I’ve received many, many inquires about what I recommend when it comes to a prenatal. This post is long overdue, and I hope you find it helpful in whatever stage of life you are in.
When considering to start a family, it is recommended to start taking a prenatal vitamin regularly 3-6 months prior to trying to conceive. Stress, medications like birth control, poor soil quality, and environmental conditions can deplete our bodies of essential nutrients especially if a well-rounded diet isn’t a major focus. Women of child-bearing years are chronically low in numerous nutrients that are critical for a growing fetus. In addition, an egg takes 90 days to fully develop prior to being released. Taking a prenatal can help with egg quality. Once the egg is fertilized you’ll want to make sure your body has a full reserve of folate for optimal neural tube development. When considering nutrients, a prenatal will likely cover 90%, but there are a few others I recommend incorporating for optimal health of mom and baby. Let’s start with those that 100% should be in a prenatal vitamin.
The Prenatal Multi-Vitamin
Not all prenatal vitamins are created equal. One thing I am pretty picky about when it comes to my personal body is nutrient quality. While taking any prenatal will be better in the long run than taking none at all, many are filled with artificial colorings, additives, and fillers. The key to supplementing nutrients is how bioavailable they are. Broken down in simple terms, this means how easily the body will absorb the nutrients and assimilate them into our bloodstream. This is important as baby will only get a portion of what is absorbed, so ideally we’d like to fully absorb everything. I always recommend taking a prenatal with food as some of the nutrients are fat-soluble and will only be absorbed when taken with fats. In addition, you’re less likely to become nauseated when taken with a meal. These are the key nutrients I look for in a prenatal multi-vitamin:
Methylfolate
Folate is undoubtedly one of the most important nutrients during pregnancy. Low folate levels in mother is linked to higher risk of congenital heart defects, low birth weight, and preterm birth. Unfortunately, the synthetic version of folate, folic acid, is used in most prenatal vitamins. Folate is vital to many functions in the body and especially important for fetal development. In order for the body to use folic acid, it must first convert it to the active form, known as 5-MTHF (short for 5-methyltetrahydrofolate). This form of folate has been methylated, meaning it is ready to be utilized in the body. “Not all people process folic acid well. Some have a genetic variation in the enzyme involved in the metabolism of folate known as MTHFR” (Lily Nichols). It is estimated that 40-60% of the population has a form of this genetic mutation and thus impaired ability to use synthetic folic acid. Another bioavailable form of folate that is recommended is folinic acid. Optimally, a prenatal should contain 400 mcg-800 mcg of methylfolate and/or folinic acid.
Vitamin A
Vitamin A is important for skin health, eye development, and immune function. Vitamin A is also required for vitamin D metabolism. The prenatal should contain a form of vitamin A called Beta Carotene and retinyl palmitate as getting too much of just the form retinyl palmitate is not recommended in pregnancy. This is one reason a prenatal verses just a multi-vitamin is important.
B12
B12 is important for conception as low levels can be associated with miscarriage and infertility. It helps support red blood cell formation and metabolism. If you are vegetarian or vegan, this is crucial to get in a supplement form. At least 200 mcg is ideal.
B6
B6 helps support healthy levels of progesterone which is needed for healthy uterine lining for implantation. Hormonal contraceptives can deplete B6 so if you have taken any form of birth control make sure the prenatal you are taking prior to conceiving contains B6. Adequate B6 levels can help combat morning sickness. 15 mg is recommended.
Calcium
Calcium is important for the development of healthy bones. Calcium malate is the best bioavailable form. A prenatal should contain 100-400 mg. Proper calcium (in combination with magnesium) can also help support milk supply when the menstrual cycle returns postpartum.
Vitamin D
If you have been following me for a while, you know how much importance I place on vitamin D. When it comes to building and supporting another life it is no different. During conception and pregnancy I recommend supplementing with an additional 3000-4000 IU of D3 or cholecalciferol per day, but it is wise to ask to have your levels checked when bloodwork is drawn during the first trimester and at the halfway mark. Ideally, your levels should be > 40 ng/mL. Vitamin D can help improve fertility, reduce insulin resistance in women with PCOS and it plays a role in preventing fibroids and endometriosis. Vitamin D plays an important role in preventing rickets and supporting proper bone development. Maternal vitamin D deficiency may also be associated with risks of asthma, language impairment, schizophrenia, type 1 diabetes, and multiple sclerosis (Read Food for Pregnancy pg. 99). Does of vitamin D are usually well lower than 3000 IU so I recommend additional supplementation (see below).
Iron
Iron is needed for your ability to build new red blood cells, which deliver oxygen to the baby. Iron supplementation leads to longer gestation and improved birth weight. Look for a prenatal that contains 27 mg of iron chelate, which is a non-constipating form.
Iodine
Iodine is critical for healthy thyroid function and thus plays a role in healthy menstrual cycles and fertility, as well as, the prevention of miscarriage prevention, and stillbirth. Once pregnant, iodine deficiency can affect baby’s thyroid and brain development. Too much iodine is not a good thing though; a supplemental daily dose of 150 mcg - 250 mcg is recommended.
Choline
Choline is essential for baby’s neurological development, especially memory, focus, and attention. It is actually involved in may of the same metabolic pathways as folate, including methylation. Adequate intake may prevent birth defects. New research is showing that much higher levels of choline are needed than previously recommended. Many prenatal vitamins don’t even include choline (this is one reason I rotate brands while pregnant). Choline is abundant in egg yolks and liver. Getting adequate choline is of concern if you are vegan. Egg-eaters have on average, twice the choline intake as non egg-eaters! If you don’t consume eggs regularly (3-5 times a week), I’d highly recommend supplementing with choline. Optimally, your prenatal should contain 250-500 mcg of choline, but when so few actually contain it, any amount in my opinion is great.
Zinc
Zinc is important for healthy ovulation as it supports healthy estrogen and progesterone levels. It also supports the developing egg from oxidative damage and is important for fetal brain development/function. A daily dose of 15-45 mg is recommended.
Prenatals can be pretty expensive, especially when you take them daily, likely for 2 years straight (through trying to conceive and postpartum). The list below reflect my personal recommendations of affordable (under $40/month), yet contain bioavailable vitamins to help get the vital nutrients you and babe need. In addition, these are all 3 capsules or less per day.
Kelsey’s quality yet affordable choices:
*click the bold links below for direct access to purchase
pros: $26/ month; 3 capsules/day; screened for heavy metals, NSF certified; if you are local to Madison, WI The Healthy Place carries this prenatal and often has sales/discounts, use code 25MK for 25% anytime1
cons: no choline, lower in iodine and selenium
2) Klaire Labs Prenatal & Nursing Formula
pros: $36/ month; 3 capsules/day; contains, choline and 2000 IU of vitamin D, NSF certified
cons: may be hard to find other than through Amazon
3) Seeking Health Prenatal Essentials *use code HITENUTRITIONAPRIL10 for 10% off
pros: $27/ month; 2 capsules/day; screened for heavy metals, NSF certified
cons: no choline or iron
pros: $33/month; 2 tablets; certified glyphosate residue free on third party tests; Certified B Corp
cons: does not contain calcium and magnesium; lower in selenium and iodine.
***Sickness and nausea is a real thing for many during pregnancy, if swallowing capsules is difficult you can try a gummy form. The most comprehensive one I have come across is SmartyPants Organic Prenatal Complete.
If cost is not a concern, I recommend these:
1) Seeking Health Optimal Prenatal *use code HITENUTRITIONAPRIL10 for 10% off
pros: screened for heavy metals, NSF certified
cons: $54/month; 8 capsules/day, lower in choline than others, if anemic it contains no iron
2) Needed Prenatal Multi
pros: third party tested for every batch; 4000 IU vitamin D so no additional supplementation needed
cons: $70/month; currently only available in powder form (could also be a pro for some)
pros: 4000 IU vitamin D so no additional supplementation needed
cons: $50/month; 8 capsules/day, if anemic it contains no iron
4) Designs for Health Prenatal Pro
pros: contains choline; 4 capsules/day
cons: $44/month
pros: third party tested, screened for heavy metals, contains choline and 1200 IU of vitamin D3
cons: $52/month; 6 capsules/day
Other supplements to consider
DHA (omega-3 fats)
Omega-3 fatty acids play a key role in conception and the formation of the oocyte and embryo. I suggest taking a DHA supplement starting 6 months prior to trying to conceive. Intake of DHA is also critical for baby’s brain and neurological development. Aim for 2-3 servings of fatty fish a week: sardines, wild-caught salmon, cod, trout, mussels, or 4 oz of light tuna/week like shipjack or albacore. In addition, I recommend supplementing with a prenatal omega-3 that has both DHA and EPA every day or 3-4 times a week is enough if you are a fish eater. Ideally you want to aim for 300 mg of DHA per day to provide enough for yourself and baby. I personally take Nordic Naturals Prenatal DHA 3-4 times a week.
Vitamin D3
As mentioned above, D3 is critical for many functions in both mama and babe. I recommend a liquid form that has K2 as they work together for best absorption and function. The brands I recommend and personally use are Thorne and Seeking Health (use code HITENUTRITIONAPRIL10 for 10% off all Seeking Health supplements.
Probiotics
Maintaining a healthy microbiome is important for overall health and can also influence your risk of pregnancy complications. Probiotics are linked to lower rates or preterm birth, preeclampsia and better blood sugar levels. In addition, the particular strain Lactobacillus rhamnosus has been shown to reduce the likelihood of eczema, allergies, and asthma in babies/toddlers when taken through the third trimester. In addition, probiotics have potential to favorably shift the microbial balance in the vagina and prevent testing positive for GBS. When considering a probiotic you want one that has more than multiple different strains and contains at least 25 billion CFU. Our body naturally contains over 100 trillion bacterial cells so boasting it by 25 billion is just a small fraction. I personally take and recommend ProBiota Woman from Seeking Health (use code HITENUTRITIONAPRIL10 for 10% off.
Magnesium
The prenatal vitamins I recommend all contain magnesium, but I have found additional supplementation very beneficial. Magnesium deficiency is quite common, and even more common during pregnancy. Muscle cramps and headaches are a common symptoms of deficiency. Supplementing with magnesium may also help reduce pregnancy related nausea and high blood pressure. Magnesium glycinate is the best absorbed form and least likely to cause GI effects. I recommend 200-300 mg per day of magnesium; most prenatals have less than this. Magnesium glycinate can have a relaxing effect and can also help relieve stress and improve sleep so it’s ideal to take one hour prior to bedtime.
Resources:
https://education.seekinghealth.com/should-you-take-iron-during-pregnancy/
https://drbrighten.com/the-best-prenatal-vitamins-and-when-to-start-taking-them/
https://avivaromm.com/prenatal-vitamins/
https://lilynicholsrdn.com/folate-pregnancy-folic-acid-mthfr/
https://education.seekinghealth.com/how-to-use-prenatal-vitamins-for-the-health-of-your-child/
Real Food for Pregnancy, Lily Nichols