Prenatal Vitamin selection by a registered dietitian for pregnancy and preconception

How I evaluate prenatal vitamins for my clients as a registered dietitian and nutrition expert.

How I evaluate prenatal vitamins for my clients as a registered dietitian and nutrition expert.

How many prenatal vitamin options are on the market? Hundreds?  Thousands? The options can be dizzying.  To make matters worse, many companies have very VERY creative marketing teams to make their brand look like the best thing since sliced bread.  


As a fertility and prenatal dietitian, there are certain nutrients that I look for when selecting a prenatal vitamin.  While I prefer to provide individual recommendations for each person’s unique needs, I am happy to share my general thoughts on prenatal vitamins for those trying to conceive as well as those already pregnant! This is not a substitute for medical advice and not individualized or personalized recommendations. I am simply sharing my thought process when considering prenatal vitamins.


I also want to add that this does not include any supplements that I may recommend for fertility reasons. That requires a much more individualized approach and varies depending on many factors. 


First, let’s tackle what turns me off of a prenatal vitamin:


·     Too many pills are considered one serving.  Fistful of pills can lead to pill fatigue. Pill fatigue can lead to noncompliance and women just giving up on taking their supplement alltogether!  Two, maybe three pills max is as high as I am willing to go.

·     Calcium and Iron in the same supplement.  Calcium and iron may compete for absorption, so naturally I do not like to see both nutrients taken at the same time.  

·     Synthetic folic acid instead of methylated folate.  Choosing supplements that contain folate instead of folic acid may be a touch more pricey, but it is worth the investment. Unless you are 100% certain that you do not have an MTHFR mutation, folate should be taken.  Folate is the active form of Vitamin B9 and Folic acid is a synthetic form of vitamin B9. The body does not convert folic acid into active vitamin B9 very well, so un-metabolized folic acid may build up in the bloodstream. Many experts recommend not choosing folic acid. READ MY BLOG POST ON FOLATE VS FOLIC ACID.

·     A prenatal that does not contain iodine.  Prenatal vitamins should contain 150 mcg iodine.  If it has 200 mcg or more, I think that is too much and may lead to mom taking in too much iodine which can be dangerous.  

·     A prenatal that contains Vitamin D2 instead of Vitamin D3. The D3 source is the preferred and is thought to be absorbed well. 


Now, what do I not worry about as much in a prenatal:

·     Selenium. While selenium is a very important nutrient for those ttc and pregnant, not every prenatal contains this nutrient. Adequate selenium can easily be taken in by eating one Brazil nut every other day, so its an easy one to supplement through food.

·     DHA/EPA. It is recommended to take in at least 200 mg of the omega-3 fatty acid DHA daily. I personally think that EPA (another essential fatty acid) is just as important when pregnant or ttc.  Eating a variety of seafood or fish (low mercury) two times a week is a great way to get EPA into your diet. Supplementation can be considered as a plan B.

·     Choline. Choline is SUPER important during pregnancy, and many prenatals do not contain this key nutrient.  300 mg/day is needed, and that is a LOT!  With that much needed, it would be tough to fit that much of the nutrient into a prenatal along with all of the other nutrients needed in the supplement. Often, I will recommend a separate choline supplement


Do I recommend a different prenatal for those ttc vs. already pregnant?


Sometimes!  This concern is based on my own professional opinion and not off of something I read in a text book. I have concern when women who are ttc are taking a prenatal that contains very high amounts of iron.  Excess iron does not get excreted by your body they way many other nutrients do, and over time may accumulate in the liver. I hate to think this way, but some women are TTC for YEARS, and I do not feel comfortable with them taking daily supplements with upwards of 30 mg iron per day without any way for their bodies to excrete any excess efficienctly. If a doctor feels that you need more iron, by all means follow doc’s orders. If you have a medical condition like iron deficiency anemia, you may need additional iron as well. These recommendations are typically fine to continue during the first trimester of pregnancy as well. 


There are other supplements that have been shown to support a woman’s fertility, but that is beyond the scope of this post. Need more guidance? I am always happy to help!

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This was created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

(Please note this post is intended to provide insight on how I approach prenatal vitamin choices. This is not meant to be used as personalized medical advice. You should consult your doctor or dietitian before you implement any supplemental or dietary changes into your plan of care.)