Buzz
Selecting a prenatal vitamin is one of the first important choices that expectant mothers face, and it can be a tough one. With so many options available, the ingredient list can seem overwhelming, and the pills themselves tend to be large. A quick search on Amazon shows over 500 options for "prenatal vitamins," not to mention the numerous direct-to-consumer brands. While there is a set of essential nutrients common to all prenatal vitamins, some formulas offer more of certain ingredients, while others include additional nutrients or have different chemical forms of the vitamins. To simplify the process of choosing your prenatal vitamin, here are a few expert-recommended factors to consider.
Who is recommended to take a prenatal vitamin?
Ideally, you should start taking a prenatal vitamin before pregnancy, according to Emily Oken, M.D., a professor of nutrition at the Harvard TH Chan School of Public Health. "The nutrients we need increase during pregnancy, so it's beneficial for all women to take a prenatal vitamin and mineral supplement to complement the nutrients from their diet," says Marie Caudill, Ph.D., a professor of nutritional sciences at Cornell University.
DHA, iodine, choline, and biotin: not found in every prenatal, but worth considering
Fish is an essential source of docosahexaenoic acid (DHA), says Emily Oken, M.D., a professor of nutrition at the Harvard TH Chan School of Public Health. She recommends women consume two servings per week of DHA-rich, low-mercury fish such as trout, salmon, or sardines. If fish doesn’t appeal to you, Dr. Oken reassures that there's no harm in taking a prenatal supplement containing DHA.
Fish also provides iodine, a nutrient Dr. Oken notes is often deficient in the U.S. diet, leading to thyroid issues and developmental delays in children. She advises opting for iodized salt and selecting a prenatal vitamin that includes 150 micrograms of iodine, which Dr. Oken says is present in only about half of all prenatal vitamins.
Choline and biotin, though not present in every prenatal, are highly recommended by Dr. Caudill. “Choline is crucial for brain and eye development,” Dr. Caudill explains, and biotin is necessary for fetal growth. These nutrients are still emerging in research, which is why they haven’t yet been included in official prenatal guidelines. Additionally, Dr. Oken suggests that women consult with their healthcare provider to determine if they have specific needs, like extra iron for anemia or additional vitamin D if blood tests show insufficiency.
B12 and folate: found in all prenatal vitamins in varying forms
While vitamin B12 is included in all prenatal vitamins, it is particularly important for women following vegetarian or vegan diets since it is naturally found in animal-based products. Dr. Oken points out that "low B12 levels have been linked to poor fetal growth, preterm birth, and certain birth defects." Look for a prenatal that provides at least 2.6 micrograms of B12. Dr. Caudill also recommends a methylated form of B12, the "bioactive" version that is most easily utilized by the body.
Dr. Caudill advises that opting for the bioactive version of a nutrient is generally a smart choice, except when it comes to folic acid. Folic acid is the only form of folate with strong evidence supporting its ability to reduce neural tube defects, such as spina bifida. "Other forms [of folate] may also help reduce neural tube defects, but the evidence isn’t as robust," Dr. Caudill clarifies.
Some vitamin companies are replacing folic acid with L-methylfolate due to concerns about common gene variations involved in the folate metabolism. Stuart Shapira, M.D., Associate Director for Science and Chief Medical Officer at the CDC's National Center on Birth Defects and Developmental Disabilities, explains that folic acid is proven to reduce neural tube defects, even for women with these genetic variations. "If women, regardless of whether they have [common variations in the MTHFR gene], consume the recommended 400 milligrams of folic acid daily, they will all achieve adequate blood folate levels to help prevent neural tube defects in their pregnancies," Dr. Shapira explains.
Folic acid is especially critical before and during the early stages of pregnancy because the neural tube closes between the fourth and sixth week—often before many people even know they’re pregnant. "I think anyone planning a pregnancy should consider taking a prenatal to ensure they have all the necessary nutrients to support the pregnancy… and continue until the end of lactation," advises Dr. Caudill.
How much is too much?
When it comes to nutrient amounts, more isn’t necessarily better. "There’s no need for a vitamin to exceed 100% of the recommended amount for a pregnant woman. Too much of a particular nutrient can create an imbalance," says Dr. Caudill. However, recommendations can slightly differ between organizations like the FDA and the American College of Obstetricians and Gynecologists (ACOG). For example, the FDA suggests 800 micrograms of folic acid, double the amount recommended by ACOG. "But there’s no need for a prenatal to have 1,000 micrograms of folic acid," Dr. Caudill notes. That would amount to 250% of the daily value based on ACOG's guidelines.
What to expect
Do those large pills deserve a hefty price tag? “Prenatal vitamins shouldn’t be overly expensive. There are many common generic brands that cover all the essential nutrients,” says Dr. Oken. However, Dr. Caudill believes it might be worth investing a little more in a prenatal with bioactive ingredients and additional nutrients like choline, biotin, and iodine. “But a more affordable prenatal will still be beneficial compared to not taking one at all,” she emphasizes. Over-the-counter prenatal vitamins range in cost from about 4 cents a day to over a dollar per day.
If cost is a concern, a prescription prenatal might actually be less expensive than an over-the-counter one, depending on your healthcare plan (they are free for those with Medicaid).
Prenatal vitamins can come with a side effect: they may cause nausea or constipation, often due to the iron content, explains Dr. Oken. "If this happens, try taking them at a different time of day or avoid taking them first thing in the morning when you’re likely to feel more nauseous." Before lunch, she suggests, might be a better time to take them.
Refining the options
Dr. Oken emphasizes that it’s crucial for women to consult with their doctor about their specific health needs. Discuss potential recommendations based on your personal lab results or diet, and if cost is a concern, request a prescription if that could help reduce costs through your health plan. If fish isn't a regular part of your diet, a supplement with DHA and iodine may be helpful. Current research suggests considering a supplement containing both choline and biotin. If your budget permits, opting for the pricier bioactive forms of these nutrients could enhance absorption, with the exception of folic acid, which is widely supported by research for preventing birth defects. Don’t delay your research—taking a prenatal vitamin before pregnancy offers significant benefits.
