Prenatal multivitamins are extremely important to start taking at least 6 months prior to conception to ensure you do not enter pregnancy with any vitamin deficiencies. Pregnancy increases the need for many vitamins and minerals, which makes it extremely difficult to catch up if you are entering pregnancy with a deficiency. If you are already taking a multivitamin, it is typically safe to trade it out for a prenatal multivitamin if you are a female of child bearing age. If you are trying to conceive or planning to in the next year, it is important to start taking a prenatal vitamin.
Food sources are the ideal way to obtain your vitamins and minerals prior to supplementing, but some nutrients are difficult to obtain in the amounts needed from diet alone, especially in pregnancy. The level of importance of these vitamins when growing a baby, warrant the use of supplements. Not all prenatal vitamins are created equal, so it’s vital to know what to look for when choosing.
Dosing: be sure to read the serving size at the top of the nutrition label - if it says 3 pills, that means you need to take 3 of these to meet the values they have listed. If your multivitamin has you taking 2-3 pills per day, I would recommend taking them split throughout the day as your body is limited in how much it can absorb at one time.
Nausea: if you’re feeling nauseous when taking your multivitamin, it can be helpful to take it with food.
Percent Daily Values: these percentages on nutrition labels are based on recommended daily amounts (RDAs) and generalized for the public. Many women need higher than these amounts in pregnancy. Especially if you have a deficiency in a certain micronutrient, you may need additional supplementation outside of the prenatal multivitamin. As an example, vitamin D is a common deficiency outside of summer months, and is often required to supplement additionally.
Specific Vitamins:
B - vitamins
Activated B-vitamins are easier for your body to metabolize. Examples of names to look for include L-methylfolate for folate (more on this later), pyridoxal-5”-phosphate for vitamin B6, and methylcobalamin for vitamin B12.
Folate
It is extremely important to ensure your vitamin has folate rather than folic acid. Folic acid is a synthetic version, and it is estimated that 60% of people have a genetic mutation in the MTHFR enzyme, reducing their ability to activate folic acid. Folate (L-methylfolate or 5-methyltetrahydrofolate) is the active form that you would get from food sources, and what you want to see on the label of your prenatal multivitamin. Folate is essential for preventing neural tube defects in your baby.
Vitamin A in the active form (retinyl palmitate).
This is a larger vitamin that some companies don’t include. Most women are not eating adequate amounts of vitamin A in pregnancy, so it’s important that your multivitamin have this.
Choline
Many prenatal multivitamins don’t include choline because it is bulky and would increase the number of pills you’d need to take. If you do not consume choline in your diet (egg yolks, liver, red meat), consult your provider regarding whether you should supplement choline.
Iron
Some companies also don’t include iron. If your provider is concerned about your iron levels (it is common to have low iron levels in pregnancy due to increased blood volume) be sure to check whether your prenatal multivitamin includes iron or if you need an additional supplement.
A note on Omega-3s:
Omega-3s are rarely included in a prenatal multivitamin, but are a key nutrient to consider. DHA is essential for a healthy pregnancy and baby - whether through diet or supplement. This key nutrient aids in the development and protection of your baby’s brain and neurons. Discuss particular amounts in food or supplements with your provider.
These are a few key components to consider when looking for a prenatal vitamin. There are various pros and cons to every version, and your needs will depend on your current health, diet, lifestyle, and nutrient status. Remember that supplements are intended to supplement your diet, and it remains important to eat a nutritious diet. This guide does not replace medical advice, and you should always review your supplements with your provider.
Greenberg JA, Bell SJ, Guan Y, Yu YH. Folic Acid supplementation and pregnancy: more than just neural tube defect prevention. Rev Obstet Gynecol. 2011 Summer;4(2):52-9. PMID: 22102928; PMCID: PMC3218540.
Adams JB, Sorenson JC, Pollard EL, Kirby JK, Audhya T. Evidence-Based Recommendations for an Optimal Prenatal Supplement for Women in the U.S., Part Two: Minerals. Nutrients. 2021 May 28;13(6):1849. doi: 10.3390/nu13061849. PMID: 34071548; PMCID: PMC8229801.
Real Food for Pregnancy. 2018. Lily Nichols.