Do You Need a Prenatal?
Prenatal supplement?
Ideally, your diet should provide all the nutrients you need...in a perfect world. Although it’s best to get the majority of your nutrients from whole food sources, a good quality supplement may help fill in the gaps. Think of the name literally, the purpose of “supplements” are to supplement a balanced, nutrient dense diet.
There are tons of supplements readily available at most stores, the problem is not all supplements are created equally. For example, the FDA is not authorized to review dietary supplements if the supplement does not include a new ingredient not sold in the US prior to 1994. This means that most supplements do not need prior approval to be sold in the US. This leads to false claims, such as saying the product contains a nutrient in certain amounts when it does not.
Third Party Testing
Supplement manufacturers can have their products tested by 3rd party testing companies. Third party just means the testing company has no stake in the supplement company, so testing results are truthful and more accurate. On the other hand, if a supplement company conducts their own testing, they may misrepresent the results for better sales. Third party testing helps to ensure you are getting what you paid for. A few third party companies to look for include: USP (U.S. Pharmacopeia), NSF International, UL, and Consumer Labs.
Where to buy?
Vitamins and minerals are often heat/light/humidity sensitive. Buying supplements online from warehouse stores may be convenient, but it does not ensure you are getting the original quality. Instead, try to buy supplements from retailers that specialize in these products - where supplements are stored in temperature and humidity controlled environments.
Choosing supplements
Supplement needs are very individual. Your overall diet, the quality of your foods, medications you take and how well your body absorbs nutrients all play a role. For this reason, I have difficulty suggesting one prenatal vitamin that essentially meets all needs during pregnancy for every pregnant person. What I can say is that you do not need to spend your life savings on supplements, but the cheapest pill is not always the best choice. Also, a one a day pill may not provide enough nutrients needed to supplement your diet during pregnancy. Review the form of the vitamins, the amount, the source (if listed) and third party testing.
Absorption
For best absorption, take your prenatal with meals or food. Also, your body can only absorb so much of a certain nutrient at once. If your prenatal contains multiple pills for one dose, take them throughout the day, instead of all at once.
Form
Another issue is the bioavailability of the supplement, meaning how well your body will absorb and use the nutrient. Many supplement companies use the most inexpensive form of the nutrient, which is not always absorbed well in the body.
Look for activated forms of B vitamins. Due to genetic variations, some people cannot utilize certain forms of vitamins. The active form is more bioidentical (look/act similar) to those found in food, making them more bioavailable or easier to absorb and use.
Folate There is natural folate found in food and folic acid which is synthetic or man-made. It is best to look for active forms of folate (which are closer to the natural form), such as folinic acid (also seen as calcium folinate) or L-methylfolate (also seen as L-5-MTHF or L-5-methyltetrahydrofolate or 6(S)-L-methyltetrahydrofolate).
B12 Look for methylcobalamin or adenosylcobalamin. Try to avoid cyanocobalamin.
B6 Look for pyridoxal-5 phosphate.
Vitamin A Most prenatals contain vitamin A in provitamin form, seen as beta carotene. Provitamin A is beneficial to the body, but it is not as efficiently converted to the active form of vitamin A in the body. The active form is preformed vitamin A or retinol (seen as retinyl palmitate). Look for a prenatal that contains some preformed vitamin A. However, more is not better in this case. In large doses, over 10,000 international units, preformed Vitamin A is dangerous during pregnancy.
Vitamin D Look for vitamin D3 or cholecalciferol.
Omega-3 Look for DHA (Docosahexaenoic acid)
Look for a prenatal with calcium OR iron. These nutrients compete with each other for absorption and should not be taken together.
Other nutrients to look for include: iodine, choline, magnesium, selenium and zinc
Remember, your body understands and can utilize nutrients from food way better than supplements. Focus on a nutrient dense diet along with taking a prenatal.
References
Center for Food Safety and Applied Nutrition. Questions and Answers on Dietary Supplements. U.S. Food and Drug Administration. https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements. Published 2019. Accessed October 31, 2020.
Paul C, Brady DM. Comparative Bioavailability and Utilization of Particular Forms of B12 Supplements With Potential to Mitigate B12-related Genetic Polymorphisms. Integr Med (Encinitas). 2017;16(1):42-49.
Greenberg JA, Bell SJ, Guan Y, Yu YH. Folic Acid supplementation and pregnancy: more than just neural tube defect prevention. Rev Obstet Gynecol. 2011;4(2):52-59.
Lamers, Y., Prinz-Langenohl, R., Brämswig, S., & Pietrzik, K. (2006). Red blood cell folate concentrations increase more after supplementation with [6 S]-5-methyltetrahydrofolate than with folic acid in women of childbearing age. The American Journal of Clinical Nutrition, 84(1), 156-161. doi:10.1093/ajcn/84.1.156
Cooperman T. Heat's Impact on Vitamins & Supplements. https://www.consumerlab.com/answers/do-supplements-lose-effectiveness-in-the-heat/vitamin-temperature/. Published June 12, 2019. Accessed October 31, 2020.