Choosing a prenatal multivitamin can be very confusing. There are so many options out there, and you can find them everywhere. You can find prenatals online, in health food stores, and even in drugstores, so which ones do you choose?  The fact is that not all prenatal vitamins are created equal.  Many prenatal vitamins are missing nutrients, the nutrients are not in the active form, or the amounts are so low that they simply do not do what they should. For example, many common prenatal vitamins are deficient in folate, B12, iodine, choline, iron, zinc, vitamin D, and K2. So, how do you know which one to take? Here, I am going to summarize some of the nutrients that are important to keep in mind when choosing a prenatal multivitamin.

Folate

Folate is arguably the most important nutrient to include in your prenatal.  Folate deficiencies can lead to issues with both mom and baby. Dietary supplementation of folate in early pregnancy has been shown to decrease the risk of neural tube defects. Low folate status in pregnancy has also been associated with preterm births.

You may see folate in your prenatal in several different forms, but they do not work the same way. The most common form that you will see in prenatal vitamins is folic acid, which is the synthetic form of the nutrient.  Folic acid has to be converted in the body to the active form, l-methylfolate.  About 40-60% of the population have a reduced ability to do that conversion due to a MTHFR gene variant. Inadequate folate intake or supplementing with folic acid when you have a reduced ability to use it, increases the risk of neural tube defects.

Vitamin B12

Vitamin B12 is often included in small amounts or in a cheaper and synthetic form that is not as readily used by the body (cyanocobalamin).  It is important to have B12 in a prenatal because, along with folate, it regulates fetal growth.  Studies have shown that lower vitamin B12 status during pregnancy may be associated with a higher risk of pregnancy complications, lower birth weight, and adverse long-term health outcomes for baby such as impaired cognitive function and increased diabetes risk.

Iodine

Your thyroid uses iodine to make thyroid hormone, so an iodine deficiency puts you at risk for hypothyroidism. Iodine needs increase during pregnancy and low iodine intake affects both you and baby, potentially even leading to pregnancy loss. For baby, iodine status also affects brain development and growth. Even mild iodine deficiencies can result in poorer cognitive outcomes in children. Severe iodine deficiencies can even lead to fetal growth issues and even congenital hypothyroidism.

Iodine is also really important while breastfeeding. Breastfed babies rely on iodine through breastmilk to produce thyroid hormone, which is necessary for growth and cognitive development. Iodine concentration in breastmilk is directly related to mom’s iodine intake and, therefore, baby’s growth.

Choline

Choline is also so essential during pregnancy yet so often left out of prenatals. Choline is important for baby’s brain development and placenta formation. It may also prevent neural tube defects. Choline intake throughout pregnancy may also have lifelong effects on baby’s memory and attention. Many women struggle to get enough choline through diet, so it is important to choose a supplement with choline.

Choline needs are higher during lactation than at any other point in your life. Mom’s intake of choline directly affects the amount of choline and its metabolites in breastmilk. Choline is important for your baby’s brain development and function. It may also be better than lecithin for clogged ducts.

Zinc

It is important to choose a prenatal that includes zinc. Zinc deficiency is common and linked to many adverse events. For example, zinc deficiency in pregnancy may put you at higher risk for miscarriage, preterm delivery, and stillbirth. It has also been linked to placental issues, neural tube defects, and low birthweight. Zinc deficiency during pregnancy may also have life-long effects for baby, predisposing your baby for chronic disease later in life.

Iron

Iron deficiency is a big issue during pregnancy. It has been estimated that only 20% of women have enough iron stores for pregnancy! Not getting enough iron during pregnancy increases your risk factors for many complications including preeclampsia, hypothyroidism, and preterm birth. It can also affect baby’s brain development and growth. Iron deficiency in pregnancy can also have life-long effects for baby, increasing baby’s lifetime risk of obesity, diabetes, and high blood pressure.

Vitamin D

Many women are vitamin D deficient prior to pregnancy. In fact, vitamin D deficiency during pregnancy may put you at higher risk of preeclampsia, having a low birthweight infant, and gestational diabetes. Getting enough vitamin D during pregnancy is also important for baby’s health including their bone health. Maternal vitamin D deficiency has also been associated with increased risk of asthma and type 1 diabetes. Many prenatals do not include sufficient amounts of vitamin D to prevent maternal deficiency. The RDA is set at 600IU/day which has been shown to be insufficient to maintain normal vitamin D levels. Prenatals with 2,000 IU vitamin D have been shown to maintain vitamin D levels for the majority of women without risk of excessive blood levels. So, make sure that the prenatals include the D3 form and ask for testing for further personalized guidance on supplementation. You should also ensure that your prenatal contains the nutrients that work synergistically with vitamin D including vitamin A, vitamin K2, zinc, and magnesium.

Vitamin K2

Vitamin K2 is yet another nutrient that is often missed in prenatal supplements. It is really challenging to get vitamin K2 through diet alone. It is only found in fatty animal foods and some fermented foods. So, it is important to find a prenatal vitamin that includes vitamin K2.

Vitamin K2 is important because it works synergistically with vitamin D, and it is essential for bone mineralization, ensuring that calcium is deposited in bone.  It is required for the development of your baby’s skeleton.

What about after delivery? Should you stay on a prenatal? Do you need a separate postnatal? You should stay on a prenatal/postnatal for the entirety of your breastfeeding journey and at least 6 months postpartum if you are not breastfeeding. Many nutrient needs such as choline and vitamin D are even higher postpartum and while breastfeeding. If you are taking a quality prenatal supplement with sufficient amounts of the nutrients listed above, you should not need to switch to a dedicated postnatal after delivery.

Other important supplements to consider during pregnancy and during postpartum: Iron, Fish oil, and probiotics, but I’ll leave these for another post.

If you have more questions about supplements and what pre or postnatal multiviatmin is right for you, contact me at info@wholehealthbaby.com or book a consultation here. Be sure to also check out the Whole Health Baby Pre+Postnatal Multivitamin. Developed by naturopathic doctors to contain nutrients that are often left out of other prenatals. Only 2 easy to swallow pills per day are needed to give you the nutrients required for preconception, pregnancy, and beyond.

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