The Best and Worst Prenatal Vitamin article has been the most requested article that I have written so far. I didn’t want to disappoint with this article, so I put extensive time and research to outline everything needed to choose the best prenatal vitamins. I’ve included the optimal amounts of every nutrient based on research and correct forms of the nutrients for building healthy babies worldwide. By taking these steps, I believe we can begin to reduce the disease statistics dramatically in one generation.
The Importance of Prenatal Nutrition
Risk factors for heart disease, high blood pressure, cancer, diabetes, allergies, asthma, mental illness, PCOS, and obesity have been consistently been linked in research studies to prenatal nutrition during the first 9 months of pregnancy.
Women who take multivitamins may be less likely to experience ovulatory infertility; women who take six or more tablets had the lowest relative risk for infertility. This shows you the importance of supplementation from the beginning of conception.
At Nutrition Genome, the nutrigenomic analysis shows you the most beneficial diet based on unique genetic variants and biochemicial needs. Choline, omega-3’s and folate requirements can vary dramatically woman to woman. Knowing how to hit your personal nutritional targets helps shape the gene expression of the child during pregnancy and even extend to the grandchildren. It also gives the mother sufficient reserves so that her health isn’t dramatically altered.
Epigenetics is the study of how this expression occurs from our diet, environment, relationships, and stress. What you eat has an epigenetic effect on your genes. According to David Williams, principal investigator for the Linus Pauling Institute at Oregon State University, “DNA expression can be altered at any age, but the fetus is especially susceptible because these pathways are very active as tissues grow and differentiate.”
In other words, a mother’s eating habits, exercise regime, stress levels and environment actually have the power to shape the gene expression passed down.
Click on the images below to read more about how nutrigenomic testing can help you have a healthy pregnancy.
Prenatal Vitamin and Mineral Research
According to the 2009 statistics from the U.S Department of Agriculture, here is the list of nutrients that women are commonly low in and support the need for prenatal supplements:
Vitamin E: 86%
Vitamin B6: 35%
Vitamin B12: 30%
I have created a chart for the optimal levels of vitamins and minerals during pregnancy. You will not find a perfect prenatal vitamin supplement that hits all of these perfectly, but it will allow you see what you might be missing. Below this chart is a very detailed summary of the research used to come to reach these conclusions. You can treat this like a mini prenatal vitamin and mineral guide to create a well-balanced diet. You can also scroll right to the bottom if you just want to know my prenatal recommendations.
Vitamin A as Retinol (3,000-10,000IU from your diet)
There has been a major scare over the past few years regarding vitamin A and teratogenic (birth defects) effects on the fetus, lowering vitamin A recommendations for pregnant women and leading to multiple supplement companies to keep lowering their vitamin A content, or completely switching to beta carotene. Read this section carefully and educate yourself, because it will be challenged by your doctor.
The American Pediatrics Association cites vitamin A as one of the most critical vitamins during pregnancy and the breastfeeding period, especially in terms of lung function and maturation. According to the European Journal of Nutrition, The German Nutrition Society (DGE) recommends a 40% increase in vitamin A intake for pregnant women and a 90% increase for breastfeeding women. They also state that “pregnant women or those considering becoming pregnant are generally advised to avoid the intake of vitamin A rich liver and liver foods, based upon unsupported scientific findings.”
Up until the 1950s, a relatively large number of studies showed that laboratory animals (pigs, rabbits, chickens, rats, and mice) fed vitamin A–deficient diets gave birth to malformed offspring and spontaneous abortion. A 2000 study on pregnant mice found that high (100 mg/kg) and moderate (50 and 25 mg/kg) doses of vitamin A as retinyl acetate resulted in significant facial, heart and thymus abnormalities.
Finally, neural defects and craniofacial malformations were found in children born in regions where glyphosate-based herbicides (sprayed on GMO crops) are used due to glyphosate-induced endogenous retinoic acid activity.
The truth is, both vitamin A deficiency and toxicity can cause birth defects and affect the baby’s health.
Studies that Found Safety
#1 A 1997 study found that women consuming doses of vitamin A between 8,000 and 25,000 IU from supplements and fortified cereals were no greater in the major malformations group or the group with neural tube defects than in the normal control group. The researchers concluded, “If vitamin A is a teratogen, the minimum teratogenic dose appears to be well above the level consumed by most women during organogenesis.”
#2 A study found that human epidemiologic studies do not establish at what level vitamin A becomes teratogenic; however, pharmacokinetic data presented in this paper indicate that blood levels of retinoids from women taking 30,000 IU/d of preformed vitamin A are not greater than retinoid blood levels in pregnant women during the first trimester who delivered healthy babies.
#3 A clinical trial was carried out in Hungary in which a supplement of 6000 IU of vitamin A did not increase the incidence of fetal malformations.
#4 According to the American Journal of Clinical Nutrition, up to 20 case reports of the relationship between a high vitamin A intake and an adverse pregnancy outcome in humans were published in the past 30 years. These reports are of limited use for establishing a quantitative link between vitamin A intake and teratogenic events, however. Furthermore, the pattern of the observed malformations is not always consistent with the retinoic acid syndrome, thus calling into question the origin of these malformations.
Studies that Raised Caution
Teratogenesis of high vitamin A intakes has been reported in several animal species. The pattern of birth defects sometimes called “retinoic acid syndrome” includes the central nervous system, craniofacial, cardiovascular, and thymus malformations. Similar abnormalities were observed in humans when pregnancies occurred during therapeutic treatment with retinoic acid, especially isotretinoin (Accutane). This synthetic form of vitamin A used for acne is well known to cause birth defects.
This study concluded that among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, an estimated 1 infant in 57 had a malformation attributable to the supplement.
According to the American Journal of Clinical Nutrition:
The teratogenicity of high vitamin A intakes during pregnancy remains unclear and it is unlikely that new findings will shed light on this issue over the next few years. Human clinical trials are not ethically possible, so we must rely on those already performed, on forthcoming epidemiologic trials, and on our knowledge of vitamin A metabolism and functions, which is largely derived from animal studies. This information clearly shows that the teratogenicity of vitamin A is biologically and physiologically possible, yet its real occurrence in humans seems limited.
One drawback in all human studies is that the specific effects of vitamin A intake cannot be determined. Most of the information comes from the use of supplements or, at best, supplemented foods, that are taken on a regular basis and in moderate doses. However, data from animal studies clearly show that one single, high dose of vitamin A can be teratogenic, provided it is given at a critical period of embryonic development.
Beta Carotene is Not Vitamin A
If you look at the label on prenatal vitamins you will see vitamin A listed, but next to vitamin A you will find (as beta-carotene). This is true of many regular multivitamins as well. Assuming a vitamin A conversion rate for beta-carotene for juice is 4:1, and fruit and vegetables between 12:1 and 26:1; the total vitamin A contribution from beta-carotene intake represents 10-15% of the RDA. This does not take into genetic variants of BCMO1 that decrease the conversion another 57%, dietary fat intake (the conversion requires fat) and thyroid disorders.
If the vitamin A supply of the mother is inadequate, her supply to the fetus will also be inadequate, as will later be her milk. The major problem is that post-natal supplementation will not correct this issue. A clinical study in pregnant women with short birth intervals or multiple births showed that almost 1/3 of the women had plasma retinol levels below 1.4 micromol/l corresponding to a borderline deficiency. Vitamin A deficiency is the western world should no longer be ignored for a healthy diet.
That being said, I believe prenatal vitamins should use D. Salina or vegetable sourced beta-carotene and mixed carotenoids and vitamin A is best from the diet.
Conclusion for Vitamin A
From my research, it appears that vitamin A in the form of supplements given at a large dose or a high intake of glyphosate from processed food during a time of key embryonic development is the key understanding of toxicity. Natural vitamin A from food – or even from supplements less than 10,000 IU in relationship to vitamin D intake does not appear to have any evidence that proves causation of toxicity. Vitamin A helps protect against toxicity of vitamin D, and vitamin D helps prevent against toxicity of vitamin A. The absence of this understanding is also a major omission in this studies.
For numerous generations, liver was recommended once a week during pregnancy. I know my mom ate liver once a week, took vitamin A supplements and ate a lot of eggs while she was pregnant with me. Approximately 3.5 oz. of liver has 52,000 IU of vitamin A. Since vitamin A is fat-soluble and stored in the liver, once a week would give you your weekly dose of vitamin A.
If you didn’t like liver, taking 1 tsp. virgin cod liver oil daily would be equivalent to approximately 21,000-35,000IU per week. Even three bright orange pastured eggs per day (vitamin A is higher in pastured eggs) could give you up to 3,000IU per day, or 21,000IU per week.
The optimal dosage of vitamin A would be very hard to determine since it also probably changes person to person. However, a dose of 3,000-10,000IU daily and 3.5 oz. of grass-fed liver once a week does not appear to pose any toxicity risk while appearing to supply optimal vitamin A. In my opinion, this is a more responsible recommendation than wrongly thinking you can get all the vitamin A you need from beta-carotene.
Vitamin C (400mg-750mg split in two doses daily)
According to data from the US National Health and Nutrition Examination Survey (NHANES), 31% of US adults do not meet the estimated average requirement for vitamin C, and this is for an RDA that has been drastically reduced over the years. If you read studies on our Paleolithic ancestors, they obtained approximately 400mg per day. Today, the RDA is only 60mg and is wrong.
Having a low intake of vitamin C during pregnancy may be associated with high blood pressure, swelling of the hands, feet and face, upper respiratory infections, pre-eclampsia, anemia, and low birth weight. Large quantities of ascorbic acid are utilized by the female during conception and are necessary to formation and integrity of the fetal membranes. Vitamin C also reduces blood lead levels, important due to today’s water and air quality.
During pregnancy, plasma levels of vitamin C normally fall approximately 10 to 15%. A combination of vitamin C from a prenatal and from the diet should hit 400-500mg daily. This need may be higher for those prone to respiratory infections, low immunity, and high stress.
If you are experiencing infertility, one study showed that the rate of pregnancy was significantly higher in the vitamin C supplementation group of 750mg: 25% within six months, while only 11% of the untreated women became pregnant in the same time period.
Vitamin D3 (Vitamin D level between 40-50ng/ml, 2,000IU-4,000IU)
The largest randomized controlled trial to date from the Medical University of South Carolina took 256 pregnant women and separated the group into two groups, 2,000 and 4,000 IU daily starting 3-4 months of pregnancy. A control group of 400IU was not allowed because the ethics committee felt that this would endanger the women and their newborns. This is the amount women have taken with just a prenatal vitamin!
The results showed that the 4,000 IU group had 2.4 times higher of having an infant in the 50th percentile of birth weight compared to the 2,000 IU group. Lower vitamin D levels were predictive of preterm delivery, infections, and other complications.
In this posthoc analysis, achieving a 25(OH)D serum concentration >40 ng/mL significantly decreased the risk of preterm birth compared to <20 ng/mL.
In a very recent 2016 study, pregnant women with low vitamin D levels at 20 weeks more likely to have a child with autistic traits.
Get your vitamin D levels tested early and supplement as necessary to support your baby’s health.
Vitamin E (22-30mg as d-alpha tocopherol and mixed tocopherols)
One study concluded that “consumption of high doses of Vitamin E (over 400IU) during the first trimester of pregnancy does not appear to be associated with an increased risk for major malformations, but may be associated with a decrease in birth weight.” What is interesting about this is that research has associated low birth weights with an increased risk of heart disease later in life, something vitamin E is associated with preventing in the right dosage.
Another study found that supplemental vitamin E (400IU) from the second trimester of pregnancy did not appear to affect the risk of pregnancy outcomes and occurrence of preeclampsia.
While vitamin E shares an antioxidant commonality with vitamin C, it does not appear to warrant the same use of higher doses. Low dietary intake of vitamin C was associated with a trend towards an increased incidence of either severe pre-eclampsia or eclampsia. A small increase in the incidence of severe disease was also seen in the group of women with a high intake of vitamin E from supplements and dietary sources.
Regarding beta-carotene, vitamin C, and vitamin E for those struggling with fertility. One study found that a shorter time to pregnancy was observed with higher beta-carotene intake for those who were overweight, a higher vitamin C intake for those at an average or underweight, beta carotene and vitamin C for those under 35, for those over 35, higher vitamin E intake.
Based on the available evidence, I think 22-30mg is the correct amount, not 400IU or higher.
Vitamin K1 and K2
Vitamin K is essential for the formation of at least three proteins involved in blood clotting as well as of other proteins found in plasma, bone, and kidney. Vitamin K deficiency primarily affects the blood clotting process. Newborn infants are at high risk of deficiency because breast milk contains inadequate concentrations of vitamin K and their intestines are not yet colonized with vitamin K-producing bacteria.
Studies have found that the blood thinning drug Warfarin – which depletes vitamin K – has been shown to cause birth defects. This shows the importance of vitamin K that hasn’t been fully elucidated yet. Vitamin K2 is believed to be instrumental in teeth and bone formation.
Vitamin K is provided by the diet and gut bacteria. There is no known toxicity for K2 and therefore an upper limit hasn’t been established. The optimal amount is still being determined for pregnancy, but a conservative amount of vitamin K2 from supplementation is currently in the 65 mcg-100mcg range, depending on your diet.
B1 Thiamin (1.4mg to 2mg)
Conventional treatment for gestational diabetes increases the proportion of infants born with a low birth weight, a risk factor for cardiovascular disease and diabetes in later life. During pregnancy, approximately 50% of the women develop a biochemical deficiency of the b vitamin thiamine. The need for thiamine goes up in the third trimester. Causes of thiamine deficiency include a milled grain-based diet, high alcohol intake, gastrointestinal disorders and prolonged cooking of foods.
Thiamine is essential for glucose oxidation, insulin production by pancreatic beta-cells and cell growth. Research has stated that thiamine supplementation is a good preventative and treatment of gestational diabetes because it improves their glucose tolerance and stimulates the intra-uterine growth, thereby preventing a low birth weight to ensue from conventional therapy which only improves glucose tolerance.
B2: Riboflavin (1.4mg to 2.4mg)
Riboflavin deficiency has been implicated in preeclampsia.
Riboflavin plays a special role in MTHFR 677 where it has been found to stabilize the enzyme. Studies have shown that the MTHFR 677 TT genotype is associated with high homocysteine when riboflavin (B2) status is low. Many doctors will see a homozygous MTHFR 677 and automatically give high amounts of methylfolate (1-5mg) without looking at riboflavin, B6, B12 or choline status. Often, 400-800mcg of methylfolate is sufficient and more than this can cause anxiety issues depending on variants in other genes.
B6 (2.2mg to 10mg as Pyridoxal-5-Phosphate)
Pyridoxal phosphate (PLP) is the physiologically active form of vitamin B6 and is a coenzyme in over 100 known reactions. In multivitamins, B6 is often labeled as pyridoxal hydrochloride, which is not absorbed as well as PLP. PLP is expensive, and many companies do not use it because it increases the price of their product. PLP is worth the money.
An epidemiological study done at Tufts University in 2008 found that a substantial percentage of the population had inadequate B6 status. Studies have also consistently shown that in comparison with nonpregnant controls, pregnant women have lower plasma levels of vitamin B6.
It has been suggested that low B6 is associated with gestational diabetes and ”pregnancy depression”—described as pessimism, crying, tension without sleep, or appetite disorders. Vitamin B6 plays a very important role in mental health, needed in the formation of histamine, serotonin, and dopamine.
All forms of vitamin B6, especially PLP, cross the placenta into the fetal blood where its concentrations are two to five times higher than those in maternal blood. The most substantial decrease in plasma PLP levels is found between the fourth and eighth months of pregnancy, paralleling the period of most intensive growth of the fetus.
B6 is higher in organ meats than muscle meats and is needed for amino acid metabolism. Therefore a high lean protein intake low in B6 increases the need for B6. This is also true of vitamin A. The elevation of estrogen during pregnancy also increases the need for B6. The deficiency of B6 leads to morning sickness and nausea, which can be treated successfully with B6 supplementation.
If you have been on birth control for a long period of time, B6 needs may be higher. Long-term use (>30 months) of oral contraceptives containing high levels of estrogen was associated with significantly lower maternal and umbilical cord serum vitamin B6 levels than those in women who took no oral contraceptives, and evidence indicates that their vitamin B6 reserves may be decreased in early pregnancy.
B7 Biotin (30-50mcg)
The need for biotin increases with pregnancy and deficiency has been linked to birth defects. At least one-third of women develop marginal biotin deficiency during pregnancy, and there are prenatal vitamins that do not contain any biotin. The highest levels of biotin are actually found in organic pastured egg yolks and is connected to hair growth.
B9 (600-800mcg as Methylfolate)
Folate is one of the most well-known nutrients during pregnancy for preventing spina bifida. Due to its role in DNA synthesis, a deficiency has widespread consequences in fetal development. Folate and choline are methyl donors, and the addition of a single methyl group can change an individual’s epigenome.
Folic acid is a synthetic version of folate that does not exist in nature. In a study titled Is Folic Acid Good for Everyone?, the author argues that folic acid could interfere with the metabolism, cellular transport, and regulatory functions of the natural folates that occur in the body by competing with the reduced forms for binding with enzymes, carrier proteins, and binding proteins. The folate receptor has a higher affinity for folic acid than for methyl-THF—the main form of folate that occurs in the blood and might inhibit the transport of methyl-THF into the brain.
A new study from John’s Hopkins University looked at 1,391 mother-child pairs in the Boston Birth Cohort, a predominantly low-income minority population. The researchers found that very high circulating folic acid doubled the risk of autism, and B12 levels that were very high tripled the risk of autism. If both levels are extremely high, the risk that a child develops the disorder increases 17.6 times.
Homozygous variants in MTHFR 677 or a combination of a heterozygous MTHFR 677 and 1298 may put you at a higher need for folate. These variants also require B2 (riboflavin), B12, B6 and choline to normalize the methylation cycle. You want to choose folate as methylfolate and B12 as methylcobalamin.
If you were advised to take a high amount of methylfolate (1-5mg) and had a bad reaction, niacin is actually given due to niacin’s ability to quench excess methyl groups. It makes much more sense to give methylfolate as part of a B-complex because it includes niacin and other B-vitamins that provide balance.
B12 (2-10mcg as Methylcobalamin)
Cyanocobalamin is the synthetic B12 form found in cheap multivitamins and fortified foods. Cyanocobalamin must be converted to methylcobalamin and requires the split of a cyanide (the toxin) molecule from cobalamin. Like folic acid, the ability to make this conversion is impaired in many people.
As mentioned above, one study found that very high circulating folic acid doubled the risk of autism, and B12 levels that were very high tripled the risk of autism. If both levels are extremely high, the risk that a child develops the disorder increases 17.6 times.
As I explored in my Best and Worst Multivitamins article, this study was done in a predominately low-income minority population and was most likely due to a diet high in processed fortified foods along with supplements containing folic acid and cyanocobalamin.
I will give you my theory on why this may have occurred, which I haven’t seen explored yet.
One, synthetic folic acid can bottleneck and block folate receptors, creating high circulating levels.
Two, cyanide is one of the air toxins found to have a statistical significance on autism risk and high oxidative stress is found in children with autism.
Three, a study found that young US children with autism and their mothers had unusually low levels of lithium compared to neurotypical children and their mothers. I will explain how this relates to excessive cyanocobalamin.
Cyanocobalamin is composed of cyanide and cobalamin and splits off cyanide, which can block the electron transport chain of the mitochondria (powerhouse of the cell and sensitive to oxidative stress). Lithium is a carrier of B12 into the mitochondria.
Excessive cyanocobalamin could theoretically both disrupt the electron transport chain into the mitochondria, deplete methyl groups for methylation, increase mitochondrial oxidative stress, and cause very low lithium levels trying to keep up with the high circulating blood levels of B12 that are struggling to make it into the mitochondria. Mitochondrial dysfunction is one of the medical disorders that has been consistently associated with Autism Spectrum Disorders.
Studies have estimated that 82% of pregnant women in the world may have inadequate intake of dietary zinc! Why is this happening? Drop in liver and shellfish consumption, zinc from plants is poorly absorbed, grains high in phytic acid will actually block zinc uptake, and very high amounts of copper or iron in the diet will compete with zinc at absorption sites.
Zinc deficiency can lead to congenital abnormalities, poor immunity, abortions, intrauterine growth retardation, premature birth, and preeclampsia. Oxide forms of zinc should be avoided.
Copper plays a role in the brain, tendons, skin development, increasing iron absorption and processing oxygen. Too much can cause preeclampsia and intrauterine growth retardation while low serum levels have been linked to pathological pregnancies and miscarriage. Serum copper increases during pregnancy and is doubled at full term with peaks at the 22nd, 27th and 35th gestational week.
There is a balance between zinc and copper levels that is very important (approximately 15mg of zinc to 1mg of copper). Adequate zinc will push down excess copper, but too much zinc will push it too low. Conversely, insufficient zinc will lead to elevated copper levels.
A form of copper called “cupric oxide” in prenatal vitamins should be avoided. If the type of copper is not listed, ask the company if it is cupric oxide.
Iron requirements are reduced during the first trimester, increases for the second and third trimester of pregnancy due to oxygen requirements and infant storage during the breastfeeding phase and is especially high after delivery. Iron deficiency can lead to postpartum depression, fatigue, and poor breast milk production or quality.
It is recommended to enter pregnancy with higher levels of iron and ferrtin levels to meet your requirements fully. Approximately 40% of women entering pregnancy with insufficient iron reserves and unfavorable iron status, and 25% get iron deficiency anemia.
Women suffering from iron deficiency anemia during the first two trimesters are twice as likely to deliver early and three times the risk of having a low birth weight. Iron deficiency during the third trimester also affects the hippocampus; involved in learning, memory, and cognition, leading to cognitive dysfunction that could continue to adulthood.
Research has stated that “the amounts that can be absorbed from even an optimal diet, however, are less than the iron requirements in later pregnancy.” I wonder if this would be true if women ate liver once a week? In 3.5 oz. of liver, there is 17.7mg of iron. In 3.5 oz. of beef, there is 2.6mg.
Nevertheless, many women would rather have another option and supplementing is recommended. You want the right dosage for your levels. Remember that too much iron can be constipating, taking vitamin C at the same time helps iron absorption, copper increases iron absorption, and vitamin A helps mobilize iron storage.
The main forms of iron you want to avoid are gluconate and sulfate, which are constipating. I recommend Iron Bisglycinate. A 2014 double-blind study found that 25mg of Iron Bisglycinate was as effective as 50mg of ferrous sulfate for pregnant women. They also experienced lower gastrointestinal complaints and their babies had slightly higher birth weights.
Choline (550mg to 930mg)
As of June 17th, 2017, the American Medical Association voted to support evidence-based amounts of choline in all prenatal vitamins, noting that most prenatal supplements currently contain little if any choline.
Choline plays an important role in the liver, gallbladder, vulnerability to toxins, preventing spinal cord and brain defects, and the future mental health of the child. Genetic polymorphisms in PEMT may alter the dietary requirement for choline and increase the likelihood of developing signs of deficiency (fatty liver, gallbladder issues during pregnancy) when choline intake is inadequate.
The choline pathway is actually enriched with DHA, which of course also plays a prominent role in brain development. One analysis found that a higher choline intake (930 compared with 480 mg/d) augmented the rise in choline/DHA in nonpregnant women and choline needs are increased during the third trimester of pregnancy. The researchers found that a higher choline intake along with supplementary DHA acted synergistically to produce the greatest enrichment of choline and DHA in red blood cells. This is a major find for mental health.
An article from NPR came out this month that explored whether or not supplementing with the choline could enhance brain growth in the developing fetus and prevent mental illness. One group of moms-to-be were given phosphatidylcholine and the other group was given a placebo. The dosage was large; 900mg total. However, this is also close to the amount recommend during the 3rd trimester of pregnancy.
After birth, infants were given either 100 milligrams of liquid phosphatidylcholine or a placebo once a day for approximately three months. A test was administered at 5 weeks old testing simultaneous clicking sounds while measuring brain activity.
The results published in 2013 in the American Journal of Psychiatry by Freedman’s group show that 76 percent of newborns whose mothers received choline supplements had normal inhibition to the sound stimuli, while 43 percent of the newborns did not. Those who do not have a normal inhibition to the sound stimuli have been found to have an increased risk for attention problems, social withdrawal and, later in life, schizophrenia.
The results show that choline might steer the infant brain away from a developmental course that predicted mental health problems.
Omega-3 Fatty Acids (400-600mg DHA)
Omega-3 fatty acids are vitally important during pregnancy as they are critical building blocks of fetal brain and eyes, but are also crucial for preventing postpartum depression. DHA is transferred from the mother to the fetus at a high rate during pregnancy, thereby depleting maternal stores. This is a very important point to understand for all vitamins and minerals transferred from the mom to the fetus. If an expecting mom does not have sufficient reserves, this can drastically affect her pregnancy.
A recent study found that an estimated 106,000 high-risk preterm births could be avoided in the US and 1,100 in Australia alone every year if women supplemented with prenatal DHA.
The studies demonstrating the greatest efficacy have used doses in the range of 1–2 g/day of fish oil. One study found that Mexican women that supplemented with 400mg of the omega fatty acid DHA delivered babies who weighed more and had larger head circumferences.
The lowest concentrations of DHA were found in North America and Canadian breast milk. Levels of DHA averaged only 0.17% of total fatty acids in contrast to the highest levels found in Japan where DHA represented 0.99% of the total milk fatty acids.
I believe fish oil should be supplemented separately if adequate DHA is not obtained in the prenatal.
Data from the National Health and Nutrition Examination Survey suggest that more than half of pregnant women have urinary iodine concentrations below 150 mg/dL. Inadequate iodine intakes during pregnancy result in fetal loss, stillbirths, cretinism, and mental retardation of the newborn infant.
As of 2015, The US Council for Responsible Nutrition’s new guidelines calls for all dietary supplement manufacturers and marketers to begin including at least 150mcg of iodine in all daily multivitamin/mineral supplements intended for pregnant and lactating women in the United States. The optimal dose may be 200-300mcg. If you have suffered from hypothyroidism, this makes sufficient iodine along with selenium, zinc, vitamin C, vitamin A and vitamin D that much more important.
A study in 2009 found that 51% of US prenatal multivitamin brands did not contain any iodine and, in a number of randomly selected brands, the actual dose of iodine contained in the supplements did not match the values on the label.
A study from JAMA in 2018 found that low iodine levels may impair fertility. Compared with women with normal iodine levels or mild iodine deficiency, women with iodine-creatine ratios lower than 50 μg/g had a 46% lower chance of becoming pregnant in any menstrual cycle.
Fluoridated water displaces iodine, creating a higher need for this crucial mineral and filtering fluoride.
Selenium (60-70mcg, 200mcg for infertility)
Selenium is a primary mineral needed by glutathione, our master antioxidant system. It also blocks the uptake of mercury and plays a significant role in the reproductive system. Selenium deficiencies may lead to gestational complications, miscarriages and the damaging of the nervous and immune systems of the fetus.
As you will see in the study below, 200mcg of selenium was used along with magnesium to resolve infertility. Selenium has also been found to resolve infertility in men.
Magnesium plays a special role in regulating blood sugar, preventing muscle spasms, increasing energy, preventing preterm contractions and fertility.
In one study, six women with a history of unexplained infertility or early miscarriage and who had failed to normalize their red cell magnesium (RBC-Mg) levels after four months of oral magnesium supplementation (600 mg/day) were investigated for red cell glutathione peroxidase activity.
They were compared with six age-matched women with a history of unexplained infertility or miscarriage who did normalize their RBC-Mg levels on magnesium supplementation. The six non-normalizers had significantly lower glutathione levels than the six normalizers.
After a further two months of 200 micrograms daily oral selenium as selenomethionine and oral magnesium supplements, all six women normalized their magnesium and RBC-selenium levels. All 12 previously infertile women have produced normal healthy babies all conceiving within eight months of normalizing their RBC-Magnesium levels.
During pregnancy, a woman’s body provides daily doses between 50 and 330 mg to support the developing fetal skeleton. A recommendation in the US and Europe has continually been 1,000mg, while the average intake is 800mg in young women. Vegetables high in calcium, calcium-rich Gerolsteiner mineral water), and dairy can reach your daily calcium targets. Since calcium blocks lead uptake, getting adequate calcium is crucial.
Calcium absorption and utilization are tightly regulated. For example, many foods that contain oxalic acid bind to calcium; often found in foods that contain calcium. Too much calcium affects the absorption of magnesium, while higher amounts of magnesium increase the absorption of calcium. Calcium deficiency is rare in pregnancy but appears in cases of hypoparathyroidism, severe dietary inadequacy and in individuals who are unable to eat foods high in calcium.
Calcium needs go up in the third trimester and during labor. For this reason, I recommend Gerolsteiner Mineral Water (let it go flat) as an electrolyte drink during labor.
Worst Prenatal Vitamins
The search for the best prenatal vitamin is not an easy feat. Especially since the FDA tested 324 multivitamin-multimineral products that targeted pregnant women or small children for the presence of lead, and found that only 4 of them, or 1% tested lead-free. A 2018 study found that out of twenty six common prenatal vitamins in Canada, multiple samples exceeded established standards for lead toxicity with one sample yielding very high levels. Three samples registered inorganic arsenic levels above acceptable limits and toxic elements such as aluminum, nickel, titanium and thallium were detected in all samples.
It is important to note that the air, water, and soil contain lead and it is in our food. What you want to look for are very low levels when multivitamins use whole foods. The safe upper limit for lead according to the FDA is 25mcg per day for pregnant women, but I think this amount should be much lower.
Lead is of particular concern during pregnancy because it causes fetal brain damage, limited IQ, and can lead to behavioral and learning disabilities in young children. Research has also found that lead exposure has a multigenerational effect all the way down to your grandchildren. Then add in food dyes, poor forms of vitamins and toxic additives, and it is no wonder it is so hard to find a good prenatal vitamin.
There is an argument that lead is present in the soil and therefore is naturally higher in supplements that contain whole foods. While this may be true, I have seen companies able to source whole food ingredients with much lower lead levels than competitors. Seek out these companies.
Calcium blocks lead uptake while vitamin C lowers blood levels of lead. Calcium is often absent in multivitamins and vitamin C is often too low or whole food based, which has a very short half-life. These are both important to keep lead levels low.
1. One A Day Women’s Prenatal
A very common recommendation. One of the first things you will see is a list of food dyes: Red 40 Dye, Red 40 Lake, Yellow 6 Lake, and DL-Alpha-tocopheryl Acetate – the synthetic form of vitamin E that is continually problematic in studies.
What is wrong with food dyes? These food dyes have been found to inhibit mitochondrial respiration; the powerhouse of your cell that houses maternal DNA and I talked about in detail under the B12 section. Red 3 causes cancer in animals, with evidence that other dyes also are carcinogenic. Three dyes (Red 40, Yellow 5, and Yellow 6) have been found to be contaminated with benzidine or other carcinogens. At least four dyes (Blue 1, Red 40, Yellow 5, and Yellow 6) cause hypersensitivity reactions and numerous studies found Yellow 5 positive for genotoxicity.
An advisory panel to the Food and Drug Administration recently acknowledged that synthetic food dyes can exacerbate the conditions associated with ADHD and other behavioral problems. While the consumption of synthetic food dyes has increased five-fold since 1955, the number of children diagnosed with ADHD increased from 150,000 in 1970 to 5.4 million by 2007.
A 2007 study in Lancet found such a strong correlation to synthetic food dyes and hyperactive behaviors in children, that they contacted the British government concluding that the harm done by artificial food dyes to children’s IQ was similar to the impact of lead on their developing brains and that banning these additives would result in a 30 percent reduction in the prevalence of ADHD in children.
2. Centrum Specialist Prenatal Complete Multivitamin Supplement
Centrum made my worst list for Best and Worst Multivitamins, and their formulation for a prenatal is also as disappointing. Aside from having the wrong forms of folate and B12, you will also find corn starch, synthetic vitamin E, and polyethylene glycol – essentially plastic and the main ingredient in Miralax, not FDA approved for children. Some families have reported concerns to the FDA that some neurologic or behavioral symptoms in children may be related to it.
Other ingredients include polyvinyl alcohol (synthetic polymer), sodium benzoate (when combined with vitamin C as found in this formula you create benzene, a known carcinogen), sodium selenate (a form of selenium considered to be highly toxic and induce DNA damage) and sucrose.
3. Vitafusion Prenatal
This formula uses folate as folic acid, B12 as cyanocobalamin, is missing iron, B1, B2, vitamin K and numerous minerals like selenium, iodine, copper, manganese, and boron. It uses a very small amount of EPA (50mg) and DHA (15mg) that isn’t nearly close to enough for a pregnant woman.
It also has glucose syrup, sucrose, and natural flavors, which should always be confirmed to be MSG free. Quite honestly, this should not be allowed to be marketed as a prenatal vitamin.
4. Rainbow Light Prenatal One Multivitamin
This is also a very popular prenatal multivitamin. It contains only 400IU of vitamin D2, which is too low and not as effective as D3, folate as folic acid, B12 as cyanocobalamin and magnesium in the oxide form (only 4% is absorbed).
Based on reviews on Amazon, there also appears to be some serious issues with quality control since three different reviewers all found black substances on the pills.
5. NatureMade PrenatalMulti
This uses 400IU of vitamin D, folate as folic acid, B12 as cyanocobalamin, a poor form of zinc, is missing copper, selenium, iodine, manganese, boron and choline.
Best Prenatal Vitamins
Remember that your prenatal will also require a separate DHA fish oil product. There was a California Proposition 65 lawsuit against CVS Pharmacy, GNC, NOW Health Group, Omega Protein, Pharmavite (Nature Made brand), Rite Aid Corp., Solgar, and Twinlab Corp for selling fish oil laced with PCB’s, which are one of the most dangerous environmental pollutants. PCB’s are strongly tied to cancer and multiple birth defects. You want to choose your fish oil wisely.
I recommend Nordic Naturals Prenatal DHA or the Nordic Naturals Vegan Prenatal DHA for vegans and vegetarians. If you would prefer to use cod liver oil or wild salmon oil for more vitamin A, I recommend Virgin Cod Liver Oil or Polar Power. In many cases, you also need more vitamin D (check your levels), choline (pastured eggs are your new best friend), calcium, magnesium or iron (I recommend Iron Bisglycinate by Thorne Research).
If you are looking for extra calcium and magnesium supplementation, I recommend Pure Encapsulations Cal/Mag 2:1.
Just like plant-based protein powders, you are going to have a wide range of opinions regarding digestion of prenatal vitamins for the same reason one person craves one food that repels another.
Remember to take your prenatal with food so that you absorb the carotenoids and fat-soluble vitamins A, D, E and K.
Cost: $39.95 for 30 servings
Serving: 4 capsules daily
This intelligent prenatal formula was just released by an impressive team with a background in biochemistry and genetics and has taken the #1 spot. Like Naturelo, this company reached out to me for any improvements that could be made. I am excited that women now have access to a product of this quality that supports maternal and fetal health that was also designed with all of the new FDA requirements.
You can review their 2020 certificate of analysis (COA) here.
This prenatal will provide you with a tremendous foundation. Some of the highlights include:
VitaminIQ provides 350mg choline from sunflower and 200mg TMG (that acts as a secondary methyl donor in the same pathway) for a total of 550mg choline + TMG.
50/50 Blend of carotenoids and vitamin A palmitate. The vitamin A addition is very helpful for those that are not getting enough in their diet and have a poor conversion of beta-carotene to vitamin A as seen in the Nutrition Genome Report.
Sulforaphane from broccoli sprouts – oxidative stress protection, blood sugar balance, brain development, protection from toxins.
50mcg (2000IU’s) of vitamin D3 from black olives.
Correct doses and forms of all B vitamins – too high of a dose of B vitamins and wrong form can make pregnant women feel anxious and nauseous.
Chelated minerals for easier digestion and assimilation including 400mg calcium from red algae.
300mg iodine from Icelandic Kelp – this was another big change for 2018 FDA DV% that almost doubled.
400mg of calcium from red algae and aquamin
175mg magnesium malate, my favorite form of magnesium.
70mcg selenium (selenomethione, the best form)
15mg zinc bisglycinate
Capsules can be opened and added to smoothie, drink or food. It is GMO-free, vegan, yeast free, soy free, gluten free and has zero fillers, artificial ingredients or harmful additives.
Formulation Improvement and/or Additional Nutrition Needed
- You may need more vitamin D (if tested low)
- You may need more iron based on blood work
- You will need DHA supplementation
Cost: $39.95 for 60 servings
Serving: 3 capsules daily
This prenatal product launched on January 4th, 2017, and has been updated in 2018 and 2019. Naturelo has reached out to me to review their formula and offer any improvements. While their initial formula was excellent, they have been very responsive to feedback and making changes as needed.
The FDA recently made dramatic changes in 2018 to the DV% and certain measurements. This article reflects the latest updates to the Naturelo Prenatal formula in 2019. Naturelo is also available to be shipped to the UK and is GMO-free, yeast free, soy free, gluten free and has zero artificial ingredients or harmful additives. Click here to view their latest 2020 certificate of authenticity (COA) lab results.
Natural full spectrum carotenoids
19mg of natural vitamin E
90mcg of Vitamin K2 MK-7, the form less consumed in the diet
3.4mg of B6 as P-5-P
800mcg of methylfolate
4.8mcg of methylcobalamin (B12)
Correct amounts of all the other B-vitamins
210mg of magnesium citrate and 295mg of calcium
13mg of zinc amino acid chelate
27mg of iron
290mcg of iodine
70mcg of selenium
100mg of choline
100mg of DHA from algae
Formulation Improvement and/or Additional Nutrition Needed
- You may require more vitamin D (check your levels early even before conception)
- You may require more dietary calcium
- You require more DHA from fish oil
- You may require more dietary choline
Cost: $51.27 for 60 servings
Serving: 2 tablets daily
This product follows many of The Health Beat guidelines with high-quality whole food based ingredients in the right form. It has been tested to be exceedingly low in heavy metals, no harmful additives and is pesticide and herbicide free. The formula uses a combination of whole foods, synthesized nutrients like methylcobalamin and choline, and brewers yeast. Brewers yeast is used to make bread and beer and is naturally high in B-vitamins, chromium, and selenium.
There is another version of the “Baby and Me” formula, but this one is superior.
300mg of choline, rare to find in a prenatal
600mcg of methylfolate from broccoli
10mcg of methylcobalamin
8mg of B6 as P-5-P
30IU of natural vitamin E in the mixed tocopherol form
18mg of iron
150mcg of iodine
15mg of zinc chelate
50mcg of selenium
Formulation Improvement and/or Additional Nutrition Needed
- It contains 600IU of vitamin D and you may need 2,000IU to 4,000IU
- Does not contain any magnesium or calcium, however, most prenatal’s will not provide nearly what you need for both
- You may need more iron
- You will need DHA supplementation
Cost: $20.85 for 30 servings
Serving: 2 capsules daily
What I like about this one:
27mg of iron
800IU of vitamin D
800mcg of methylfolate
10mcg of methylcobalamin
150mcg of iodine
75mcg of selenium
10mg zinc citrate
1mg copper glycinate chelate, not cupric oxide
Formulation Improvement and Additional Nutrition Needed
- Vitamin D: You may need 2,000-4,000IU of vitamin D
- A low dose of B6 in the suboptimal form: Should be P-5-P instead of pyridoxine HCL in a higher amount. This is my major criticism of this product, and I have let the company know.
- Vitamin E: Should include mixed tocopherols and ideally tocotrienols in the 20-30mg range
- 15mg of zinc citrate would be preferable
- Missing vitamin K, choline and DHA
Serving: 30 servings of powder
This formula is designed for those who can’t or do not tolerate swallowing pills. It is also a stronger formula that I have only recommended for those who have had trouble getting pregnant, keeping a pregnancy, certain food allergies and their Nutrition Genome Report has shown multiple genes and health issues requiring higher amounts of specific vitamins and minerals. Choose the chocolate version that I have listed here. After reviewing the Certificate of Analysis of each powder, the vanilla version – while technically still in the safe range – has a higher level of arsenic.
This formula does not contain copper and has very little iron. This may be a good thing if you have elevated copper levels and your iron intake and levels are optimal.
Here is a summary of some of the dosages:
2,000IU of vitamin D
200IU of vitamin E
5,000IU of both beta-carotene and retinyl palmitate (if you do not eat eggs, dairy or use cod liver oil, this form of vitamin A is necessary)
20mg of B6 as P-5-P and pyridoxine hydrochloride
800mcg of methylfolate
150mcg of methylcobalamin and adenosylcobalamin
475mg of calcium malate
250mg of magnesium malate
250mcg of iodine from Icelandic kelp
20mg of zinc bisglycinate
250mg of choline
There are also compounds that are added for digestion (L-carnitine, Betain HCI, ginger root), detoxification (milk thistle) and provides 15mg of pea protein.
Cost: $24.61 for 30 servings
Serving: 3 capsules daily
Thorne recently updated their prenatal formula is a stronger formulation for those who may have absorption issues. Thorne also updated all their minerals to bisglycinate chelates, which are more stable and have a higher absorption rate. It uses 45mg of iron bisglycinate and 25mg of zinc bisglycinate for those who want a prenatal that addresses low dietary iron or iron levels and zinc intake.
You should be aware that there are some high levels of vitamins like B12, and therefore may only be best for those with absorption issues. While the formula is mostly well designed, some have reported that it makes them nauseous.
Formulation Improvement and/or Additional Nutrition Needed
- Does not contain the mixed tocopherols for vitamin E
- Contains 1,000IU of vitamin D, but you may need more depending on your current level
- Contains low levels of magnesium and calcium
- Does not contain vitamin K2, only K1
- You will need additional DHA and choline
Other Articles of Interest