I recently had a conversation with a friend about prenatal supplements. I mentioned that not all supplements are created equal and that some, including prenatal supplements, can be dangerous. My friend, who happens to have three healthy children, was shocked to hear that taking the wrong prenatal vitamin can be harmful to both mom and baby.
I had another conversation with a patient about all the different prenatal vitamins on the market and which ones are best. As we went through the different prenatal vitamins, we saw how each brand had different levels of key nutrients. Which amount of each was better?
Based on these conversations, I want to share exactly what to look for, and what to look out for, to ensure you’re taking the best possible supplement for both you and your baby.
Dangerous ingredients lurking in prenatal vitamins
Before and during pregnancy, your nutritional levels change. While the best source of the necessary vitamins and minerals is a balanced diet with plenty of fruits and vegetables, prenatal vitamins are useful in filling in the gaps.
However, because the Food and Drug Administration does not regulate vitamins, not all prenatal vitamins are created with your safety in mind and what’s in a prenatal vitamin can vary widely between brands.
One of the most important things you can do is educate yourself on the recommended levels of vitamins during pregnancy and look for a prenatal vitamin that fills in the gaps of what you consume. If you have questions about taking more than the upper range of the recommended daily intake for vitamins and minerals, Thorne has written a great article.
Additionally, it’s important to recognize that because the FDA does not regulate vitamins, not all supplements undergo testing for contaminants like heavy metals, pesticides, or harmful bacteria—all of which can be harmful to both you and your fetus. I look for prenatal vitamins made without additives and coatings.
You should look for prenatal vitamins with NSF, USP, or other third-party testing labels to ensure higher safety standards. (I share a few of my favorites below.)
By understanding what’s in your prenatal vitamin and ensuring it meets high-quality standards, you can avoid these potentially harmful components and prioritize what your body truly needs.
When to start and stop your prenatal vitamin
I recommend starting your prenatal vitamin 3-4 months before trying to conceive so that you can have enough folate and iron before becoming pregnant. That way you can help prevent neural tube defects as well as iron deficiency anemia, which can put you at risk for first-trimester miscarriage. The other reason it is important to take a prenatal in the preconception phase is that often women feel too sick to take their prenatal vitamins in the first trimester. If they have been taking it for 3-4 months in the preconception phase, they can let go of the guilt or anxiety many moms experience of not being able to take their prenatal in the first trimester.
I recommend taking your prenatal postpartum for 3-4 months to help you recover from the increased demands of pregnancy, labor & delivery, and postpartum. If exclusively breastfeeding, keep taking your prenatal vitamins until you are done exclusively breastfeeding. Talk to your birth care provider for any other specifics of when to start and stop.
Here is my one postpartum caveat, especially for moms who have been consistent during pregnancy. I often tell moms to skip their prenatal week 1-6 postpartum. I recommend this for a couple of reasons. First, I find that the extra b-vitamins can impact sleep at this delicate time. Second, it’s just too much to ask of a mom with a newborn. Now, if you are anemic or had a lot of blood loss during delivery, you will need to continue with an iron supplementation.
One patient asked a great question, “Can taking a prenatal for too many years in a row while not pregnant or breastfeeding give me too many fat-soluble vitamins?” The answer is yes, it can. However, if you eat a diet low in fat-soluble vitamins, continue to breastfeed, take antibiotics regularly, or have other malabsorption issues like celiac disease or Crohn’s disease you may need those extra fat-soluble vitamins. If you have any questions about the right prenatal vitamin for you, let’s schedule an appointment.
In particular, you should not take an abundance of the fat-soluble Vitamin A, in the form of retinol, which can harm fetal development.
Beta-carotene, another form of Vitamin A, is generally considered safe, but large amounts over a long period can cause carotenemia, a condition that turns the skin yellow or orange. Carotenemia is harmless and reversible by stopping beta-carotene consumption. You’ll notice below that the prenatal vitamins I recommend contain beta-carotene as their Vitamin A source.
What to look for in a prenatal vitamin
A high-quality prenatal vitamin should provide the essential nutrients you and your baby need for a healthy pregnancy. Here are key nutrients to look for when choosing a prenatal vitamin.
At a minimum, your prenatal vitamin routine should contain:
- Folate: 400 mcg daily reduces the risk of neural tube defects
- B12 and other b-vitamins
- B6 ideally as pyridoxal 5 phosphate
- B12 ideally as methylcobalamin
- Iron: helps your body make the healthy red blood cells it needs
- If your prenatal doesn’t have iron, which some don’t, make sure you are getting enough iron in your diet or a solo iron supplement
Important Fat-soluble vitamins:
- Vitamin D: helps absorb calcium and helps with eyesight and skin health
- Vitamin A as beta carotene or retinyl palmitate: helps with skin, eyesight, and bones
- Vitamin E: supports the immune system, helps prevent oxidative stress, and aids in fetal development
- Vitamin K
Many prenatal vitamins contain these helpful nutrients:
- Vitamin C: promotes healthy gums, teeth, and bones
- Iodine: an essential nutrient for brain development
- Calcium: helps build strong bones and teeth and helps preserve your bone density
- Zinc: helps with cell growth, immune function, and proper fetal development, particularly brain and skeletal growth.
- 30 mg/d of zinc picolinate
Other important nutrients for pregnancy:
- Choline: supports a fetus’s brain and spinal cord.
- DHA: a type of Omega-3 fatty acid that helps support healthy brain development
Folate, Folic Acid, B12, and MTHFR Mutation
I recommend that your prenatal vitamins have folate, the active form of B9, and not synthetic folic acid.
An MTHFR mutation is a change in the MTHFR gene that affects how your body processes folate and homocysteine. If you know you have the MTHFR gene SNP and/or a history of recurrent pregnancy loss it’s even more important to take folate.
In the particular case of recurrent pregnancy loss,
“The conventional use of large doses of folic acid (5 mg/day) has become obsolete. Regular doses of folic acid (100–200 μg) can be tolerated in the general population but should be abandoned in the presence of MTHFR mutations, as the biochemical/genetic background of the patient precludes a correct supply of 5-MTHF, the active compound. A physiological dose of 5-MTHF (800 μg) bypasses the MTHFR block and is suggested to be an effective treatment for these couples. Moreover, it avoids potential adverse effects of the UMFA syndrome, which is suspected of causing immune dysfunction and other adverse pathological effects such as cancer (especially colorectal and prostate).”
Servy EJ, Jacquesson-Fournols L, Cohen M, Menezo YJR. MTHFR isoform carriers. 5-MTHF (5-methyl tetrahydrofolate) vs folic acid: a key to pregnancy outcome: a case series. J Assist Reprod Genet. 2018;35(8):1431-1435. doi:10.1007/s10815-018-1225-
You don’t want too little or too much folate and B12, which is why taking a good quality prenatal for the right amount of time is important.
If you have a family history of Autism, it’s important to note that too much B12 or folate can be an issue as well. Researchers say that while folate deficiency is not safe for a developing fetus, excessive amounts could also be harmful. In this study, high maternal vitamin B12 levels (≥81th percentile) were associated with increased risk for offspring childhood autism.
If you are taking your prenatal vitamins consistently, with the correct timing, and at the recommended dose, you don’t need to be layering with additional b-vitamins without medical supervision.
The prenatal vitamins I recommend most
With so many options on the market, it can feel overwhelming to decide which prenatal vitamin is right for you. Below, I’ve compared some of my favorite brands, focusing on key nutrients like iron, folate, B12, and iodine. As you will see, even good prenatal vitamins have varying levels of different vitamins.
As a naturopathic doctor with over sixteen years of experience, I professionally recommend all of these prenatal vitamins. Each of these brands has the high safety standards I mentioned earlier.
Thorne Basic Prenatal — 3 capsules daily with food
- Folate: 1.7mg DFE 5-MTHF
- Iron: 45 mg iron bisglycinate
- Iodine: 150 mcg
- B6: 12mg Pyridoxal 5′-Phosphate
- Choline: 110mg
- DHA: None
- B12: 200 mcg methylcobalamin
- Vitamin A: 450 mcg beta carotene, 600mcg palmitate
Over the past 17+ years, this is the prenatal I recommend the most.
Pros:
- High in iron and well-absorbed
- Well-rounded with all the necessary vitamins included including folate
- Generally well tolerated
Cons:
- No DHA included, – Add Thorne Prenatal DHA
SmartyPants Organic Prenatal Multivitamin — 4 gummies daily, with or without food
- Folate: 600 mcg DFE L-methyl folate
- Iron: None (requires separate supplementation)
- Iodine: 290 mcg
- B6: 2mg Pyridoxal 5′-Phosphate
- Choline: 11mg
- DHA: 171 mg o-Linolenic-acid
- B12: 3.5 mcg methylcobalamin
- Vitamin A: 520 mcg, 50% beta carotene, 50% retinyl palmitate
I recommend this for women who can’t tolerate swallowing pills in pregnancy.
Pros:
- Easily tolerated even in the first trimester during morning sickness
- Includes DHA
Cons:
- It doesn’t contain iron
- On the lower end of the vitamin percentages
Needed Prenatal Multi — 3 capsules daily or powder with food
- Folate: 551 mcg L-methyl folate
- Iron: None (requires separate supplementation)
- Iodine: 150 mcg
- B6: 15mg Pyridoxal 5-Phosphate
- Choline: 150mg
- DHA: None (requires separate supplementation)
- B12: 200 mcg, 50% methylcobalamin, 50% adenosylcobalamin
- Vitamin A: 1500 mcg, 50% beta carotene, 50% retinyl palmitate
Pros
- Multiple options in capsules or powder
- Well tolerated
Cons
- Not an all-in-one prenatal solution
- Doesn’t contain DHA or Iron. However, you can customize missing nutrients with other Needed products like DHAs and Iron
Ritual Essential Prenatal — 2 capsules daily, with or without food
- Folate: 1,000 mcg methylated folate
- Iron: 18 mg ferrous bisglycinate
- Iodine: 150 mcg
- B6: None
- Choline: 55 mg
- DHA: 350 mg
- B12: 8 mcg, methylcobalamin
- Vitamin A: None
Pros:
- Well tolerated & only 2 capsules/day
- Simple – only has the “essentials” for those with a well-rounded diet
Cons:
- Not as well rounded as the other vitamins
- It doesn’t include B6
- A low amount of iron is included
Metagenics Wellness Essentials PlusOne™ Prenatal Daily Packs — 1 packet daily
- Folate: 1,700 mcg DFE calcium L-5-methyltetrahydrofolate
- Iron: 30 mg ferrous bis-glycinate
- Iodine: 176 mcg
- B6: 20 mg pyridoxine HCl and pyridoxal-5-phosphate
- Choline: 450 mg
- DHA: 1 g
- B12: 800 mcg, methylcobalamin
- Vitamin A: 1,650 mcg, mixed carotenoids, and retinyl palmitate
The main reason I reccomend Metagenics is the Convenient Package for those clients who need help organizing!
Pros:
- Convenient all-one-package
- Well rounded including all recommended nutrients
- On the higher end of each vitamin amount if you have a poor diet
Cons:
- Not as easily tolerated by some
- Not as customizable based on what you specifically need
Choosing the right prenatal vitamin is one of the most important steps you can take for your prenatal health and your baby’s development. If you have any questions about the right prenatal vitamin for you, let’s schedule an appointment. There’s a lot of information thrown at us regarding prenatal vitamins by influencers’ recommendations, ads, etc. It can be hard to know which prenatal vitamin is the best choice for you and your baby based on your diet, lifestyle, and preferences.
