May 14, 2019

Whether you are looking to get pregnant or have already received the positive pregnancy test, you may be wondering about one or all of these questions:

·      Should I be taking a prenatal supplement? 

·      Which prenatal supplement should I buy?

·      What should I look for in a prenatal supplement?

·      Are prenatal supplements safe for me and baby? 

We’ll be answering all these questions and more in today’s article!

Should You Be Taking A Prenatal Supplement?

Most health professionals recommend that women looking to get pregnant soon or those who are pregnant should take a daily prenatal supplement.  Technically, it is possible to get all the nutrients you need while pregnant from food.  However, with pregnancy, think of a prenatal supplement as “insurance” for you and your baby.  A prenatal vitamin/mineral supplement can help you make sure you are getting the appropriate amounts of key nutrients that are essential for the growth and development of your baby (and keep you healthy too!).

While research has consistently shown that getting our nutrients from foods is superior to getting them from supplements, in the case of pregnancy, A prenatal vitamin can help you fill in the nutritional gaps with your diet.  In my professional opinion, for most people this prenatal supplement “insurance” is worth it because getting enough of the key nutrients needed during pregnancy decreases your babies’ risk for having birth defects (like neural tube, heart, limb, and palate birth defects) and other health problems. However, a prenatal supplement cannot replace a healthful diet!  It is still important to eat a healthy, balanced diet before, during, and after pregnancy!

 All in all, yes, I do think that it is worth it to take a prenatal vitamin/mineral supplement if you are trying to get pregnant or as soon as you find out that you are pregnant.  Make sure to talk to your doctor and dietitian to get the “OK” before taking any new supplements, especially if you have preexisting health or medical conditions.

What does the research say?

• Several studies have demonstrated that taking a multivitamin with at least 400 mcg of folic acid before pregnancy reduces risk of birth defects (neural tube, heart, limb, and palate defects).

• Taking a prenatal multivitamin regularly before pregnancy may lower the chances of baby being small for gestational age (a baby who is smaller than the usual size for the number of weeks of pregnancy).

• Taking a prenatal multivitamin regularly before pregnancy may lower the chance of preterm birth for your baby in some women.

• Women who take a prenatal multivitamin daily before and during early pregnancy have a 55% lower risk of miscarriage than women who take no multivitamins.

Prenatal Supplements I Recommend:

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1.     NatureMade Prenatal Multi+DHA

Folate – 800 mcg

Iron – 27 mg

Calcium – 150 mg (12% DV)

DHA – 200 mg

Vitamin A – 4,000 IU as beta carotene

 Pros:

• Meets needs for folate, iron, and DHA.  

• Within appropriate Vitamin A levels & comes from beta carotene.

• USP Certified

Cons:

• Larger pill

• Low in calcium (if you don’t eat 3 servings of dairy products/calcium fortified products you may need a separate supplement. I recommend this calcium supplement.)

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2. NatureMade Prenatal Multi

Folate – 800 mcg

Iron – 27 mg

Calcium – 250 mg (19% DV)

DHA – 200 mg

Vitamin A – 2,567 IU as beta carotene

 Pros:

• Meets needs for folate, iron, and DHA.  

• Within appropriate Vitamin A levels & comes from beta carotene.

• USP Certified

Cons:

• Larger pill

• Low in calcium (if you don’t eat 3 servings of dairy products/calcium fortified products you may need a separate supplement. I recommend this calcium supplement.

• Does not contain DHA (If you don’t eat 2-3 servings of fish/seafood per week you may need an additional supplement.)

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Which Prenatal Supplement Should You Buy?

The catch with prenatal supplements is that there are no official requirements as to levels or nutrients that a prenatal vitamin has to contain, so you see the actual levels and nutrients included vary quite a bit when comparing brands.  Choosing the right prenatal supplement is important because many prenatal supplements either 1) don’t have all the nutrients you need during pregnancy, 2) Have way too much of the nutrients you need (this is unneeded and can be dangerous), 3) Don’t include enough of all the nutrients you need during pregnancy.

The good news is, I have listed what to look for and the amounts needed for you below! 

When buying a prenatal vitamin/mineral supplement, you are going to need to look at the nutrition facts label.  I have listed the nutrients that pregnant women need in higher amounts and have also included the specific amount you need for pregnancy so you can read and compare the prenatal supplements at the store. 

When Choosing a Prenatal Supplement Look for These Things:

General Recommendations

• Aim for ~100% of the Daily Value for at least: Folic Acid or Folate, Iron, and Calcium. If you give any prenatal vitamin’s nutrition label a quick glance, it is a general rule of thumb to ideally have ~100% of the Daily Value Percentage for at least: Folic Acid or Folate, Iron, and Calcium.  Remember you are still eating food which means you are going to get these nutrients (and others) through food each day as well.  So, we don’t need to be worried about going overboard with supplements.  If the percentages are close to 100% then you are likely going to “fill in the gaps” if you don’t quite consume enough of these nutrients each day without going overboard.

• Watch out for Gummy Vitamins. Many women choose gummy prenatal vitamins because they are more appealing, appetizing, and some think they are better tolerated.  Most gummy vitamins don’t contain any iron, which is a big downside since pregnant women have even higher iron needs than women who are not pregnant.  Not getting enough iron can lead to iron-deficiency anemia which will make you feel exhausted and lethargic and isn’t great for baby either.  Find a prenatal supplement with iron if you can and if you are having problems tolerating it, talk with your doctor and/or dietitian who can help you.

• Avoid prenatal supplements with herbs, other botanicals, amino acids, and/or caffeine.  The isn’t really much evidence showing that these additions are safe or beneficial for those who are pregnant.  It is best to stay away from these ingredients to keep you and your baby safe.

• Choose supplements that have the USP certified label. Supplements are currently presumed safe and do not require FDA approval or review before they are marketed. The dietary supplement manufacturer (not the FDA) is responsible for making sure the supplements they sell are of high quality and safe to consume. Obviously, the company selling the supplement wants to make money by selling it’s product to consumers. So, you can see how there is a huge conflict of interest and overall a large problem with unregulated supplements on our shelves. Supplements that have the USP certified label mean that the supplement company has had a third party test their product to meet high quality and safety standards. As a dietitian, I am very hesitant to recommend supplements that do not contain the USP certified label.

  The USP certified label guarantees that the supplement:

  • Contains the ingredients listed on the label, in the declared strength and amounts.

  • Does not contain harmful levels of specified contaminants.

  • Is made according to FDA and USP Good Manufacturing Practices, using sanitary and well-controlled processes.

  • Will break down and dissolve within a specified amount of time so the active ingredients can be released and absorbed by the body.

Most Important Nutrients Needed

• Folic Acid or Folate (600 mcg/day) – A pregnant woman needs ~600 mcg of folic acid per day.  Folic Acid is a vitamin that helps reduce the risk of birth defects that affect the spinal cord.

• Iron (27 mg/day) – A pregnant woman needs at least 27 mg of iron each day.  This is a significant increase compared to pre-pregnancy needs because your body increases red blood cell production to meet the needs required for your baby to grow and develop normally.  Iron deficiency is one of the most common nutritional deficiencies during pregnancy because it is very difficult to meet iron needs during pregnancy with food alone.  *If you do have an iron deficiency, your doctor may increase your needs to get your iron back to normal ranges.

• Calcium (~1,000mg/day for women aged 19 to 50) – A pregnant woman needs ~1,000 mg/day of calcium (1,300 mg/day for pregnant women ages 14 to 18 years old).  Calcium is needed to build your baby’s teeth, bones, heart, nerves, and muscles so they are healthy.  If a pregnant woman does get enough calcium for her and baby, the calcium needed for baby will be taken from her own bones.

  • Note: Many prenatal vitamins are low in calcium so you may need an additional calcium supplement if you don’t get enough calcium from foods.

• DHA (at least 200/mg/day) – A pregnant woman needs at least 200 mg/day of DHA, an omega-3 fat.  This nutrient is essential for the development of your baby’s brain, nerves, and eyes.  If you don’t eat 2-3 servings of fish (8-12 ounces) per week a DHA supplement may be beneficial for you.

  • Note: Many prenatal vitamins do not contain DHA so you may need an additional DHA supplement if you don’t get enough from foods.

• Less than 3,000 mcg (or 10,000 IU) of Vitamin A per day.  Consuming large amounts of Vitamin A as retinol (aka vitamin A acetate or palmitate) can be dangerous for you and baby.  It increases the risk for birth defects and can also be toxic for your liver. Choose a supplement with the majority of Vitamin A coming from beta-carotene, which is much safer for you during pregnancy.

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Having Trouble Tolerating Prenatal Vitamins?

Some people struggle with tolerating prenatal vitamins during pregnancy (especially in the 1st trimester when morning sickness tends to be bad).  Here are a few suggestions:

·      Take Prenatal Supplement with/or after a meal and/or in the evening. This may decrease queasiness and reduce stomach irritation. 

·      Talk to Your Doctor. If you are having trouble tolerating your prenatal supplement(s) talk to your doctor about it.  It may be possible to find a supplement that is smaller, is easier to swallow, or that is liquid or chewable but still contains iron.  There are options to help you do the best you can until morning sickness passes.  

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Additional Notes:

• If your diet was largely inadequate prior to becoming pregnant, if you have certain chronic medical conditions, or if you are pregnant with more than one baby, you may benefit from a prescription prenatal supplement.  Talk to your doctor if you think this applies to you.

• If you have had a pregnancy affected by neural tube defects (like spina bifida), I recommend you talk to your doctor before becoming pregnant as you may need higher, prescription level doses of folic acid prior to becoming pregnant.

• If you are ever curious about how you are doing with a specific nutrient level, talk to your doctor and ask if you can get tested to check to see if these nutrient levels are within normal range.

• For a full list of nutrient needs during pregnancy, schedule a meeting with your dietitian.

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DISCLAIMER: This article is for educational purposes only and should not replace medical advice given to you by your doctor.  For individualized help, visit with your doctor and registered dietitian.

*No products were sponsored in this post, however, this post does contain affiliate links.

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Sources:

1.     Ward EM. Expect the Best. 2nd ed. Nashville, TN. Turner Publishing Company;2017,2009.  

2.     Klemm S. Eating Right During Pregnancy. Academy of Nutrition and Dietetics. https://www.eatright.org/health/pregnancy/what-to-eat-when-expecting/eating-right-during-pregnancy. Published January 9, 2019. Accessed May 13, 2019.

3. USP Verified Products Listings. https://www.quality-supplements.org/verified-products/verified-products-listings. Accessed May 13, 2019.