This article was written by Progyny’s Chief Medical Officer, Dr. Janet Choi. Read on to learn about the factors to consider when choosing a prenatal vitamin. Please speak to your doctor about your own individualized recommendations.
Since pregnancy is your goal, let’s talk vitamin supplements.
I am frequently asked if there is one “best” prenatal vitamin. There is not! Keep in mind that the FDA (Food & Drug Administration) does not regulate over-the-counter supplements in the same strict way they do medications, and therefore vitamin companies do not have to prove via research studies that their supplements are safe and/or effective. So, where do you start?
- Look for something easy to find: Readily available at your local pharmacy or online.
- Prioritize one that is easy to ingest: If you don’t enjoy taking many pills or keeping track of them, try to find a prenatal vitamin that delivers the daily supplement dose via one pill or a couple gummies. Follow the label’s daily recommended dosage—some vitamin supplements only require one pill a day while others may require up to 3 or 5 a day spaced apart.
- Choose one that is easy to tolerate: There are many prenatal vitamins to choose from so if one does not sit well with your digestion, try another one!
- Opt for a trusted brand when possible: Some manufacturers will submit to further review by an independent reviewer for quality control- such as Consumer Lab, NSF International or US Pharmacopeia, but this is not a requirement. Speak to your doctor about brands they recommend.
What should your prenatal vitamin contain?
Prenatal vitamins are a helpful tool when trying to conceive as they contain the recommended daily vitamins and minerals necessary to support your health both during and before pregnancy; they can even reduce morning sickness if you take them before conceiving. When selecting a prenatal, you’ll want to make sure they contain the following important elements:
- Folic Acid (B9): The most important supplement to take during preconception and pregnancy is folic acid (vitamin B9). Low folic acid intake is associated with higher risks of neural tube defects (birth defects affecting a baby’s spinal cord and/or brain). Additional benefits may include lower risk of heart defects in your baby as well as a lower risk of premature delivery. Thankfully, you can reduce your risk if you ingest at least 400micrograms (mcg) of folic acid daily (combination of food with supplements) starting 1-3 months preconception and increasing to 600mcg a day during pregnancy. Most prenatal vitamins contain at least 400mcg in their daily dosage.
While methyl-folate has been touted to be “better” for certain individuals, the CDC and ACOG advise (based on current research) that folic acid is the supplement to take.
You can find the naturally occurring form – folate – in foods like beef liver, asparagus, brussel sprouts, certain nuts, and beans like kidney beans, but it is best absorbed via fortified food/supplements.
If you, your sperm source, or a prior pregnancy have been affected by a neural tube defect or if you are on medications to manage a seizure disorder, you may be advised to take an increased dose of folic acid. You should speak with your doctor about prescription folic acid while trying to conceive and during the first few months of pregnancy.
When taken in excess, folic acid can mask a certain type of anemia associated with nerve damage, so do not take more than the recommended dose unless advised by your physician.
- Iodine: Iodine is crucial to thyroid function, as the thyroid gland makes important hormones that regulate how your body functions/metabolizes energy. A daily dose of 150mcg is recommended for preconception, and 220mcg daily dose during pregnancy. Food sources include iodized salt, where iodine has been added in the production process. You can also get iodine from seaweed, fish (such as cod) and dairy products. Individuals who are deficient in iodine may suffer thyroid problems as well as higher rates of miscarriages. Iodine deficiency during pregnancy also impacts the fetus, sometimes leading to thyroid dysfunction as well as intellectual/brain development problems.
- Iron: Iron supports blood cell development and prevents anemia, a condition in reproductive aged women commonly caused by menorrhagia—heavy menstrual periods. A daily dose of 8milligrams (mg) daily for all adults, and 27mg during pregnancy, is recommended. Iron deficiency might be linked with preterm delivery as well as low infant birthweight and brain developmental issues. The best sources of iron come from animal products like meat, chicken, and oysters. While you can find iron in certain plant foods such as spinach and lentils, they are not as well absorbed; if you follow a strict vegetarian diet, you will need more iron via supplement & should discuss this with your doctor. Most prenatal vitamins have some added iron, but if you find that you are feeling more constipated, try a prenatal without iron.
- Please note that too much iron can be toxic and, rarely, fatal so you want to make sure you are ingesting the correct amount and keep it away from young kids who might mistake your prenatal vitamin for candy.
- Try to take certain other medications (i.e., thyroid medications)—at least a few hours apart from your iron/prenatal vitamin as they may interfere with your stomach’s absorption of the medication.
- Vitamin B6: Also known as pyridoxine, this vitamin helps with brain and immune system development in a pregnancy. A daily dose of 1.3mg during preconception, and 1.9mg during pregnancy is recommended. You can find Vitamin B6 in a lot of various foods, including fish, potatoes, and chickpeas (which give you more than half the daily recommended dose in just 1 cup). Vitamin B6 is also a safe and effective way to manage morning sickness during early pregnancy and can be taken in doses of 25mg 1-3 times per day.
- Vitamin B12: This vitamin is needed for blood and nerve cell development and maintenance, as well as DNA production, and is readily found in animal products like eggs, milk, fish, and meat. The recommended daily dose is 2.4mg during preconception, and 2.6mg during pregnancy. Vitamin B12 is not found in plants, so if you adhere to a vegetarian diet, it is recommended you look for it in your prenatal.
- Vitamin A: Vitamin A helps promote healthy skin, eyes, and reproductive health, as well as fetal bone development during pregnancy. 700mcg a day of retinol activity equivalent (RAE) is recommended before pregnancy, and 770 mcg RAE during pregnancy. Think of bright colors when seeking Vitamin A food sources – carrots, sweet potatoes, mangoes, and apricots are all great options. Less colorful vitamin A –rich sources include beef liver and even vanilla ice cream. Please note that taking too much vitamin A in supplement form can cause serious birth defects. As such, you should only take your prenatal vitamin as recommended on the label and avoid using adult “mega vitamins,” which frequently contain vitamin doses that are much higher than recommended for pregnancy.
- Calcium: Calcium improves bone and dental strength and health for the fetus and gestational carrier. 1000mg a day is recommended for both before and during pregnancy. Bone density temporarily goes down in the pregnant individual and during nursing –though it usually normalizes after. Calcium is also essential for how all our cells function—for instance, for an egg to be properly fertilized by sperm, calcium needs to be able to flow across the egg cell membrane. Dairy products are great calcium sources, as well as sardines with their bones, kale, and broccoli. Certain vegetables like spinach have calcium but also contain substances that interfere with your body’s ability to absorb calcium, so make sure to consider this when choosing sources. Because calcium can cause constipation, not all prenatal vitamins contain it, so make sure to check the label.
- Vitamin D: This vitamin helps your body absorb calcium, which promotes bone strength, and as such, consuming adequate calcium is one of the best ways to prevent osteoporosis. Sunlight exposure helps your skin manufacture vitamin D, but make sure to be mindful with sun exposure to mitigate risks of skin cancer. Food sources of Vitamin D include fatty fish, like trout or salmon and fortified milk (whether dairy, almond, soy, oat). Too little vitamin D can lead to a disease called rickets in babies and children, where the bones become very soft and deformed. Conversely, too much vitamin D (usually from ingesting too much vitamin D supplementation), can lead to kidney problems & heart arrhythmias. The recommended daily dose is 600iu or 15mcg a day before and during pregnancy.
- Omega 3 fatty acids (ALA; DHA; EPA): These fatty acids are an essential part of our cell membranes, especially in the eyes, sperm, and brain. There are mixed studies on the capacity of omega 3 consumption during pregnancy to promote fetal brain development; some support this correlation while others suggest there is none. Found in most prenatal vitamins, omega 3 fatty acids can sometimes upset your stomach, so if you are feeling nauseated or finding you are burping [fishy odors], consider switching to a prenatal without omega 3 for a while. Some patients also experience less of these side effects when taking their vitamins before bed.
- Choline: Choline promotes fetal brain and spinal cord development, which we need to maintain our cell membranes. Food sources include eggs, meat, soybeans, lentils, and broccoli. Many prenatal vitamins do not contain choline, so be sure to look for it specifically on the label. A daily dose of 425 mg is recommended during preconception, and 450 mg in pregnancy.
Once you’ve selected a prenatal vitamin, remember that compliance is very important, especially if you are not used to taking supplements or medications. Store your vitamin in a place you’ll see it every day – some recommend your bedside table, near your keys, or your skincare products. Taking these steps can help you integrate your vitamins into your daily routine.
Keep in mind that taking vitamins does not replace a healthy diet. In fact, many of the supplements discussed can be found naturally occurring in foods. Try to follow, more days than not, a healthy, balanced diet. One approach is the Mediterranean plate, which prioritizes fruits and vegetables of assorted colors, as well as whole grains and smaller amounts of animal protein. Think of the prenatal vitamin as what it is intended to be—a supplement to a healthy diet and, hopefully, a healthy pregnancy!
Dr. Choi is a board-certified reproductive endocrinologist with more than 20 years of experience in the field. Prior to joining Progyny as Chief Medical Officer, she was the Medical Director of CCRM New York for seven years. Dr. Choi has written, published, and lectured extensively on infertility, onco-fertility, and fertility preservation, and is an active member of the American Society for Reproductive Medicine (ASRM), the American College of Obstetricians and Gynecologists (ACOG), as well as the New York Obstetrical Society. She has been selected as one of New York Magazine’s Top Doctors as well as a New York Super Doctor annually since 2018; a Castle Connolly Exceptional Woman in Medicine every year since 2019; and has been annually listed with Castle Connolly’s “Top Doctors” since 2015.
Please note this content is for informational purposes and is not intended as a substitute for medical advice. Please consult with your healthcare provider about your specific journey. It is particularly important to speak with your doctor and/or nutritionist to ensure a healthy pregnancy course if you follow a strict vegetarian diet, have underlying medical conditions such as inflammatory bowel disease or celiac disease, diabetes, cystic fibrosis, thyroid disease, seizure disorder history, or alcohol dependency, if you are taking certain medications such as metformin or (PRILOSEC), or had a history of certain surgeries such as gastric bypass.