Prenatal Vitamins Aren't Created Equal — Are You Taking Quality Supplements?
We’re huge advocates for getting the nutrients essential for a healthy pregnancy and baby from quality whole and real foods. However, some nutrients are tricky to obtain in the required amounts from food alone.
When it comes to good health and nutrition, we believe food comes first, always. Unfortunately, we cannot rely completely on food alone to provide us with all the nutrients we need — especially during such a pivotal period in our lives as pregnancy.
This is due to a combination of how food is produced (i.e. intense farming practices and lower nutrient levels in the soil) as well as lifestyle factors such as exposure to stress, environmental pollutants and the increasing use of medication (such as the contraceptive pill and antibiotics).
As a result, nutrient imbalances can develop and impact your health and the health of your unborn baby. A quality prenatal vitamin can help fill this gap — supplementing, but not replacing a nutrient-dense, whole and real food diet.
Ensuring all the essential nutrients are available to you and your baby during pregnancy is critical. Even a marginal nutrient deficiency may cause you to feel especially tired, experience unwanted pregnancy symptoms, or fall ill easily with colds and flu. Furthermore, a nutrient deficiency during pregnancy may impact the health and wellbeing of your baby in the short and long term.
Therefore, pregnant women are commonly advised to take a good multivitamin and mineral supplement formulated specifically for pregnancy and breastfeeding, along with an omega-3 supplement. It may also be beneficial to take iron, vitamin D and probiotic supplements.
*It’s recommended to check certain nutrient levels prior to conception or as soon as possible to identify what does, and does not, need to be supplemented.
However, you need to choose your supplements wisely.
Many supplement companies formulate their products using synthetic forms of nutrients. Because synthetic nutrients are in a different form or state to how they occur in food, they’re not as easy for our body to absorb and metabolise.
Supplements using nutrients extracted from or grown in food, such as food-state nutrients, do not have this problem. Instead they provide the nutrient in a form as it would be found in real food, enhancing the body’s recognition and therefore use of these nutrients.
A good example of the difference between a synthetic and food-state nutrient is folate.
Supplementing the correct form of folate is especially important — as opposed to synthetic “folic acid”. Research shows up to 60 per cent of people have a reduced ability to use folic acid due to their genetics (a gene variant in the MTHFR enzyme) and therefore require the active form, L-methylfolate. Inadequate folate intake, or supplementing with folic acid when you genetically cannot utilise it, increases the risk of neural tube defects in your baby.
For example, a popular and heavily prescribed prenatal vitamin is Elevit. Even though Elevit contains 800mcg of folic acid, it’s synthetic and may clog folic acid receptors in your digestive tract and result in low absorption.
How do you know which supplements are good quality?
Here is a guide for selecting quality pregnancy supplements:
Look for a prenatal vitamin that contains ‘activated’ B vitamins, which are easier for your body to metabolise. Examples of activated B vitamins include:
Folate (L-methylfolate, also called 5-methyltetrahydrofolate or Calcium Folinate which is folinic acid)
Vitamin B6 (pyridoxal-5” -phosphate)
Vitamin B12 (methylcobalamin and/or adenosylcobalamin and/or hydroxocobalamin)
Check the ingredients on the label for added fillers and binders designed to ‘bulk’ them out and/or bind them into tablets or capsules. These include ‘anti-caking agents’ such as magnesium stearate, silicon dioxide, sucrose, acacia gum, microcrystalline cellulose, cornstarch and even talc. You want to avoid supplements that contain these.
Choose a prenatal vitamin with a comprehensive formula. One that includes activated B vitamins (such as folate, vitamin B12, biotin) as well as iodine, choline, magnesium, selenium, vitamin D, zinc, vitamin K, calcium, copper, manganese, potassium, vitamin A (look for natural beta carotene and avoid synthetic equivalents like Accutane or Retin-A).
If you do not eat eggs, it’s recommended you take a choline supplement. Choline is required for fetal brain development, placental function, helps prevent neural tube defects, and shares many of the same nutritional benefits as folate. The latest scientific research is showing that choline also plays a major role in preventing pre-eclampsia, hypertension, small-for-date babies, premature delivery. Two main sources of choline are eggs and liver, which contain 140mg and 290mg respectively. Beans, lentils, split peas, kidney beans, spinach, broccoli, cauliflower also contain choline but in much lower quantities. During pregnancy the daily recommended intake of choline is 450mg-600mg.
Folate is a member of the B vitamin family and needed for the production of DNA in your baby’s cells. Folate deficiency has been linked to neural tube defect (such as spina bifida). Studies show supplementing for 3-6 months prior to conception and during the first 12 weeks of pregnancy reduces the risk of neural tube defect by up to 70%, as well as reducing the risk of ‘small for gestational age’ babies, cleft lip and palate, autistic disorders and antenatal depression.
Vitamin D is essential for healthy skeletal growth and bone development in your baby. Considering the majority of the population is deficient in this nutrient, it’s recommended all pregnant and breastfeeding women take a vitamin D supplement. Opt for a supplement which contains Vitamin D3 as it’s more effective at raising and maintaining vitamin D levels in the body.
Choose an iron supplement that’s easily absorbed, like iron bisglycinate. Steer clear of ferrous fumarate or ferrous sulfate as these may cause constipation, nausea and heartburn and are less efficiently absorbed. During pregnancy iron needs are 1.5x higher than usual. The recommended intake of iron is 27mg per day in pregnancy.
Choose an omega-3 supplement that delivers at least 300mg or more DHA per daily dose and also contains EPA. EPA is another type of omega-3 fat and is responsible for transporting DHA across the placenta. Aim to choose a high-quality brand of fish oil that’s been tested to be free of contaminants, like heavy metals and PCBs. Omega-3 fatty acids DHA and EPA are crucial for your baby’s healthy brain and vision development as well as improved cognitive and intellectual abilities, reduced risk of premature birth and reduced risk of allergies in children as they grow up.
Omega 3 essential fatty acids are termed “essential” as our body cannot make them. Therefore we need to ingest these oils as part of a whole and real food diet and/or quality supplements. In Australia, quality brands are Nordic Naturals or Orthoplex White Label.
If you’re vegan or vegetarian and have opted to take an omega-3 supplement made from algae or flaxseed, be aware not everyone is able to convert the omega-3 found in the vegetarian forms into the beneficial fatty acids DHA and EPA. Taking a plant-based Omega 3 oil provides only very minor levels of EPA and DHA.
Iodine deficiency is a worldwide issue. Iodine is needed for the early stages of your baby’s growth and nervous system development, especially during the first three months. Only use quality supplements that provide both Potassium iodide and Iodine or as part of a quality multi-vitamin.
Taking probiotics during pregnancy can increase your baby’s immune strength, as well as improve your baby’s ability to tolerate lactose once born. Beneficial flora support your health too. Choose a probiotic supplement that offers a mix of different strains (at least 12-15), including Lactobacillus, Bifidobacterium and Streptococcus.
When deciding which supplements to take, and what dosages are right for you, we recommend you consult with a qualified and experienced Naturopath who can align with your medical practitioner.
To ensure you’re getting the most benefit from the supplements you’re taking, follow these tips for how and when to take them:
Take your supplements alongside a meal or snack, rather than on an empty stomach, as this improves absorption and minimises side effects such as nausea.
Make sure you don’t take your supplements 30 minutes to 1 hour either side of coffee as caffeine is a nutrient inhibitor. (Ideally you’ve given up coffee now that you’re pregnant)
For optimum absorption, separate your supplement dosages out across the day. For example, if the recommended dose is 2-3 capsules a day, space these out across the day rather than taking them all at once.
As B vitamins can boost your energy, it’s best to take these in the morning or throughout the day (avoid taking your prenatal close to bedtime as it may interfere with sleep).
Folate should not be taken on its own, or with iron, as it is frequently prescribed. All the B-group vitamins need to be taken together as this is how they occur in nature – they help each other and if one is missing, the others may not work.
Fish oils are best taken at the end of a meal to minimise side effects such as nausea and also because the oils shut down digestion. Always store fish oils in the fridge. And during times of “baby brain” increase your Omega 3 intake – up to 2 capsules three times daily.
Many nutrients compete for absorption and some take precedence over others. One that you need to be particularly aware of is zinc as many substances interfere with the body’s ability to absorb it. These include other minerals such as iron and calcium, phytates (found in foods including beans, grains, nuts and seeds), oxalates (found in foods such as rhubarb, spinach and chocolate), tannins (found in tea, coffee and red wine — not that you’re drinking these beverages at the moment), and some types of fibre. Given these zinc-blockers are so widely spread throughout different foods and drinks, it’s best to take a standalone zinc supplement i.e. in addition to your prenatal vitamin, and to take it away from meals and other supplements.
The absorption of iron is greatly reduced by calcium (dairy) and caffeine. An iron supplement is best taken first thing in the morning (upon waking and before food) or after exercise. And only every second day (not daily) to maximise absorption.
Other ways to maximise the amount of iron your body absorbs from the supplements you’re taking and the foods you're eating include:
Eating foods high in vitamin C, or acidic foods, with foods that contain iron i.e. add beef mince to tomato sauce or squeeze a lemon over a four bean salad.
Not eating iron-rich foods with calcium-rich foods, calcium supplements or antacids, as these minerals can compete for absorption.
Cooking plant foods to improve the amount of iron available.
Not consuming caffeine for at least 30 minutes either side of eating iron-rich foods as caffeine blocks absorption.
Soaking, sprouting or fermenting grains, legumes, nuts and seeds to decrease the content of phytic acid and optimise the absorption of heme-iron.
There are many considerations when choosing to supplement. We recommend you consult with a qualified and knowledgeable healthcare provider when deciding which supplements to take to support your pregnancy. It’s recommended you check your nutrient levels prior to conception, or as soon as possible, to identify what does, and does not, need to be supplemented.