Jill is a Registered Dietitian Nutritionist who has provided medical nutrition therapy in a variety of settings: while a Certified Nutrition Support Clinician in the hospital setting, she provided nutrition support to patients in the Neonatal Intensive Care Unit at the University of Chicago Medical Center; the Surgical Intensive Care Unit and Burn Unit at Bridgeport Hospital and has assessed and counseled patients, young and old, with various medical conditions.
In theory, taking a prenatal vitamin could be considered one of the easiest things you can do when thinking about TTC (trying to conceive).
In reality, choosing which prenatal or which supplements to take can be a confusing and overwhelming task, especially since these things can seemingly be a key ingredient to "all of your hopes and dreams.” And that’s a lot of (undue) pressure.
With so much information out there, you may feel pressure to take ALL the vitamins (which, by the way, is not the best course of action), or to find the perfect choice. Neither mindset is particularly helpful - which is why I am here to help answer your questions, provide a few pointers, and hopefully shift the focus and relieve some pressure.
First, let’s take a step back and focus on food. Getting essential nutrients from eating a balanced diet (including foods from all food groups) is the first step in helping you to prepare your body for pregnancy and to grow a healthy baby. Choosing nutrient-dense foods like whole grains, lean proteins, and colorful fruits and vegetables gives you the best "bang for your buck" in terms of meeting your micronutrient (and macronutrient) needs, not to mention fiber and phytonutrients unmatched by any supplement.
Incorporating these nutrient-dense foods into your meal plan is complemented by taking a prenatal vitamin and is essential and beneficial for conception, a healthy pregnancy, and a healthy baby.
And so, I give you 10 things to think about when considering vitamins and supplements for pregnancy.
10 Pieces of Advice When Picking a Prenatal Vitamin
1. Start early, start now.
Taking a daily prenatal is beneficial 3 months (or more) prior to conception, fertility treatments, and/or pregnancy. It helps set the stage for healthy development and supports healthy growth through pregnancy and beyond.
2. Consider your personal preferences, allergies, and medical or religious needs.
For example, do you need a kosher or vegetarian supplement? What about allergen-free? Or do you require special dosing or additional supplements, as is the case for people with the genetic mutation, MTHFR? Do you have a history of bariatric surgery or anemia?
3. Note the daily serving size.
The number of daily pills or capsules required to get the nutrients listed on the bottle’s nutrition label is listed as the “serving size” on the label. Believe it or not, this serving size can range depending on the brand from one to even up to six pills daily. Is the recommended serving realistic for you? Taking less than the recommended dose may increase risk of birth defects and nutrient deficiency. Additionally, taking more than what's recommended on the bottle is neither better nor safe for you and the baby, and it can even mask other nutrient deficiencies.
4. Compare cost.
While some prenatal vitamins may seem more costly at first glance, they may actually provide a 2 or 3 month supply, making them a more cost-effective option. Along the same lines, some may include DHA, and therefore may not require additional supplementation.
5. More does NOT necessarily mean better.
There are a lot of important vitamins and minerals needed for pregnancy. Getting them each in an individual pill, in addition to eating a well-balanced diet, could be a lot to swallow (pun intended). I generally recommend taking a prenatal that meets all or most of the nutrient needs recommended. While you may not find an all-inclusive prenatal that suits your specific needs, you may only have one or two extras to add, rather than remembering to take several pills during the day. Additionally, this can help reduce the risk of nutrient deficiencies and overdoing it (if nutrients are excluded, doses are missed or accidentally repeated).
6. Avoid gummies.
Yes, they are colorful, sweet, and make taking vitamins easier to swallow for some. Usually, though, with a gummy multivitamin or prenatal vitamin, some essential nutrients are missing or present only in lower doses. This is especially true for iron. If you struggle to swallow pills, your nutritionist/practitioner can help you find a more tolerable option without compromising the nutrients you need.
Folic acid (the synthetic form of the B vitamin, folate)
Including at least 600 mcg folic acid is beneficial for anyone thinking about TTC (at Illume Fertility, we recommend 800-1000 mcg for pregnancy). Why? During the first 28 days of conception, a neural tube develops, ultimately becoming the baby’s spinal cord, spine, skull, and brain later in pregnancy. A birth defect (called a neural tube defect) can occur without adequate folic acid, reiterating the importance of taking a quality prenatal several weeks or months before conception. In addition, folic acid plays a role in DNA synthesis of red blood cells, nervous system, and proteins, and helps to support the placenta and prevent miscarriage, preterm delivery, and maternal anemia.
Food sources includelentils, beans, spinach, eggs, seeds, oranges, and nuts.
Checking this level is a regular part of your bloodwork in our practice. With regard to fertility and reproduction, Vitamin D assists with ovulatory regulation and healthy egg formation. Normal levels can have been associated with higher IVF success in some studies and are essential for a healthy pregnancy. In contrast, a Vitamin D deficiency is associated with an increased risk of pre-eclampsia, gestational diabetes, poor bone growth, and low birth weight in newborns. Most prenatal vitamins contain some amounts of vitamin D, however, your healthcare provider may suggest additional supplementation to help keep your levels within the normal range.
Food sources include fortified milk, yogurt, cereals, egg yolks, and fatty fish.
Choline is big in the science world lately. Higher maternal intakes of choline during pregnancy can improve pregnancy outcomes and baby’s health (ie: lower risk of pre-eclampsia, reduce risk of neural tube defects, ease the baby’s response to stress, improves aspects of brain function, and has benefits that continue while breastfeeding). Despite this scientific evidence, most prenatal vitamins haven’t caught up yet and may only have small amounts of choline, if any. A good way to make up the difference is through a well-balanced diet.
Food sources include egg yolks, beef, pork, salmon, navy beans, broccoli.
Iron is needed to make the hemoglobin protein that carries oxygen to tissues. The need for iron doubles in pregnancy to accommodate maternal and fetal blood supplies. Ensuring adequate intake can help prevent anemia, fatigue, preterm delivery, and low birth weight in babies.
Food Sources include red meat, poultry, fish, pork, iron-fortified cereals, grains, lentils, and beans.
This is an essential omega-3 fatty acid beneficial for the development of your baby’s brain, vision, and nervous system. Some prenatal vitamins include this, but getting enough of this nutrient often requires additional supplementation.
Food sources include wild salmon, sardines, anchovies, and DHA-omega eggs.
This is a naturally occurring antioxidant produced in our body and is essential for cellular energy production. Supplementing this has many health benefits. Specifically, with regard to fertility, it has been shown to improve sperm motility, density, and morphology, as well as improved egg quality. Your doctor may recommend supplementing this, particularly if you are undergoing IVF. There are different forms of this nutrient, some more readily absorbed than others. Talk to your practitioner to determine what dosing and form are best for you.
9. Keep it up.
Continuing your prenatal for 6-12+ months after you have delivered can help restore and replenish your body and help meet your and your baby’s needs, especially if you are breastfeeding.
10. Remember, we are here to help.
While these nutrients are important, many others are as well, and a regimen is not necessarily a "one size fits all" kind of deal. The question of "What nutrients do I need?" can ultimately best be answered after your fertility specialist has evaluated all of your bloodwork. Always check with your healthcare provider before starting a vitamin regimen, and ask which additional supplements may suit your individual needs.
Being Proactive With Prenatal Vitamins
With these 10 takeaways in mind, I hope you feel a bit more confident in choosing your prenatal vitamin. At Illume Fertility, we do have a premium selection of vitamins and supplements we trust. If you’re a patient and are interested in purchasing through us, please contact your nutritionist or care team. Good luck on your path to parenthood - you’re already taking a proactive first step!