Guest blog by Liane Moccia, a Registered Clinical Herbalist.
When you told your doctor you were ready to start trying to get pregnant, did they say “Congratulations. Start taking a prenatal and come back in one year if you aren’t pregnant.”?
But which prenatal? Are they all good enough? Is a prenatal multi enough, or should you include other supplements? Are the brands at the big-box stores okay? Should you go with a prescription brand? Is there one brand that is the best for everyone? And when should you start taking a prenatal multivitamin?
If you feel overwhelmed, you are not alone! As a clinical herbalist and fertility specialist, these are common questions I hear from people every day.
When I meet with a new client, we always review the supplements they are currently taking. Unfortunately, very often the prenatal vitamins that they are taking are not ideal.
Information is abundant, but a lot of it is misleading, and it’s no wonder many people are confused. It’s hard to know which brands are most absorbable, contain the right dosages, and are not filled with unnecessary fillers and dyes.
In this article you will learn how to pick the best prenatal vitamin… whether you are trying to conceive, are already pregnant, or plan to get pregnant in the next year. You can also download a supplement cheat sheet to take with you when shopping to help you confidently choose your prenatal multivitamin.
Mistake #1: Not starting soon enough
Are you waiting until you are pregnant before starting a prenatal multivitamin? Or are you waiting until you are actively trying to get pregnant before starting a prenatal multivitamin?
Many people understand the important role a prenatal multivitamin plays in the healthy development of their baby after conception, but many don’t realize that taking a prenatal multivitamin can help improve your chances of getting pregnant.
In one study by Ward and Eaton (1995), 367 couples were given a prenatal multivitamin plus folic acid, and told to abstain from alcohol, tobacco, and street drugs (both partners). After two years, 89% of the couples had given birth to a healthy baby (statistically higher than average pregnancy and live birth rate in the general population). Even more interestingly, among the 204 couples previously diagnosed with infertility, 86% went on to achieve a healthy pregnancy.
Another study compared pregnancy rates in women taking a prenatal multivitamin compared to folic acid alone. The prenatal multivitamin group had a 66% pregnancy rate versus 39% in the folic acid alone group, supporting the importance of a broad range of nutrients during the preconception time.
Good nutrition is the foundation for optimal egg quality and fertility. It takes an enormous amount of energy and nutrients to develop a healthy egg. It takes 3-4 months for an egg to develop, mature, and ovulate. During this time there are many factors that can contribute to overall egg quality, and ensuring adequate levels of nutrients is an important factor. In addition to a healthy diet, supplements can help ensure adequate levels of nutrients that are needed for optimal egg quality.
Start taking a prenatal vitamin at least four months before you start trying to conceive or, ideally, up to one year before are ready to get pregnant. Because of the time it takes for an egg to develop and ovulate, any nutrients you start taking today will affect the egg you ovulate in about four months.
Mistake #2: the wrong form of folate
You have probably heard that folate or folic acid is vital for developing a healthy baby because it helps prevent neural tube defects. Folate is a B vitamin naturally found in dark, leafy greens, citrus, nuts, and liver. In addition to helping prevent neural tube defects, folate is also important for egg quality and preventing miscarriage.
But there is a big difference between folic acid and folate. Folate is the active, natural form of B9. Folic acid is the inactive, synthetic form of the vitamin and must be converted to the active form for your body to be able to use it.
Which is best for you?
Fifty percent of the population has a genetic variant in the MTHFR gene that may interrupt their ability to effectively convert folic acid to its active form in the body. In that case, choosing a supplement with the active form of folate is recommended. Even for people who don’t have this genetic variation, an active form of folate, such as methylfolate, doesn’t hurt and may be better absorbed. Generally, brands that use folic acid often use less expensive and less absorbable forms of other vitamins and minerals as well.
But, not everyone tolerates the methylated form of folate. There are some people who have adverse reactions, especially in higher forms. This is why a lot of people feel more comfortable working with a practitioner.
My first choice when looking at a prenatal supplement is to choose one with the active form of folate, or methylfolate, and if we determine that form isn’t working for that person then can talk about switching to a non-methlyated form like folic acid or folinic acid.
Mistake #3: not enough vitamin D (in the optimal form)
Vitamin D has been studied for its role in fertility and pregnancy, and the results are clear: higher levels of vitamin D are associated with increased fertility rates and decreased miscarriage rates.
Vitamin D deficiency is widespread in general and particularly common in pregnancy even when taking prenatal vitamins. Research on vitamin D has exploded over the past few years, and there is growing evidence that higher levels of vitamin D are associated with higher pregnancy rates, decreased miscarriage rates, and fewer obstetric complications such as preeclampsia and gestational diabetes.
Improving your vitamin D level before pregnancy is associated with a lower incidence of miscarriage. One study found that for every 10 ng/mL increase in vitamin D levels before conception there was a 12% lower risk of miscarriage; reaching adequate levels before pregnancy was found to be more protective than reaching adequate levels by 8 weeks of pregnancy.
How much vitamin D you should take depends on your current levels. Most labs test for 25-OH vitamin D (25-hydroxy vitamin D) and use 30 ng/mL as the cutoff for normal. But numerous vitamin D experts recommend the optimal range should be >40 ng/mL.
It’s best to work with a practitioner to get your levels tested so you can supplement accordingly. Knowing your vitamin D level can help choose the right dosage to stay in the optimal range. A prenatal supplement with 2,000 IU (50 mcg) is a good place to start for most people. You could also supplement your vitamin D separately. When choosing a prenatal supplement, look for vitamin D3, not D2.
Mistake #4: missing choline
Choline is required for fetal brain development, placental function, and preventing neural tube defects. It is essential for baby’s cognitive function, especially memory, focus, and attention. While choline can be obtained from the diet, many women’s diets fall short, especially if you don’t eat eggs. Newer research is finding that higher levels of maternal intake of choline during pregnancy are directly related to improved attention in childhood.
The American Medical Association (AMA) in 2017 published new advice stating that prenatal vitamin supplements should contain ‘evidence-based’ amounts of choline. But unfortunately, choline is absent from most prenatal vitamins currently on the market, and less than ten percent of pregnant women achieve target intake levels.
The current recommended amount of choline intake per day (including from food) is 450 mg, but some studies are showing higher levels may be beneficial. The study showing increased attention in childhood used 950 mg of choline per day during pregnancy.
Here are a few food sources of choline:
- Eggs, including the yoke: 145 mg
- 3 ounces ground beef or chicken breast: 72
- ½ cup beans: 45 mg
- ½ cup broccoli: 30 mg
- ¼ cup almonds: 18 mg
If you want to want to get your choline from food it is absolutely possible. Sometimes people find it helpful to work with a practitioner to create a plan that meets the choline requirements, and then they are good to go on their own.
Aim for at least 450 mg per day through a combination of food and supplementation. Choosing a prenatal supplement with at least 100 mg is a good place to start! You could also supplement choline separately from your prenatal to get closer to the recommended level.
Mistake #5: contains artificial colors, synthetic fillers, and other “junk”
Artificial food colorants (AFCs) are synthetic dyes used in food and supplements solely for aesthetic appeal and offer no beneficial nutritional value. In fact, studies suggest they may be harmful. AFCs have been linked to hyperactivity and other behavioral effects in prenatally exposed rats, and human studies have found a correlation between childhood AFC consumption and adverse neurobehavioral outcomes.
Common AFCs include Blue #1 and 2, Citrus Red #2, FD&C Red #40, Yellow #5 and #6, Green #3, and Red #3. Titanium dioxide, also used for color in supplements, has been linked to digestive issues, lung problems, and possible cancer concerns.
Magnesium Stearate is used in the manufacturing process to prevent ingredients from sticking to equipment and machinery. However, magnesium stearate may hinder the body’s ability to optimally absorb vitamins and minerals and may have a laxative effect on the GI system.
Hydrogenated oils (such as hydrogenated soybean oil) are often in supplements because they help extend shelf life. They are also high in trans fats. Research has confirmed the connection between trans fats and a whole host of health issues, including cardiovascular disease, preterm birth, preeclampsia, and nervous system disorders in infants.
Artificial colors, fillers, and hydrogenated oils offer no benefit in prenatal supplements, and evidence suggests they have the potential to do harm. There is no reason to settle for a supplement with any of these unnecessary ingredients when better options exist.
Pulling it all together
Now that you know exactly what to look for when choosing a prenatal supplement, you can feel confident knowing the prenatal multivitamin you pick will help provide a strong foundation for preconception health. Download the Supplement Cheat Sheet to pull all of these recommendations together and help you confidently choose your prenatal multivitamin. Download a copy here.
Liane Moccia is a Registered Clinical Herbalist who helps people take charge of their fertility, prepare for pregnancy, balance hormones, and manage stress. Liane’s own infertility diagnosis led her to the healing power of plants and ultimately a career change to help others on similar journeys. You can learn more about working with Liane on her website.
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