Confused about prenatal vitamins? Here’s a guide to what you should look for on the label when choosing one.
Thank you to Balchem, a nutritional ingredient supplier, for sponsoring this post!
When I was pregnant, I had the very best intentions. My diet would be full of salmon, leafy greens, and fruit smoothies. I’d exercise every day. And I’d be one of those women who only looks pregnant from the front.
Life had other plans for me.
For the first 3-4 months of both of my pregnancies, I was plagued with soul-crushing nausea from the moment I woke up until the moment I went to sleep. I threw up at the grocery store and at Starbucks, in front of a patio full of unlucky patrons. I could barely keep down water, much less fruit smoothies, and ended up being treated for dehydration. I couldn’t handle any exercise more intense than walking. And by my eighth month, I looked pregnant all over.
So I took my doctor’s advice in those early months and ate whatever sounded good, which ended up being a random assortment of foods including white cake with vanilla frosting (had to be white cake, had to be vanilla frosting), pink grapefruit, tortilla chips, and Carnation Instant Breakfast. So much for those good intentions.
Thankfully, life improved partway through my second trimester, when I could finally stomach a salad. But if I had relied solely on food for the nutrients I needed the most during those early months, I would’ve fallen woefully short—and those first few months of pregnancy are critical for fetal development.
That’s why I get a little nervous about online chatter I see in some circles, denouncing prenatal vitamins as unnecessary or unnatural. Though I absolutely support choosing nutritious foods throughout pregnancy (when you can stomach them!), it worries me that some women may end up missing out, especially women who don’t (or can’t) get a nutritious diet or women carrying multiples, who need even more nutrients during pregnancy.
Prenatal vitamins have changed a bit since I was a mom-to-be, and there are new recommendations for what they should contain. Talk to a registered dietitian or other healthcare professional to figure out the best options for you, but here’s a guide to what you should look for when picking a prenatal:
CHOLINE
This is a major and important change to prenatal vitamins. There’s a brand new recommendation from the American Medical Association that choline now be present in all prenatal vitamins in a meaningful amount. That’s because choline has a special importance during pregnancy. It protects against neural tube defects (like spina bifida) and is involved in healthy brain growth. It may play a part in memory and knowledge retention and even positively impact your child’s mental health. Trouble is, it can be hard to get what you need through food alone. Case in point: Women of childbearing age are getting less than half of what they need, and only nine percent of pregnant women take in enough—making it even more critical for women to get choline in a prenatal supplement during pregnancy. Most prenatal vitamins contain between 0-55mg of choline, so look for one at the higher end of that range.
Food sources: Beef, eggs, Brussels sprouts, poultry, wheat germ, and edamame. It’s actually going to be easier to know which foods contain choline because the FDA has called on food manufacturers to voluntarily include the amount on the first update to the food label in 20 years. Here’s a free one-day pregnancy meal plan that includes choline-rich foods.
IRON
Iron needs jump during pregnancy from 18mg a day to 27mg. That’s because your volume of blood increases during pregnancy, and iron makes a component in blood that carried oxygen (including to the baby). Iron is also involved in prenatal brain growth. Iron deficiency is the most common nutritional deficiency during pregnancy, and not getting enough can lead to low birth weight.
Food sources: Poultry, dark green leafy vegetables, beans. Eating foods rich in vitamin C along with iron-containing foods (like strawberries on a spinach salad or bell peppers with a bean burrito) can help you absorb it better.
FOLIC ACID
Folate is a vitamin that’s critical in protecting against neural tube defects (folic acid is the form found in fortified foods and supplements). The key time for folic acid is in the first three months of pregnancy, when the neural tube (the brain and spinal cord) is developing. Since many women may not even know they’re pregnant in those first few weeks, it’s recommended that all women of childbearing age get enough every day. Keep in mind that getting adequate folic acid through food alone can be hard if you’re eating a gluten-free diet or eating all whole-wheat products, since enriched grain products are fortified with it.
Food sources: Beans, citrus fruits, nuts (some fortified cereals contain folic acid too).
VITAMIN D
Vitamin D helps your body soak up the calcium from foods–and during pregnancy, you’re depositing calcium in your baby’s bones AND in yours. Though your body can produce vitamin D through exposure to sunlight, many women (wisely) wear sunscreen or may live in places that don’t get a lot of sun (like here in Ohio!).
Food sources: Fortified dairy and non-dairy products, mushrooms exposed to UV light, salmon.
DHA
A kind of omega-3 fatty acid, DHA is known to be key in prenatal development of the brain and eyes. Though DHA is found naturally in fish, most Americans don’t eat enough fish to get what they need.
Food sources: Fish and DHA-fortified products like orange juice, milk, and eggs.
For more information about choline, visit the Choline Information Council.
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It’s so important to get adequate amounts of all of these, but I just want to add a bit to the iron! Of course, if the mother isn’t getting enough of any nutrient to provide for herself and the baby, the mother will suffer – not the baby! Baby always takes priority nutritionally. Iron is no different, and – as you pointed out – blood volume increases during pregnancy.
Anyway, what I think is super interesting is how a newborn will have 4 months of iron stores in their bodies when they are born! The mother needs to make sure she is getting enough iron to allow the baby to build up these stores, as well as take care of her own needs.
Great article and great information! 🙂
Hi Amy–good point about the iron stores! Thanks for your comment.
This is a great article! I learned alot and sparked a lot of research. I was curious if there are certain brands of prenatal vitamins you would suggest to a patient. I know vitamins are not regulated, so how do i know if i can trust the brand that they are putting it what they are saying? Do you have suggestions of brands that you trust?
I am an RD at WIC and we recommend everything you’ve recommended too! We also recommend iodine, since people aren’t getting enough as often anymore as they’re avoiding salt! Great post!
Nikki–so glad to hear that!
Thanks for this post, Sally! I am currently pregnant with my first and had a rough first trimester, too. The foods I wanted to eat – and normally eat – just did not sound good! Even much of my second trimester I did not want many foods. I’m thankful for my prenatal vitamins and also green smoothies as I was able to get some veggies in on days when I didn’t think I could eat many!