Whether you recently learned you’re pregnant or you’re thinking about trying to conceive, you’ve got a long list of stuff to do. One thing that needs to be pushed to the tippy top of that list? Buy a bottle of prenatal vitamins and start taking them, ASAP. We can already hear the questions formulating: If I’m not even pregnant yet, do I really need a prenatal vitamin? and If I’m already taking a multivitamin, isn’t that enough to cover me? The quick answers are yes and no, but we talked to the experts to find out why you need to take prenatal vitamins when you aren’t even pregnant yet and which are the best prenatal vitamins for you.
What are prenatal vitamins?
The word “prenatal” in the name is a pretty big clue here: These are special vitamins meant to be taken before giving birth, and that sets them apart from your average multivitamin. “The key nutrients in prenatal vitamins are iron and folate,” explains Bradley Price, an OB-GYN from Austin, Texas. “Iron is a key building block in the machinery for getting oxygen to every part of the body, as well as through the placenta to baby. Very few women have adequate iron stores in their bone marrow, so iron supplementation during pregnancy is crucial.” [pullquote align=”center”]While a general multivitamin supplement can be helpful for the average population, Price says they’re no replacement for prenatal vitamins.[/pullquote] That extra iron in prenatal vitamins helps prevent anemia for moms-to-be during pregnancy, and it also helps women avoid the risk of blood transfusion if blood loss is higher than average during delivery. Prenatal vitamins are also packed with folate or folic acid, a B vitamin that Price calls “one of the most important nutrients women can take to protect the health of the baby.” Among the benefits of folate touted by doctors is a lower risk of baby developing neural tube defects such as spina bifida and anencephaly and a lower risk of preterm birth, which carries with it a variety of risks to a baby. Dietary guidelines from the American College of Obstetrics and Gynecologists recommend that pregnant women get at least 600 micrograms of folic acid daily from all sources for that reason, and sources can include prenatal vitamins.
The Difference Between Prenatal Vitamins and Regular Vitamins
But you’ve got a multivitamin you’ve been taking for years, so you’re all set, right? Well, unless it’s specifically labeled “prenatal,” probably not. While a general multivitamin supplement can be helpful for the average population, Price says they’re no replacement for prenatal vitamins as they’re designed specifically for the nutritional needs of those who are pregnant—and their babies. Even grabbing your Granny’s vitamins thinking it’s better than nothing could put you and baby in a bad spot, he explains, because “supplements marketed for the elderly contain very little iron because this age group requires minimal iron and are actually at higher risk for getting too much iron.”
When to Start Taking Prenatal Vitamins
In part because of the name, there’s a common misconception out there that prenatal vitamins are only supposed to be taken by pregnant women, says Kara Manglani, a certified nurse midwife and founder of The Fertile Times. “Ideally, you should start taking prenatal vitamins three months before trying to become pregnant,” Manglani says. “In fact, there is no downside to taking prenatal vitamins, so the earlier the better.” That’s been a recommendation of the American College of Obstetricians and Gynecologists for years, however a prenatal health and nutrition survey of U.S. women performed on behalf of the March of Dimes in 2017 found just 34 percent of women said they started taking the prenatal vitamin or multivitamin before they knew they were pregnant. Most providers agree that if you’re of “childbearing age” and thinking about getting pregnant, now is the time to start popping a prenatal vitamin. Another bonus? Some studies indicate that taking prenatal vitamins may actually reduce baby’s risk of autism. Researchers at the University of California, Davis, followed 700 California families with children from 2003 to 2009. Their study, published in the medical journal Epidemiology in 2011, claims that “women who reported not taking a daily prenatal vitamin immediately before and during the first month of pregnancy were nearly twice as likely to have a child with an autism spectrum disorder as women who did take the supplements—and the associated risk rose to seven times as great when combined with a high-risk genetic make-up.” [pullquote align=”center”]“Facing this array of side effects, many women are reluctant to take their vitamin regularly, if at all.” —Bradley Price, MD[/pullquote] A second study, published in the British Medical Journal in 2017, looked at more than 270,000 kids born in Stockholm, Sweden, between 1996 and 2007. Researchers say they found that women who take prenatal vitamins during their pregnancy may be able to lower their child’s risk of developing autism associated with intellectual disabilities by as much as 30 percent. Of course, correlation does not equal causation, and other studies have purported that too much of two specific vitamins—B12 and folate—during pregnancy may have the opposite effect! Still, doctors stress the need to take prenatal vitamins because of what they definitely do know, thanks to other studies. “We do know that taking folic acid supplementation prior to conception decreases the risk of having a baby born with a neural tube defect, such as spina bifida,” says Mary Jane Minkin, an OB-GYN and clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine. “We do know that babies in utero take iron from their moms—and if mom is anemic to begin with, she will likely become more anemic—and feel even more exhausted,” Minkin says. “We know that vitamin D is important for many organ systems to work properly. So a good prenatal contains proper amounts of all of those vitamins.”
How to Choose the Best Prenatal Vitamin
Before you hit the vitamin aisle at your local pharmacy, your best bet for finding the best prenatal vitamin for you is a trip to your OB-GYN or midwife’s office. They can test your blood to see what your iron and other levels look like and help you determine what nutrients you really need right now. Some doctors advocate for a prescription-strength prenatal vitamin, as they typically have different amounts of folic acid than the kinds you’ll find in the store. While an over-the-counter prenatal vitamin will likely contain about 800 mcg (micrograms) of folate, you’ll find about 1,000 mcg in prescription prenatals, Price says. “But the key difference is the iron source,” he adds. “OTC sources typically contain iron salts, such as ferrous sulfate, gluconate, or fumarate, which are all poorly absorbed and aggravate acid reflux, leading to nausea, indigestion, heartburn, and constipation. Facing this array of side effects, many women are reluctant to take their vitamin regularly, if at all.” Price recommends Prenate Mini, a prescription-strength prenatal vitamin that puts the iron molecule between two amino acids, so it’s absorbed efficiently in the same part of the small intestine as amino acids. But other women may find that an OTC option works for them, says Manglani. “There is a huge selection to choose from when selecting an OTC vitamin,” she says. “This gives you a lot of choice, but it is also important to make sure you select a prenatal vitamin that has all the necessary nutrients.”
What to Look for in a Prenatal Vitamin
To ensure you do select the right prenatal vitamin, Manglani suggests you look for a one that includes the following, or that you take a vitamin that includes some of these ingredients, along with supplements that your healthcare provider approves.
Compared to folic acid, Manglani says methyl-folate is better absorbed by the body but still provides the necessary nutrients. The recommended intake is between 400 and 1,000 mcg per day.
This mineral will help mom stay healthy, Price says, and it will also help your body as it works to produce more blood to pump through the body and carry oxygen to the baby. Look for a vitamin that delivers 30 mg per day.
The recommended daily intake of vitamin A is 770 mcg, and this is not a case of “770 is good, so more is better.” Manglani advises moms-to-be to be wary of anything with more than 5000 IU (short for International Unit), as vitamin A toxicity can lead to birth defects.
It’s recommended that you get at least 400 units of vitamin D, a fat-soluble vitamin that’s typically found in fish and dairy products, a day. Most adults also get vitamin D from spending time in the sun. Because it’s recommended that parents keep newborns out of direct sunlight to protect their fragile skin, recent studies have shown a risk of vitamin D deficiency in babies. Consuming vitamin D in your prenatal vitamin has not only been linked to a reduction in the risk of pre-eclampsia during pregnancy, but it helps boost baby’s vitamin D levels.
Moms-to-be should shoot for at least 1,000 mg per day, Manglani says. This will help the fetal skeleton develop, and it can be obtained via your prenatal vitamins and the consumption of calcium-rich foods such as yogurt and milk.
Because of the impact pregnancy can have on the thyroid gland, the American Thyroid Association recommends iodine supplementation before and during pregnancy as well as while breastfeeding. Look for a supplement with about 150 mcg per serving.
Choline and DHA (Docosahexaenoic Acid)
Thought by scientists to help improve a baby’s brain development, these nutrients are not always available in prenatal vitamin form and may require an extra supplement, Manglani says. You can check with your provider to see if there is one that’s good for you. The recommended level of DHA is 200 to 300 mcg, while it’s suggested you get about 450 mgs of choline.
When Prenatal Vitamins Aren’t Worth It
In addition to making sure your prenatal vitamin has those ingredients outlined above, there are also a few other things to watch out for. Buying the wrong prenatal vitamin might not be worth it. Here’s what the experts recommend: You’ll want to make sure any bottle of vitamins you’re considering has been thoroughly reviewed by reputable agencies, warns Vin Amin, president of vitamin maker Eu Natural. “Look to see that the supplement has been made to meet FDA standards and cGMP, which stands for current Good Manufacturing Practices,” Amin suggests. “This ensures your product has been manufactured and packaged based on the latest regulations.” [pullquote align=”center”]Prescription vitamins may be covered by your health insurance. That could net out to a cheaper or even free prenatal vitamin.[/pullquote] You’ll also want to be wary of junk “fillers” added to a prenatal vitamin, Amin warns. Check the supplement facts panel in the “other ingredients” section on the bottle. If you spot magnesium stearate, titanium dioxide, or silicon dioxide, you know you’ve picked up a vitamin packed with fillers. If you’re a vegetarian, you should also beware that many prenatal vitamins come in gelatin capsule form, which means they’ve been made from animal products. “Vegetarians will definitely want to avoid these products,” Amin says. And while it’s tempting to load up on gummy vitamins (hey, who says the kids get to have all the fun?), Amin says they’re not as potent as the capsule formulation, which means a whole lot of extra sugar intake to get the same dosage. One final thing to consider, Manglani says, is cost. While over-the-counter prenatals are cheaper for some and may be the best bet if your provider recommends an OTC vitamin, prescription vitamins may be covered by your health insurance. That could net out to a cheaper or even free prenatal vitamin, Manglani says.
Prenatals Without the Pain: Treating Nausea From Prenatal Vitamins
Some 97 percent of women do take prenatal vitamins during pregnancy according to the March of Dimes poll—which is good news—but while they should be taken all the way through pregnancy and even while breastfeeding, that doesn’t always happen. The culprit is often nausea, says Sherry Ross, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California. “With the high amounts of vitamins and minerals, prenatal vitamins are notorious for causing nausea during pregnancy,” Ross says. To help quell the nausea and stick to your prenatal vitamin routine, she suggests taking your vitamins right after eating or before going to sleep at night. It’s also okay to cut that vitamin in half (many are scored for this purpose), taking half in the morning and half at night. “If the nausea persists, I have my patients take a one-a-day multivitamin instead of a prenatal until they have a stronger stomach,” she says. Changing brands may also be a helpful option!