Choosing Your Prenatal Vitamin

Choosing the right prenatal amidst the online noise, online ads, and general confusion

Written by Dr. Fiona Callender, ND

Thinking about getting pregnant and your algorithm seems to know it? There are so many different prenatals out there, ranging from doctor recommended and covered by insurance to trendy, expensive and all over your social media feed. It can be overwhelming to sort through which one suits your needs. They often vary in nutrient content, how many pills you need per day, gummy vs. capsule, and cost. Let’s break down what you really need in your prenatal and when you might want additional support.

Can’t I get most of my nutrients in food?

Though many of us are able to get our basic needs met through foods, dietary restrictions, preferences, and where you live might make that challenging. Pregnancy is a time of increased nutritional demands in order to support both the you and your growing baby. There’s evidence that a general multivitamin (as well as specific nutrients) can improve outcomes in pregnancy. I’m going to break down my top nutrients to look for when it comes to both the health of you and the development of your baby. 

Folic acid

Let’s start with one of the most important - and most often talked about: Folic acid. This has been studied extensively for it’s benefits in reducing the risk of neural tube defects in a growing fetus. Taken regularly - especially if started preconception - folic acid can almost eliminate the risk of neural tube defects. It’s super effective and easy to take. On top of reducing the risk of neural tube defects, it also reduces the risk of some types of anemia, risks of other birth disorders, risk of preterm birth and (especially if taken preconception) small for gestational age babies. The Society of Obstetricians and Gyanaecologiest of Canada recommends that pregnant people supplement with 400mcg of folate if they are at low risk of neural tube disorders, starting at 2-3 months prior to conceiving. Most prenatal vitamins tick this box! If you are at higher risk based on your genetics or you are taking medication that impacts folic acid levels, you should speak to your practitioner about taking an additional supplement on top of this. 

We know that prenatal vitamins can sometimes be hard to stomach if you are experiencing nausea in those early weeks of pregnancy. If this is the case, talking to your practitioner about a simple folic acid supplement until you are feeling better, can be so helpful for still meeting your needs in those early (and crucial) weeks for development. 

Iron

Iron is a nutrient that I test and treat in almost everyone. About 30% of people are iron deficient by the third trimester. Iron requirements rise to about 10 times those in a non-pregnant person by the third trimester! This is partially due to expanding blood volume and the needs of the placenta and fetus. If we start pregnancy already deficient, it makes it really difficult to get those levels up by the time you are birthing your baby. Not only is iron important for how you feel throughout your pregnancy (energy levels, restless legs, mood/irritability, hairloss) it’s also crucial to have enough reserve for birth (where some blood loss occurs) and postpartum. 

A typical prenatal vitamin might have between 20-27mg of elemental iron (helping you reach the recommended dietary allowance (RDA)) but this is not usually enough to prevent iron deficiency as pregnancy progresses. 

Testing preconception and at 24-28 weeks gives us good insight as to whether you need additional support on top of your prenatal! If you are taking a gummy, be sure to see if there’s any iron in there at all. It’s often tough for gummies to pack as much in them. 

The biggest challenge with getting (and keeping) your levels high enough? Actually taking the supplements! Iron tends to come with more side effects than other nutrients, making it harder to be consistent with. If you are struggling with your iron supplement (or taking your iron-containing prenatal) during first trimester nausea, this is another conversation we can have. There are often other forms of iron that can be easier on your stomach. 

Vitamin D

Vitamin D is another nutrient that is important for pregnancy - especially early pregnancy or preconception, if we can. This is largely because early pregnancy is when placental development occurs. Supplementing before conception, or early in the first 20 weeks, can help reduce the incidence or preeclampsia, preterm birth, and markers of gestational diabetes. For the baby, vitamin D supplementation has been shown to reduce the risk of low birth weight babies. This is important because low birth weight is frequently regarded as an indicator for child mental development and physical growth later.

You may be wondering if you can get vitamin D from being outside. It’s true that vitamin D is produced by our bodies after exposure to direct sunlight, but safe sun habits (clothing and sunscreen - that we should all be using!) block the sunlight needed to produce enough vitamin D. If you are darker-skinned, have less outdoor time or you live father from the equator (all of us in Toronto!), then you are at greater risk of deficiency. 

Many prenatal vitamins contain some vitamin D - usually 400IU, though some can be up to 1000IU. This is something I would test and add an additional supplement if needed. Choosing a prenatal that has a good dose of vitamin D is a great start.

Other nutrients to consider and prioritize

Though the above are my non-negotiables in a prenatal (or added on top of a prenatal), there are some additional nutrients that can be achieved through food. Omega 3s, choline and calcium are often in prenatal vitamins (almost never in high enough doses) and are important for health of mom and baby. 

Calcium

I often give my patients - especially those who can’t or choose not to consume dairy - a calcium calculator. We go through what they are eating and determine if they are likely hitting their calcium goals. If not? We supplement. Calcium is important for building baby’s bones and maintaining moms! During pregnancy, baby’s needs are largely met by increased digestive absorption in mom but when we get to lactation, a lot of that calcium comes from her bones. We want to make sure we are reaching adequate levels during pregnancy to not go in to postpartum deficient. 

Calcium is also important for preventing preeclampsia. In those at high risk (pregnancy history, health history, advanced maternal age, elevated BMI among others) we discuss supplementation even if diet seems pretty good.

Omega 3s

There is some evidence that omega 3s  - especially DHA - may have a positive effect on baby development as well as lowering the risk of preterm birth. The benefits seem to be most significant in those who aren’t already consuming fish. Though we definitely need more research, there’s some evidence that omegas may help reduce the severity of perinatal depression. The downside? Most prenatals have under 200mg and less than 1% meet what we would consider an adequate dose. If you are looking to add omega 3s to your diet/supplement routine, your prenatal is not usually the place to do that. Talking to your practitioner about how to add omega 3s is probably a better route!

Choline

Choline is another important one that is often left out of the conversation. This is a nutrient that is needed for optimal fetal brain development. There’s some emerging evidence that choline may be beneficial in protecting against fetal alcohol exposure in pregnancy - though this still needs more research. Though we can get it from food, it’s not always consumed in adequate amounts - especially in late pregnancy when the demand is higher!

Though choline is found in about 40% of prenatals, only about 2% of those meet the recommended dose. This is another nutrient that I prescribe based on your ability to get it in your diet. A diet with no restrictions and frequent consumption of eggs (one of the top choline rich foods)? You might be OK with the amount in your prenatal. Otherwise, we supplement!

So…. which prenatal do I choose?

The answer, as with many of my answers, is it depends. Most prenatals will give you enough folic acid, which is key. Most will not fully help many patients reach their vitamin D or iron levels without additional supplementation. The prenatals I recommend (and we sell a few at the clinic) provide a good baseline dose (multivitamin level) for many nutrients and reach minimums for folic acid, vitamin D and iron. I think it’s important to also mention that more expensive is not necessarily better! I’ve seen many wellness industry folks suggesting people don’t take doctor-recommended prenatals. If you have a prenatal that is covered by your insurance, I’m not going to tell you not to take it! If it makes you nauseous or your needs change, we may need to consider switching or adding supplements on top. It’s always a discussion that takes into account your unique needs, your lab results, and your budget. 

Want more support during your pregnancy?

I’m here to help you manage your symptoms, assess your risk factors, and be a space for you to bring your questions and concerns. Curious if I’m the right fit for you? You can book a meet and greet appointment and I’d be happy to answer any questions you may have!