Prenatal Vitamins

What is in your prenatal? Why not all prenatal vitamins are made equal?

As a Naturopathic Doctor focusing in perinatal care this is an area I get lots of questions about! Moms want to know what the best options for prenatals are, when they should be taking them and is there really a difference between all of these different options from prescriptions to products purchased at health food or grocery stores. Below I hope to break down for you what to consider when choosing a prenatal vitamin, as they are not all created equal!

When choosing your prenatal there are various factors to consider, such as:

• Dosages of nutrients
• Forms of nutrients
• Additives and non-medicinal ingredients
• Quality Standards

It’s also important to remember that while not all prenatal vitamins are considered equal, any prenatal vitamin is better than none so if there are factors affecting your ability to choose please do not put more pressure on yourself and get the best available option for you!

Are prenatal vitamins required?

I do strongly recommend every woman planning to conceive, pregnant or in the early postpartum period take a prenatal vitamin. Women of childbearing years are commonly deficient in vitamins and minerals contained in prenatal vitamins and the increased demand pregnancy and breastfeeding places on the body can lead you to be even more depleted after. Mamas have enough difficulty with energy and lack of sleep – let’s help buffer this when we can! Prenatal vitamins are also beneficial when trying to conceive and often I will recommend prenatal vitamins for any woman who has begun menstruating as the nutrients needed are similar in this population.

When possible, ideally you want to start your prenatal vitamin 6 months prior to conception (however, whenever you decide to conceive or find out you are pregnant is also a great time to start if you haven’t done so already!). I recommend mamas continue their prenatal vitamin for at least 6 months postpartum and longer if you are breastfeeding (at least 3 months past your little one being weaned).

What dosages and forms of nutrients are in your prenatal vitamin?

The amount of a nutrient and the form it is in are important aspects of your prenatal. While many prenatal vitamins contain the nutrients you are looking for, they often are in very low doses or a form that is less desirable for absorption. Here are a few important ones to consider:

Iron

• Iron needs double in pregnancy and iron is required for providing oxygen to you and baby
• Deficiency is common in pregnancy – some symptoms that can indicate deficiency include low energy, hair loss, shortness of breath, headaches and restless legs (mama tip: if you are experiencing restless legs consider iron and/or magnesium deficiency as the biggest culprits!)
• Chelated forms are best absorbed and lead to the least constipation (therefore, look for terms like iron chelate or iron glycinate in your prenatal vitamin). Forms of iron such as ferrous fumarate are more constipating – something we definitely want to avoid as it’s common enough in pregnancy to be constipated!
• Dosage-wise you want to aim for 25-35 mg of iron daily
• Unsure if your iron levels are low? You can check this in blood work using the marker ferritin

Folic acid and Folate

• Folic acid vs folate – folic acid is commonly found in the prenatal vitamins, however folic acid is a synthetic form that is poorly absorbed by the body and many individuals lack the ability to convert this to the active form needed by the body (methylfolate). Methylfolate is best absorbed by the body regardless of your genetic background – therefore I recommend looking for prenatal vitamins that contain folic acid in the form 5-methyltetrahydrofolate.

Note: similarly, you want to consider this for the B12 in your prenatal vitamin as well – look for B12 in the methylcobolamin form instead of cyanocobalamin form

• Dosage – at a minimum you want to ensure you are getting at least 800-1,000 mcg from your prenatal vitamin
• Folate is most important in the first month of pregnancy to prevent neural tube defects – this is often why I recommend beginning your folate supplement prior to trying to conceive when possible

Magnesium

• Ideally you want to aim for magnesium in your prenatal that is in the form of citrate or glycinate – you will see listed magnesium citrate or magnesium glycinate in the ingredient list – these forms are easier to absorb and create less of a laxative or digestive irritating effect than the commonly used magnesium oxide
• Magnesium deficiency can increase risk of high blood pressure, restless legs, muscle tension and headaches.
• Most prenatal vitamins contain about 50mg – in many cases additional magnesium supplementation is needed if experiencing magnesium deficiency symptoms (ensure to talk to your health care provider regarding what is the best dosage for you – many women need 200-400 mg for symptom relief)

Selenium

• Selenium is an important nutrient for maintaining a healthy pregnancy, and plays a role in the nervous and immune system development of your baby
• In women with thyroid concerns, selenium is a key factor in converting your thyroid hormones to their active forms
• Checking for the presence of selenium is important in your prenatal vitamin (as common brands such as PregVit Folic 5 do not have selenium within their formula)
• Dosage – in women with an underfunctioning thyroid (hypothyroidism), 200 mcg daily in the form of selenomethionine reduced thyroid antibodies and the risk of developing postpartum thyroiditis (inflammation of the thyroid after childbirth)
• Form – look for selenomethionine rather than selenite in your ingredient list as it is better absorbed by the body (90% absorbed vs. 50% absorbed)

Choline

• Choline is an important nutrient for neurological development of baby, reduction in risk of baby developing mental health concerns including anxiety as an adult, and improved memory, focus and attention
• The best source of choline in the diet is eggs, however, if you cannot or do not eat eggs you will want to check if this is in your prenatal vitamin
• Dosage – 400 mg of choline is recommended in pregnancy

B6

• B6 is an important nutrient for baby’s brain development, as well as can reduce nausea and vomiting related morning sickness
• Form – while many prenatal vitamins contain B6 in the pyridoxine form, the best form is P5P (pyridoxal-5’-phosphate) – this form is the active form used by the body and doesn’t require the body to convert it to be used
• Women in North America are quite commonly depleted in this nutrient, especially as the birth control pill greatly reduces B6
• Dosage – you want to aim for 5-10 mg in your prenatal, however, dosages of 50-100 mg/day are more commonly used for morning sickness (often this requires a separate supplement – ensure to talk to your health care provider on what is the best option for you if you are experiencing morning sickness)

Other Ingredients in Your Prenatal Vitamin

Another important area to consider is the additives and non-medicinal ingredients contained in your prenatal. Often these additives are used to decrease cost of production of the supplements, maintain freshness, and in some cases for aesthetics (such as the pink and blue colouring seen in the PregVit Folic 5).

Ingredients you want to avoid in your prenatal vitamins (while this is not an exhaustive list it is a good initial scan to check the level at which your vitamins have unnecessary additives):

• Dyes such as Blue, Yellow and Red dye
• PEG
• Talc
• Tartrazine
• Titanium dioxide
• Shellac
• Artificial flavouring
• BHT
• Sugar – with the exception of many gummies do have sugar and so if this is the only way you can consume a prenatal vitamin at this point than the benefits often outweigh the costs!

Many prenatal vitamins found in health food stores also contain ingredients such as botanicals – I tend to recommend avoiding these for several reasons:

• Botanicals can have interactions with medications you are taking
• Certain botanicals are not safe for all women in pregnancy
• The dosage able to be achieved within a prenatal vitamin is likely insufficient to have an effect and therefore, when using botanicals in pregnancy I recommend taking them separately
• For example, one common prenatal vitamin contains red raspberry leaf – while I LOVE this herb as a tea later in pregnancy, it should not be used in the first trimester as it can increase uterine contractions and woman are unlikely to switch their prenatal vitamin throughout pregnancy.
• Another example is ginger – ginger is fantastic for reducing morning sickness, however, is usually needed in doses of 500-1,000 mg to have an effect – it’s unlikely you will reach this therapeutic dose inside a capsule that also needs to meet all your other vitamin and mineral needs!

Finding it hard to take your prenatal vitamin?

Often I see patients having difficulty taking their prenatal vitamins – with the most common barriers being morning sickness and the vitamins making them feel nauseous. To help buffer this as best you can:

• Always take your prenatal vitamin with food to reduce any nausea or symptoms from the vitamins
• Take your prenatal vitamin with your biggest meal of the day
• If nausea or morning sickness is worst in the morning, wait until the afternoon or whatever time you feel best in the day
• If the smell of the prenatal vitamin is a concern, keep it in the fridge – I also find putting them in small pill containers or a bowl on the container saves you from opening the bottle of prenatal vitamins and getting a big hit of the smell!
• Consider the chewable options (such as Smarty Pants Prenatal Gummies)

Yours in Health,
Dr. Stephanie
Naturopathic Doctor and Co-Owner of Abaton Integrative Medicine
www.abatonim.com

References

Prenatal Vitamins: Do You Need One and How to Choose. Aviva Romm. Retrieved from https://avivaromm.com/prenatal-vitamins/. Accessed May 4, 2021.
Freedman R. and Ross R G. Prenatal choline and the development of schizophrenia. Shanghai Arch Psychiatry. 2015 Apr; 27(2): 90-102.
Selenium. National Institutes of Health – Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/. Accessed May 4, 2021.