Prenatal Vitamins: What do you need to know.

The decision to take a prenatal vitamin and which one to take is an important one. In fact, most people don’t realize that not all prenatal vitamins are the same AT ALL. They are actually not regulated like medicines. They often contain too much vitamins and minerals. There is no definition on what falls into a “prenatal vitamin”. In addition, they are not a guarantee that you will be getting all the vitamins and minerals you need. So let’s begin with some misconceptions about prenatal vitamins.

Prenatal Vitamins Cover a Mother’s full vitamin and mineral needs: WRONG.

In fact, even though some prenatal vitamin supplements cover more than 100% needs of some vitamins and minerals. The same vitamin supplement will NOT cover the needs of several vitamins and minerals. To cover the gap, the mother must ensure she receives the nutrients from another supplement OR from food.

Prenatal Vitamins are good for every mother: WRONG

Prenatal vitamins can have too much of certain vitamins and minerals. So, if a mother’s diet is already sufficient in certain vitamins – she will run the risk of having too much of that vitamin or mineral.

Prenatal Vitamins are regulated by some pregnancy association: WRONG.

Prenatal vitamins just like most vitamins and mineral supplements are NOT regulated.

Dietary supplements are not regulated as drugs in the United States. There is no standard definition of what a dietary supplement labeled “prenatal vitamin” must contain and the contents vary widely. Having it be available by prescription does not imply that the supplement is better, nor safer, nor that it contains higher levels of any particular nutrient 

As you can see the choice of which prenatal vitamin supplement and wether or not to take one is essential.

Let’s start with the first question.

Can taking a prenatal vitamin supplement be harmful?

Those supplements containing nutrient levels much higher than the DRI are not recommended because of known teratogenic effects (e.g., preformed vitamin A), as well as potential epigenetic effects. Some contain many additional ingredients, including herbal preparations, many of which have not been evaluated for safety during pregnancy and may be contraindicated, especially during the first trimester.

Is taking a prenatal vitamin and mineral supplement necessary?

Most health associations including the NHS agree that taking a folic acid (400 mcg) supplement is necessary and Vitamin D is recommended (10 IU). The rest is controversial.

We do know that supplements are DEFINITELY recommended if your doctor believes your diet isn’t adequate due to a blood test or dietary assessment AND in the below cases:

• Undernourished women, including those with a history of bariatric surgery
• Teenage mothers
• Women with substance abuse
• Women with a short interval between pregnancies
• Women with a history of delivering an infant with LBW
• Pregnant women with multiple fetuses.

As for the rest of us, the choice remains unclear. I will elaborate more below on what to avoid and what can be good insurance when it comes to vitamins and minerals.

How do I choose a good prenatal vitamin?

• Look for those that contain the United States Pharmacopeia (USP), Consumer Labs, or National Sanitation Foundation (NSF) seals of approval for quality.
• Read the ingredients carefully. Some supplements contain ingredients OTHER than the vitamins and minerals needed.
• Check that the nutritional needs do not cover more than 100% nutritional needs.

Signs of a good multivitamin:

1. It contains 400-600 mcg folic acid. Folic acid deficiency is associated with preterm birth, miscarriage, and birth defects such as Spina Bifida.
2. American Thyroid Association  recommends that a  prenatal supplement should contain 150 mcg of iodine in the form of potassium iodide, not kelp or seaweed. Iodine deficiency is the most common cause of preventable intellectual developmental disability in the world.
3. Good to have: DHA
4. Good to have: Iron.

What is often missing in prenatal vitamins:

1. Choline: Choline-rich foods include milk, meat, and egg yolks, and women not eating these foods may need supplementation. Many popular prenatal supplements do not contain choline or, if so, contain very little.
2. Iron in gummies. Which is totally okay as many health agencies don’t recommend iron in pregnancy. You can discuss your diet with your doctor.
3. Calcium: calcium is often missing in prenatal vitamins. It is recommended if the mother’s diet does not have adequate calcium from yogurt and milk. You can take an additional calcium supplement if your diet is not enough. Calcium is more important in the second half of the pregnancy than the first half as the majority of calcium accretion in the baby happens then.
4. Copper: Copper interacts with iron, affecting neurocognitive and neurobehavioral development. Although not commonly included in prenatal supplements, it is recommended that copper be supplemented when zinc and iron are given during pregnancy.

What is NOT recommended as a supplement:

1. Vitamin C
2. Vitamin E: Vitamin E is an important lipophilic antioxidant, but supplementation of vitamin E (along with vitamin C) is not an effective strategy for preventing preeclampsia nor does it reduce risk of fetal or neonatal loss, SGA, or preterm delivery. Supplementation actually may be proinflammatory, preventing the switch from Th1 cytokines (proinflammatory) to Th2 cytokines (antiinflammatory) that is normal during pregnancy

Important reminders:

1. A prenatal vitamin may be necessary for mothers with compromised nutritional status.
2. Prenatal vitamins do not substitute a good diet.