How to Choose the Right Prenatal for You
Written by Annie Gager, MS, RD
October 7th, 2024
Not all prenatal vitamins are created equal.I know I have fallen prey to choosing my supplements based on pretty marketing/packages, but it is so important to choose the right prenatal for you to reduce pregnancy complications and support a healthy pregnancy.
As a prenatal dietitian, choosing the right prenatal supplement is often the very first thing I am doing with my clients because it is THAT important. I use a holistic approach to my supplement recommendations, so take this guide with a grain of salt. Your specific nutrient needs cannot be determined without a complete prenatal nutrition assessment that looks at your health history, diet history, lab work, current nutritional intake, and your specific stage of pregnancy. So please reach out to your dietitian or health care provider before making any changes to your supplement regimen during your pregnancy.
#1 Look for folate.
Taking a prenatal with enough folate (and the right type of folate) is essential and should be done as soon as you find out you are pregnant. If you wait until your first doctor’s appointment to start taking a prenatal with folate, it is likely too late to reduce the risk of neutral tube defects in pregnancy. This is because neural tube defects are formed usually in the 3rd and 4th weeks of pregnancy. Folate is a B-complex vitamin that's essential for the proper formation of a baby's neural tube, which becomes the brain and spine. Taking folic acid supplements before and during pregnancy can help reduce the risk of neural tube defects, which are severe birth defects that occur when the spinal cord doesn't close properly. The CDC recommends that all people who are able to become pregnant take 400 micrograms (mcg) of folic acid daily.
For the majority of women, folic acid is the better absorbed synthetic form of folate. The bioavailability of folate absorption from food sources is only about 65%. Folic acid has a bioavailability of about 95%. Some women are not able to absorb folic acid (those with malabsorption disorders) can take methyl folate (aka 5-MTHF), the active form of folic acid.
Women who are pregnant with more than one baby or are considered overweight/obese (using pre-pregnancy BMI) should opt for higher amounts of folic acid to ensure adequate absorption to the baby/babies.
#2 To Include Iron or Not?
Should you take a multivitamin with Iron? Well it depends on a lot of factors. Iron needs are significantly increased in pregnancy from 18 mg/day to 27 mg/day. So taking a prenatal with at least 27 mg iron sounds likes the best option, right? Well it is not necessary for everyone and can actually be harmful to your baby.
First, you want to know how much iron you are consuming in your diet. Do you eat meat? Do you primarily eat plant proteins? Animal meats contains heme iron which has high iron content and is best absorbed in the body. Heme iron sources include: beef, lamb, chicken, turkey, and fish. Plant sources of iron contain non-heme iron. Non-heme iron is less readily absorbed in the body. Only about 2-10% of non-heme iron is absorbed compared to ~25% of heme iron. Non-heme iron sources include: legumes, dark leafy greens, whole grains, fortified cereals, and potatoes.
Also, you want to know what your lab work looks like. If you are not considered anemic and are choosing to eat iron rich foods on a consistent basis, you likely don’t need an iron supplement. Iron supplements can have some nasty side effects like constipation, nausea, vomiting, heartburn and fatigue. All things that can make pregnancy less than comfortable. Excessive iron intake during pregnancy can lead to an increased risk of gestational diabetes, preeclampsia, low birth weight, preterm delivery and other health complications to mom and baby.
Food first is my mantra, but if eating adequate iron through your diet is not possible - opting for a high quality iron supplement is essential to reduce anemia during pregnancy. Your baby needs all the healthy red blood cells, nutrients and oxygen it can get!
#3 Choline
Choline is often lacking in low-quality prenatal supplements because it is expensive and has a large molecular size. It is estimated that less than 10% of pregnant women are consuming their daily needs of choline to support a healthy pregnancy. So why is choline important? Choline is critical in fetal brain and cognitive development. Choline is a “brain-building nutrient” and is involved in the formation of neural tubes, brain development, and the synthesis of lipoproteins. Choline can improve cognitive development and may protect against mental illnesses and stress disorders. It is recommended that pregnant women consume at least 450 mg choline per day to reduce risk of pregnancy complications related to deficiency. Food sources of choline include: fish, beef, poultry, eggs, beans and nuts.
It is very unlikely you will be able to find a prenatal supplement that contains 100% the recommended daily amount of choline due to its molecular size. So opting for a prenatal with choline in general is a great start + focusing on food sources of choline in the diet. An additional choline supplement may be necessary if you are vegetarian, vegan, or cannot eat enough food sources of choline during pregnancy due to *cough cough* morning sickness.
#4 My Favorite Prenatal
FullWell Prenatal Supplements
I take FullWell Prenatal supplements because #1 they are 3rd party tested for purity and potency. This means it contains what it says it does. Not all supplements are 3rd party tested because it is expensive and supplements like to add fillers to their products rather than quality ingredients. #2 I take this products because it is a dietitian-owned company supported by MDs and OBGYN’s in the prenatal realm that truly values women’s health.
Their supplements are evidence-based and backed by research to ensure you are getting the best quality products on the market rather than the cheapest.
Click here to check out the various products they offer for fertility, pregnancy, and postpartum health.
References:
https://www.cdc.gov/folic-acid/about/index.htmlhttps://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/anemia-during-pregnancy/art-20114455https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722688/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2441939/#:~:text=Choline%20is%20critical%20during%20fetal,defects%20and%20lifelong%20memory%20function.
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