Written by: Ryan Woodbury and Julie Sawaya, co-founders of Needed
Written on 5/19/21
Keep reading to learn more about prenatal vitamins, why you should take one, and what differences exist in prenatal vitamins.
With hundreds of prenatal vitamins on the market, it can be overwhelming to try to sort through the options to find the one that is best for you. That’s why we’re teaming up with our friends at Needed to walk through everything you need to know about choosing a prenatal vitamin.
Needed was founded by two women to fix the perinatal nutrition paradigm of women being undersupported during this critical phase of life. They exist to support and empower women with information around optimal nutrition that is backed by extensive research and supported by a team of women’s health practitioners.
Before we dive into the discussion, let’s take a step back and first look at some fundamental questions: what is a prenatal vitamin, why should you take one, and what differences exist in prenatal vitamins that might cause you to take pause and really think through which one you want to choose?
What is a prenatal vitamin?
A prenatal vitamin is a multivitamin that is specially designed for pregnant women. The idea behind prenatal vitamins is that women have increased nutrient needs during and after pregnancy and so a prenatal vitamin is intended for women to help meet these needs.
But here’s the problem: most prenatals still don’t meet mamas needs. This means that during one of the most nutritionally-demanding phases of life, mamas and their developing babies may be lacking in the nutrients needed to support growth and development and to sustain mama's levels of critical nutrients needed for optimal physical and emotional wellbeing.
With many nutrients, prenatal formulas haven’t caught up with the most recent research. And in some cases the research hasn’t caught up to what women actually need. This is in large part due to the fact that our food system has changed and foods simply aren’t as nutrient dense as they once were. One of our favorite practitioners wrote a great post on “Why Your Grandma Didn’t Take a Prenatal But You Should” that explains more.
So to fill in these gaps that most prenatal vitamins have in both research and practice, we partnered with health practitioners who regularly test the nutrient levels of women before, during, and after pregnancy. Testing is the only way to truly know if dosage levels are sufficient in meeting the needs of pregnant and postpartum mamas. We dove into their clinical experience, a data set of thousands of women, and what we found was shocking. Recommended Daily Allowance (RDA) levels for pregnancy and breastfeeding are off in some cases by a factor of 70-100x (as with B12)!
Why should I take a prenatal vitamin?
Despite what you may have been told, a prenatal vitamin is not just an insurance policy. The food we eat is depleted of nutrients, and even on our best days, we often fall short of what’s needed for an optimal pregnancy and postpartum. Getting a good balance of nutrients is difficult on the best of days as women aim to balance competing priorities with work and family.
But it is particularly difficult in the early days of pregnancy when nausea and food aversions throw all of our best intentions off course. Even with a “perfect” diet, a prenatal vitamin is absolutely key to ensuring you aren’t just meeting bare minimum needs, but are optimally thriving.
Even with a “perfect” diet, a prenatal vitamin is absolutely key to ensuring you aren’t just meeting bare minimum needs, but are optimally thriving.
What are the different types of prenatals?
Prenatals vary significantly in their nutrient forms, dosages, and method of delivery. Because of this, they also vary quite a bit in price and quality. Let’s break it down!
Prenatal vitamins generally contain nutrients from one of the following three sources:
- Whole food: These are made, in part or in whole, with nutrients from food. While it might sound better in theory, the reality is, whole food vitamins have significant inconsistencies in their potency and purity. This article describes these concerns in detail.
- Synthetic: The term synthetic when it comes to vitamins doesn’t simply mean man made, it means that the nutrient is made into a form that is not found in nature and not easily used by the body. Synthetic ingredients include things like folic acid and the cyanocobalamin form of B12, which must be converted to the active form of folate in the body in order to be used. Since a large portion of the population is unable to make this conversion, the synthetic form is not only ineffective, but potentially dangerous if too much accumulates in the body.
- Lab synthesized: There is a big difference between a vitamin made thoughtfully in a controlled environment that results in a vitamin that mimics a form found in nature or in the body and a vitamin cheaply made to inefficiently substitute for an active form of its natural counterpart. We call some of these lab synthesized nutrients “mindfully-made” when they are carefully created nutrients that follow the same molecular structure as that found in their naturally-occurring state. These forms are easier for your body to absorb and use.
Prenatal vitamins vary widely in their nutrient dosing, and even when it comes to what nutrients are included. For example, some choose to follow the RDA for all nutrients while others choose to dose more optimally.
In addition, some prenatal vitamins completely forego some nutrients. Choline is one example of this. While choline was recognized by the FDA in the 90s as essential to fetal development, supplement companies have been slow to incorporate it into their formulas. Choline is a bulky nutrient, meaning it takes up quite a bit of space in a formula.
For no other reason other than simply being inconvenient to include, many companies opt not to include it, or to include it in woefully insufficient amounts (typically 10% or less of the 550mg/day RDA). Yet research has shown that even higher doses, up to 930mg/day can offer additional benefits to your baby.
Another example of a nutrient you might see missing is iron. This is for good reason. Too much supplemental iron can cause oxidative stress and alter the gut microbiome. Because of this, you may want to look for an iron supplement offered separately from a prenatal to ensure you’re not getting too much.
Method of delivery
Prenatal vitamins are commonly found as pills or capsules that need to be swallowed, but other forms such as gummies and chewables have become popular to avoid having to swallow pills at a time when a heightened gag reflex and nausea can make it difficult.
When formulating our Prenatal Multi, we found that it was not possible to fit optimal dosages of all of the nutrients needed into a reasonable number (literally, less than 10!) pills. The optimal forms were also often not available to be included in a gummy form. For this reason, we chose a powder form to deliver our nutrients. It can be easily mixed into any liquid or soft food (so long as it’s cool enough to eat or drink) and has a mildly sweet taste without any added sugar that is easy for women at all stages of pregnancy to get down. (We’ll also be offering a capsule version very soon for mamas who prefer them!)
How do I choose the best prenatal vitamin?
We know that choosing the right prenatal vitamin can be quite overwhelming, so we’re breaking it down into five key items to consider when comparing prenatal vitamins:
1. Does it contain the nutrients your body can best absorb and use?
When it comes to nutrients, many vitamins and minerals can have different molecular structures or forms. The most optimal nutrients exist in the forms that work best in the body, but supplement companies often choose other forms as they are cheaper or easier to work with.
2. Does it contain the right amount of those nutrients?
Getting the right dosage of a nutrient is important. Getting too little (or in some cases too much of a nutrient) can be detrimental. In our view, many prenatal vitamins do not supply enough of the nutrients that mama and baby truly need, they are designed to meet minimum nutrient requirements to avoid fetal complications like spina bifida, not to optimally nourish mom (levels far too low).
3. Does it contain any unwanted additions?
Just as in processed food, personal care, and cleaning products, there are often unwanted additives, binding agents, fillers, chemicals, and processing agents, present in supplements. Some are intentionally added, while others are residual heavy metals and process contaminants or byproducts. Common additions to avoid include stearic acid, magnesium stearate, potassium sorbate, silicon dioxide, titanium dioxide, carrageenan, artificial colors and flavors, and corn maltodextrin.
4. Can you trust that what it says on the label is actually in the supplement?
Supplements do not require pre-market approval, meaning neither the FDA, nor any other government body, approves the launch of a new supplement. All supplements are required to be manufactured in accordance with FDA guidelines, the current Good Manufacturing Practices (cGMPs), which help ensure quality and safety. But not all companies follow these guidelines and the FDA does not have the capacity to monitor everyone.
Therefore, consumers MUST trust the company behind the product. Don’t assume that every company takes care to ensure quality or assume that what is on the label is actually in the pill or powder. Look for companies that engage third party testing and don’t be shy to contact the company to learn more about their products directly.
5. Are you able to take it daily before, during, and after pregnancy?
At the end of the day, you need to be able to reliably take your prenatal every day. For some, taking a ton of pills is not sustainable. For others, the added sugar and lack of quality nutrients in gummy options is not ideal. It’s important to find a product that both works in your body AND fits your daily life.
At the end of the day, you need to be able to reliably take your prenatal every day.
Should you take a prenatal once you’re pregnant?
You should absolutely take a prenatal for your entire pregnancy, but the truth is, you should actually start taking a prenatal before trying to conceive and well after your baby is born.
Starting a prenatal vitamin before you’re pregnant serves a few purposes:
- It starts to support any nutritional deficiencies you may have: Ideally, you’d enter into one of the most nutritionally demanding phases of life with optimal nourishment rather than already depleted. Common deficiencies include vitamin D, choline, and magnesium. In addition, the Needed Prenatal Multi contains 40mg of vitamin B6, which may help to reduce some of the First Trimester nausea. As an added bonus, many of the nutrients in a prenatal may also help support fertility too!
- Ensures optimal nutrition from the start: Your baby needs nutrients to help grow and develop from day one of conception. That is, as soon as sperm meets egg. However, most people don’t even know that they’re pregnant until two to three weeks after this time. If you aren’t taking a prenatal vitamin before you start trying to conceive and instead wait until you know you are pregnant, you’re missing out on providing your baby with the nutrients it needs during a few very critical weeks of development.
In addition to taking a prenatal vitamin before becoming pregnant and while pregnant, you should also continue your prenatal vitamin after birth. This will help the body to recover from delivery and replenish any nutrients needed. If you’re breastfeeding, it will also help supply your milk with the optimal nutrients needed to nourish your baby.
If you are breastfeeding, we recommend continuing your prenatal vitamin to at least two months after weaning. If you are not breastfeeding, we recommend continuing your prenatal to at least six months postpartum. In either case, if you are planning another pregnancy within the next year, we recommend continuing your prenatal vitamin through to your next pregnancy.
Now that you have the information to choose the best prenatal, you can set yourself up for success on your fertility journey!