diet, filled with the most nutrient-dense foods, may not be getting enough. This is in part due to the decline of nutrients in the soil our food is grown in, leading to less nutrient-dense crops. Other factors, including medication use, also play a role. For example, the birth control pill can deplete folate, a key nutrient needed to prevent birth defects. We also are not drinking mineral-rich water like we would have historically. I’m not recommending, nor do I think it is feasible, to start drinking only from fresh mountain streams, but just wanted to mention that this is a difference between our lifestyle now and that of our ancestors.

You might be wondering how historically, women have had healthy babies in some of the most challenging of circumstances. Biology helps us out here a bit and so even when mom is nutritionally depleted, baby has mechanisms to extract nutrients from mom, but those mechanisms are not without limitations. AND, the goal is not to wind up on the other side of pregnancy further nutritionally depleted!

Taking the right prenatal supplements can:

  1. Reduce nausea, heartburn, and fatigue throughout your pregnancy
  2. Support labor, delivery, and healing
  3. Aid in breastmilk production
  4. Help you rebuild and repair so you are ready for future pregnancies should you choose
  5. Result in a healthy baby!

Choosing the right prenatal supplements can be tricky with the number of options on the market. Many commercially available prenatal supplements do not contain, or have inadequate amounts of important nutrients like magnesium, iodine, biotin, pantothenic acid, selenium, manganese, chromium, and molybdenum. Further, they may not be in best, most usable and tolerated form. So, here is what you want to look for. Keep in mind that beyond these general recommendations, there are so many individual considerations when picking prenatal supplements. If you have and medical conditions, a high risk pregnancy, or history of nutrient deficiencies (i.e. anemia, vitamin D deficiency, etc.) then I recommend going to see a nutritionist for a customized protocol to get the best possible results.

MOST Important:

  • Iron: 20 mg/day at a bare minimum but ideally closer to 45mg/day*. And look for the kinds that are easiest on the stomach (i.e. less likely to cause nausea and constipation) which includes Iron Picolinate or Iron Bisglycinate. *note: iron needs varies for individuals. Your OB/GYN will probably monitor your serum ferritin concentration to watch for iron-deficiency.
  • Vitamin A: 5,000 IU/day is great. Do not ever exceed 10,000 IU/day of vitamin A with supplements due to potential toxicity. Ideally, that Vitamin A is coming from mixed carotenoids or beta carotene and palmitate. I always like to see mixed sources of vitamin A.
  • Folic Acid: this is probably the most researched nutrient in regards to pregnancy because of its direct link to neural tube defects and other complications. The amount you take is just as important as the type of folic acid. Folic acid is actually the synthetic form of naturally occurring folate and for that reason, takes a whole extra step for your body to convert into a usable form. A large number of people are genetically compromised in converting folic acid into the form the body needs (Methylfolate). For that reason, I recommend looking for a prenatal that contains a combination of Methylfolate and folinic acid to bypass a potential genetic defect in a safe way. You’re looking for 800 micrograms.
  • Magnesium: magnesium needs increase during pregnancy and yet it is estimated that mean dietary magnesium intake for pregnant women in the United States is around half of what is needed. You are looking for 200-400 mg of magnesium in your prenatal supplement. Ideally, that is coming from magnesium citrate or magnesium glycinate which are both much easier for your body to use than magnesium oxide (the cheaper option that many prenatals use) and also easier on your stomach. This is something that I’ll sometimes add on as an additional supplement for women since many prenatals don’t have quite enough. Alternatively, focusing on food-sources of magnesium and treating yourself to an epsom salt bath (epsom salts are a form of magnesium). Add 2 cups to a warm bath and perhaps a few drops of lavender essential oil and that magnesium will help soothe muscles and give you a bit of a boost.
  • Vitamin D: checking for Vitamin D deficiency is relatively routine now and a good idea prior to pregnancy and/or during pregnancy. A deficiency increases the risk of neonatal hypocalcemia, intrauterine growth retardation and slower-than-normal growth during the first year of life. I recommend at least 1000 IU/day but depending on individual need, you may need much more than that.
  • Vitamin B6: Low B6 levels are common in pregnant women due to baby demanding a good amount of it. Women who have take oral contraceptives (i.e. “the pill”) prior to conception are at an increased risk of deficiency. And guess what? Vitamin B6 is proven to help control nausea during pregnancy. Your prenatal should contain at least 10 mg of Vitamin B6.
  • EPA/DHA (i.e. omega-3 fatty acids): this is usually taken as a separate supplement, perhaps in the form of fish oil, which is a naturally rich source of EPA/DHA. These fatty acids play an important role in the development of the brain, central nervous system, and visual system. I like to see at least 300mg of DHA and a similar amount of EPA as well. NOTE: quality, testing and purity is SO IMPORTANT with fish oil! Otherwise, there are concerns with rancidity of the oil and contaminants like heavy metals. And a fish oil supplement should never taste or smell fishy, period.

Important:

  • Multiple doses: a great prenatal vitamin should be divided into more than one dose per day. I know, that makes it more of a pain to take, but it dramatically increases how much of those nutrients your actually getting. With just one big dose a day, you’re literally flushing nutrients down the toilet.  You also may find it a lot easier on your nauseated stomach to take your prenatal in divided doses (and always with food!).

Of course, there are loads of other nutrients needed during pregnancy but this is a start to helping you identify good prenatal supplement options. The right prenatal supplements combined with a healthy, varied diet, is fundamental to the health of both mom and baby. I’ll end this post with the names of a few of my favorite, trusted prenatal supplements that I use with my patients. All but one of these are professional line supplements, which means you have to get them through a healthcare professional (or risk the quality of those illegally selling them through Amazon). Some compounding pharmacies will carry these lines though so if your healthcare provider doesn’t offer them, try there.

Thorne Basic Prenatal: this is a 3/day capsule that is very well tolerated

Seeking Health Optimal Prenatal: There is a capsule version and a protein powder version. The protein powder (pea protein based) is a favorite of mine for women who are really struggling with nausea or who are having trouble remembering to take their supplements. Just one scoop shaken with water or better yet, blended with berries into a smoothie, can be sipped on. These supplements are expensive (though sometimes you can get a discount through a healthcare provider) but the quality is off-the-charts superior to basic pharmacy brands. And, Seeking Health sells directly to the public!

Metagenics Wellness Essentials Pregnancy: this is my go-to for those who like the convenience of little packets and for those women who need a little more calcium/magnesium and iron support.

Integrative Therapeutics Eskimo-3 fish oil: THE BEST fish oil on the market. Period.

 

 

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7 Comments

  1. Arwini Haid on October 27, 2015 at 10:43 am

    Eating a healthy and balanced diet is the best way to get the necessary vitamins and minerals. That goes without saying.

    But even if you’re a health superfreak who follows the food pyramid guidelines to a “tee” every day, it’s very possible you come up short on key vitamins and nutrients.

    Prenatal vitamins are something your doctor might recommend if you’re pregnant or hoping to conceive. They’re specially-formulated to give you those key vitamins you might be missing in your diet.

    So, how do you separate the wheat from the chaff (so to say) and find the best prenatal vitamins? Well, the first thing you should know is what to look for and how they differ from regular vitamins!

  2. Jenn on November 6, 2015 at 11:36 pm

    I take prenatals while I’m breastfeeding too. My pediatrician told me that should make sure I’m getting all the vitamins I need while I’m still giving so much of my body’s nutrition to my son. Taking pills every day is a big challenge for me, but I recommend staying on prenatals if you breastfeed your child!

  3. […] Ayla’s blog post on how to choose the right prenatal suppplements […]

  4. Hazel Owens on April 6, 2016 at 2:14 pm

    When I was pregnant, I was on so many supplements than I could barely keep track of them. I didn’t want to spend a lot on professional line supplements, so I had a lot of pills to keep track of. It’s nice to know that the supplements are also available through compounding pharmacies, though. Thanks for the information.

    • Ayla Withee, MS, RDN, LDN on April 6, 2016 at 3:18 pm

      Hi Hazel, you’re right, it really can add up cost-wise although one way to think about it is that the lower quality supplements are not utilized well and so you literally could just be flushing your money down the toilet! So while they may appear to be cheaper at first, I think that the cost is greater in the end both in terms of your health and how much value you actually get from them. Thanks for stopping by and commenting.

  5. spesifikasi smartphone on March 7, 2017 at 12:28 pm

    I take prenatals while I’m breastfeeding too

    • Ayla Withee, MS, RDN, LDN on March 15, 2017 at 7:23 pm

      That’s smart to continue prenatals while breastfeeding. Your nutrient needs are quite high while breastfeeding, in some cases, even higher than during pregnancy.

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