Choosing a Prenatal

There’s never a better time for women to begin maximizing their nutrient status than during preconception. Ensuring optimal nutrient intake in the months leading up to conception can increase your chances of conceiving and support a healthy pregnancy and baby.

While I do advocate for a “food-first” approach, it’s important to take a prenatal to ensure all of your nutritional bases are covered. I recommend starting your prenatal at least 3-6 months prior to trying to conceive. This gives your body time to replete nutrients and for these nutrients to benefit egg quality and maturation which actually takes place months before you ovulate. But with so many options and since all prenatals are NOT created equal, how do you choose?

Buy pharmaceutical-grade

Outside of a few rules, supplements are very loosely regulated. Unlike medications, supplements do not have to be formally approved by the FDA. For this reason, it’s important to buy high-quality supplements from reputable sources.

What does “pharmaceutical-grade” mean?

The supplement was made in an FDA-registered facility.
Pharmaceutical-grade supplement companies comply with the Current Good Manufacturing Processes (cGMP) set by the US Food and Drug Administration. These standards ensure that the product actually represents the claims made on the label including identity, purity, strength, and composition.
The supplement is third party tested for purity and potency.
The supplement excludes unnecessary allergens, additives or preservatives.

Generally, pharmaceutical-grade supplements can be bought through qualified practitioners or may be sold at specialty health food stores. They are not found at your local grocery store, Walmart, Target or sold on Amazon. Avoid purchasing through 3rd-party sellers like Amazon as these sellers may or may not be selling counterfeit or expired products and not following storage requirements. All of my clients have access to pharmaceutical-grade supplements with a 10% off discount.

Pay attention to nutrient forms

Did you know the same nutrient can come in multiple forms? These different forms can have varying levels of efficacy, bioavailability and even serve different functions in the body. Below are the specific forms of key nutrients we want to see in your prenatal supplement.

Choose Methylfolate vs. Folic Acid

Folate is probably the most well known nutrient necessary for healthy pregnancy and baby. In fact, pregnant women require 5-10x more folate than non-pregnant women. Folate is a B vitamin (B9) essential for normal neurodevelopment and brain functioning in baby including neural tube development, DNA synthesis, regulation of gene expression, synthesis of neurotransmitters and more. Folic acid is the synthetic form of folate and the form you’ll find in the majority of prenatal supplements. While folic acid may be the most common, it’s not the ideal form. Before our bodies can actually use folic acid it must be converted into its active form. Unfortunately, up to 40% of the population has a genetic variant that makes this conversion significantly less efficient. For this reason, it’s important to select a prenatal that contains an already active form of folate known as L-5 methyltetrahydrofolate or 5-MTHF. While any folate is better than no folate, opt for a prenatal with the active form of folate, 5-MTHF, whenever possible.

Methylated B’s

For the same reason listed above, it’s a good idea to always opt for the “active” form of B vitamins. Vitamin B12, B6 and B2 also play critical roles in healthy fetal brain development and growth. Adequate levels of these nutrients are associated with higher birth weights and reduced incidence of pre-eclampsia and preterm birth.

Opt for a prenatal with:

B12 as methylcobalamin or hydroxycobalamin (not cyanocobalamin)
B6 as pyridoxal-5’-phosphate
B2 (Riboflavin) as riboflavin-5’-phosphate

Choline

In recent years, choline has become increasingly recognized as a critical nutrient for mom and baby during pregnancy. In 2018, the American Academy of Pediatrics recognized choline as a ‘brain-building’ nutrient asking pediatricians to ensure pregnant women and young children have adequate intakes of choline. Choline plays a critical role in membrane biosynthesis and tissue expansion, neurotransmission and brain development, methyl group donation and gene expression. Unfortunately, most pregnant women are not getting the recommended daily amount of 450mg. Some research even suggests that 450mg may not be enough and levels up to 930mg were shown to incrementally increase pregnancy and baby health outcomes.

Despite the importance of Choline for maternal and fetal health, the majority of prenatals don’t contain choline. Make sure yours does! In addition to your prenatal, ensure adequate intakes of food sources rich in choline such as animal protein like chicken, beef, fish and eggs (must include yolk).

Vitamin D

Vitamin D plays an essential role in calcium balance, insulin secretion and glucose tolerance, immune system modulation and blood pressure regulation. Evidence suggests that mama’s with healthy vitamin D levels experience fewer adverse maternal outcomes such as hypertension, gestational diabetes, recurrent pregnancy loss, preterm delivery and postpartum depression. Mom’s vitamin D status has also been shown to impact the long-term health status of baby.

The best way to increase your vitamin D status naturally is by (safely) spending more time in the sun. However, if you work full time, live in a cold climate or an area with limited direct sunlight, getting adequate natural exposure can be difficult.

Most prenatals will contain some vitamin D, but additional supplementation may be warranted depending on your levels. Ask your doctor to check your 25-hydroxy vitamin D level at your annual well check. I recommend keeping your vitamin D levels between 50 to 80 ng/ml. Ensure your prenatal contains vitamin D3 (cholecalciferol). Generally, 2,000 – 4,000 IU of vitamin D3 is a typical maintenance dose, but you may need more if your levels are low.

A note about IRON…

Iron is one of the most common nutrient deficiencies in America. Women of child-bearing age are at a greater risk for iron deficiency due to monthly periods. However, not all women need to supplement with iron. We don’t want your iron to be too low and we also don’t want it to be too high - either can be problematic. This is why it’s important to have your primary care physician or obgyn check your levels at your annual well check. Only look for a prenatal with iron if your labs indicate you could benefit from supplementation.

Iron status is important during pregnancy because:

Blood volume doubles in pregnancy. Iron plays a key role in red blood cell production and oxygen transport for both mom and baby.
Adequate iron levels can help you maintain energy levels throughout your pregnancy
Iron is important for growth and development in infancy. Deficiency can increase risk of low birth weight, small for gestational age and preterm birth as well as abnormal psychomotor development and cognitive function in infancy.

If you’re someone who needs iron, pay attention to the form. Certain forms of iron can upset your stomach and maybe even cause constipation. However, more gentle forms of iron like iron bisglycinate or ferrochel iron can prevent this.

My favorite prenatal is PlusOne by Metagenics. In addition to a prenatal, I highly recommend a high potency fish oil that includes DHA.