There are so many prenatal multivitamins out there! Since prenatal vitamins were not all created equal and don't always contain a broad spectrum of important components, it's important to sift through and find the good, high-quality ones that will actually give your body what it needs to help grow a healthy baby and nourish you in the process.
All prenatal multivitamins are going to include things like vitamin D and folate or folic acid (vitamin B9), but many lack some important components like DHA and probiotics. You’ll need to check the label to make sure that your vitamin of choice has the right type and amount of these nutrients for your body to actually use optimally. Here are 4 essential nutrients to look for and tips for deciding if it’s the right kind for you.
1. Folate (vitamin B9)
Folate is involved in many metabolic processes in your body, but the one you probably hear about the most pertaining to pregnancy is the process of closing the neural tube. If there isn’t enough folate the neural tube may not close correctly, which can cause spina bifida or may cause other midline defects like cleft palate and cleft lip.
Did you notice that I said folate and NOT folic acid? The difference between folate and folic acid is that folic acid is a synthetic form of vitamin B9 and is not easily broken down or absorbed by your body. Folate is the more bioavailable form of B9 and is more easily absorbed.
Something to keep in mind if you have an issue with a biochemical process called methylation or know that you have an MTHFR gene variant, is that you’re going to want to look for a form of folate that is already methylated so that it can be absorbed easily. On the label, this might look like L-5-MTHF, L-methylfolate, Quatrefolic, or Metafolin. If you’re curious about methylation and MTHFR gene variants, Dr. Ben Lynch’s website mthfr.net is a great resource to check out.
Regardless, find a prenatal that has at least 600 mcg of folate. In my experience, brands like Megafood, Innate Response, Metagenics, and Orthomolecular are all good picks for prenatal multivitamins with a more absorbable form of folate (although this is not an exhaustive list).
2. DHA (an Omega-3 Fatty Acid)
DHA is very important for baby's developing brain and has been shown to increase the length of gestation and decrease the risk of low birth weight. So, if your prenatal doesn't contain it or you’re not regularly eating plenty of fatty fish, add this to your supplement list. You’ll want to make sure that your supplement of choice contains at least 300 mg of DHA per serving.
Another thing to look for, especially if you’re opting for a fish oil to get your DHA, is purity. Look for a company that has a high, strict standard of purity so you don't have to worry about things like heavy metals being present in your fish oil. Good bets are companies that either do third party testing or meet the GOED standard (this will most likely be mentioned on the bottle or box). Personally, I love Nordic Naturals brand fish oils. Their fish oils are all third party tested, most contain over 300 mg of DHA per serving, and they don’t have any fishy aftertaste! They even have a prenatal DHA product so you don’t have to dig around to figure out which of their products is best during pregnancy.
3. Vitamin D3
Vitamin D comes in two main forms – D2 and D3. The D3 form is more effective at raising vitamin D levels in your blood compared to D2, so I would recommend finding a prenatal with the D3 form in it. Vitamin D plays a big role in things like bone development, the immune system, and can even help prevent preeclampsia.
This is one nutrient that your prenatal will definitely have, but it will probably only have about 400-600 IU in it. Some recent studies have shown that this recommended number is too low, and we probably need between 1,000 and 4,000 IU for optimal health. If you don't get sun-to-skin exposure during the day, and especially if you live in a cold wintertime climate, you'll want to shoot for at least 1,000 IU per day, which may mean adding an additional vitamin D3 supplement to your regimen.
4. Probiotics
Simply put, probiotics are living microorganisms, mainly bacteria, that help support a healthy digestive system. You’ve probably heard them called the “friendly bacteria”. A probiotic supplement that includes the bacterial strain Lactobacillus rhamnosus (L. rhamnosus) has been shown to provide a lot of benefits for mom and baby. Some of these include a reduced risk of developing gestational diabetes, better balance in gut bacteria leading to normalized bowel movements, better balance in vaginal bacterial flora for baby to get upon exit, and a reduced risk of developing postpartum depression and anxiety.
When choosing a probiotic supplement, there are a couple of things to look for to make sure it’s of high quality. One good indicator of quality is packaging - an opaque or darkly tinted resealable bottle will protect the probiotics from things like light and moisture. After all, dead bacteria aren't going to do you any good! Another thing to look for is a variety of bacterial strains in the product since these can work together to provide balance to your digestive tract. As I mentioned above, during pregnancy, you’ll want to make sure that one of those strains is L. rhamnosus, since that’s the strain that’s shown to provide the most benefit during pregnancy. You’ll also want to find a product with a high number of colony-forming units (CFU). Most studies have shown the greatest benefit with 10-20 billion CFU per day. Lastly, check to see that the company is using current Good Manufacturing Practices (GMP) during production. This is a good indicator of quality and product consistency.
Some prenatal vitamins do contain probiotics, but most do not, so you'll probably have to look for a separate probiotic supplement. Two of my favorite brands of probiotics are Klaire Labs and Garden of Life. Most "women's" formulas will contain the L. rhamnosus strain already, but check the label to be sure.
Finding the right prenatal multivitamin and adding in other supportive nutrients can make all the difference for the health of mom and baby during pregnancy and beyond. There are lots of great prenatal vitamin brands out there - you just have to do a little searching to find which one is right for you. Some brands can only be distributed by healthcare providers, so if you're interested in one that you can't seem to find anywhere, or you have questions about other things to look for in a prenatal, give me a call and we can work together to find the right ones for you.
Julie Thake, DC, MS
References
Milunsky A, Jick H, Jick SS, Bruell CL, MacLaughlin DS, Rothman KJ, Willett W. Multivitamin/Folic Acid Supplementation in Early Pregnancy Reduces the Prevalence of Neural Tube Defects. JAMA. 1989;262(20):2847–2852. doi:10.1001/jama.1989.03430200091032
https://www.healthline.com/nutrition/folic-acid-vs-folate#section6
http://mthfr.net/
Greenberg JA, Bell SJ, Ausdal WV. Omega-3 Fatty Acid Supplementation During Pregnancy. Reviews in Obstetrics and Gynecology. 2008;1(4):162-169.
Makrides M. Understanding the effects of docosahexaenoic acid (DHA) supplementation during pregnancy on multiple outcomes from the DOMInO trial. Oilseeds and Fats, Crops and Lipids. 2015;23(1). doi:10.1051/ocl/2015045.
https://www.healthline.com/nutrition/omega-3-supplement-guide#section10
https://nordicnaturals.com/consumers/
http://americanpregnancy.org/pregnancy-health/vitamin-d-and-pregnancy/
https://www.healthline.com/nutrition/vitamin-d-dosage#section7
Heyden, E., & Wimalawansa, S. (2017). Vitamin D: Effects on human reproduction, pregnancy, and fetal well-being. The Journal of Steroid Biochemistry and Molecular Biology. doi:10.1016/j.jsbmb.2017.12.011
Wickens, K. L., Barthow, C. A., Murphy, R., Abels, P. R., Maude, R. M., Stone, P. R., . . . Crane, J. (2017, March). Early pregnancy probiotic supplementation with Lactobacillus rhamnosus HN001 may reduce the prevalence of gestational diabetes mellitus: a randomised controlled trial. Retrieved February 05, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/28367765
http://americanpregnancy.org/pregnancy-health/probiotics-during-pregnancy/
Olsen, P., Georgiou, C., & Williamson, M. (2011). The impact of oral probiotic use on vaginal Group B Streptococcal colonisation rates in pregnant women: A pilot randomised controlled study. Women and Birth, 24. doi:10.1016/j.wombi.2011.07.137
Slykerman, R., Hood, F., Wickens, K., Thompson, J., Barthow, C., Murphy, R., . . . Mitchell, E. (2017). Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial. EBioMedicine, 24, 159-165. doi:10.1016/j.ebiom.2017.09.013
https://www.aafp.org/afp/2008/1101/p1073.html