What to Look for in Prenatal Vitamins

From gummy chews to fish oil capsules, there are a dizzying number of choices when it comes to prenatal vitamins and supplements. To the rescue: our guide to picking the right prenatal pill, so you and your baby get the nutrients you need.

pregnant woman taking prenatal vitamin wong sze yuen/ Shutterstock

You're pregnant (congrats!) and if you aren't already, it's time to start paying serious attention to nutrition. For most women, that means taking a daily prenatal vitamin. But with tons of over-the-counter and prescription options to choose from, how does an overwhelmed mom-to-be know what to take? Read on for our guide to choosing -- and choking down -- a good prenatal vitamin.

What to look for

Prenatal vitamins often have a mile-long ingredient list that seems to include the whole alphabet of vitamins, but you should look for the right amounts of a few key nutrients.

Folic Acid
Perhaps the most important ingredient in a prenatal vitamin is folic acid, a vitamin that can help prevent birth defects of the brain and spine (called neural tube defects). The March of Dimes recommends that all women of childbearing age get 400 micrograms of folic acid daily; increase that amount to 600 micrograms of folic acid daily once you become pregnant. Many prenatal vitamins include more, which is fine, says Julie Levitt, M.D., an ob-gyn at Women's Group of Northwestern in Chicago. So even if you're already shoveling down kale salads chased by fortified OJ, make sure your prenatal vitamin contains the recommended amount of folic acid -- the nutrient has been shown to have a big impact.

You'll need twice as much of this mineral, now that you're pregnant, to make extra blood to take care of your baby. Pregnant women should get 27 milligrams of iron each day.

This mineral is vital for the development of your baby's bones, teeth, heart, muscles and nerves, and mamas-to-be should get 1,000 milligrams daily. Calcium is found in foods like dairy and dark leafy greens, but you should also look for it in your prenatal vitamin. Most prenatal vitamins contain only between 150 and 300 milligrams of calcium, so if you don't get much in your diet (if you're vegan, for instance, or lactose intolerant) consider taking an additional supplement. You'll want to down it at a different time of day than your prenatal vitamin, as large amounts of calcium can't be absorbed along with the iron in your prenatal vitamin, says Dr. Levitt.

Another reason to make getting enough calcium a priority? Skimping now could increase your risk of osteoporosis later in life. "What the fetus doesn't get through the diet, the fetus will take out of mom's bones," says Scott Sullivan, M.D., the director of maternal-fetal medicine at Medical University of South Carolina. "A supplement protects mom from being the calcium reservoir."

Vitamin D
This vitamin helps you absorb calcium and is important for your baby's bones, teeth, eyes and skin. March of Dimes suggests getting 600 IU (international units) of vitamin D a day during pregnancy, and many doctors recommend even more -- 800 or 1,000 IU -- because many people are deficient.

During pregnancy you need 220 micrograms of iodine every day to help your baby's brain and nervous system, according to March of Dimes. Dr. Sullivan recommends that your prenatal has at least 150 micrograms (foods like fish and dairy can make up the rest) and that it comes from potassium iodide, as iodine from kelp can break down before you get a chance to take it.

If I take my prenatal vitamin, am I good to go, nutrition-wise?

A prenatal vitamin provides a good nutritional foundation (especially for those early days or weeks when all you can stomach is crackers) but your diet definitely still matters. Eating fish is a prime example: Experts recommend eating two servings of low-mercury fish (think salmon, herring, freshwater trout and anchovies) a week to get the benefit of DHA, an omega-3 fatty acid that helps your baby's brain grow.

"Moms who get a lot of DHA and omega-3s in their diet have better pregnancy outcomes -- longer pregnancies, better weight, higher performance on milestones and development -- but there's been no evidence that taking these things as a pill recreates the same thing," says Dr. Sullivan. "It seems more dietary sources are important."

That said, DHA is included in many prenatal vitamins these days, too, so even the seafood-averse can get the daily 200 milligrams of DHA March of Dimes recommends.

    What types are best? Should I take a prescription vitamin?

    These days, prenatal vitamins come in all forms: tablets, capsules, gummies, chewables -- even powder and liquid options. Pay special attention to labels if you're taking an alternative formula, as it may be lower in iron, iodine, or DHA.

    "In general, gummies and chewables have less than the traditional pill because of what they're able to put in the formulation," says Dr. Sullivan.

    Prescription vitamins' formulas vary, and most women don't need one. "The only real difference is the amount of folic acid," says Dr. Levitt. "If you want to take a milligram or more of folic acid in one single tablet, it has to be [in a] prescription vitamin." You might need one if you're carrying multiples or have a history of neural tube defects in the family.

      What if I can't stomach it?

      It's a cruel irony that the time when many women can't keep anything down (early pregnancy morning sickness, anyone?) is a crucial period to get key nutrients via sometimes bulky and sometimes smelly pills. If you have a hard time swallowing your vitamin, try cutting it in two and taking half in the morning and half at night, or taking it with something slippery that you can stomach, like applesauce. Or try another brand -- vitamins vary in size, smell, and taste, and one brand might go down easier than another.

      "I always tell patients 'Buy a small quantity. Try them. See how you feel. Make sure you're not burping up fish and it's not killing your day, and then continue,'" says Dr. Levitt.

        Can I get too much supplementation?

        Even if you're managing a laudably healthy diet in addition to taking a solid prenatal vitamin, you shouldn't worry that you'll get too much of a good thing.

        "There's not much risk in over-supplementing, per se, because a lot of these are fat-soluble vitamins, so they just go into your stores; they don't poison the baby," says Dr. Levitt.

        But (and this is a big but) there are a few vitamins that you definitely don't want to overdo it on -- chiefly vitamin A, which can cause birth defects in high levels. Skip anything that lists more than 100 percent of the recommended dietary allowance of vitamin A on the back of the bottle, says Dr. Levitt.

        Most women won't get near a toxic amount, but watch out for other supplements or herbal remedies, which could contain vitamins that aren't listed under a name you'd recognize, says Dr. Sullivan.

        When in doubt, ask your doctor about your prenatal vitamin and any other supplements you're taking. You'll want a vitamin you're comfortable with, since you shouldn't necessarily drop the pill after delivery. Most doctors recommend taking a prenatal vitamin as long as you're breastfeeding, or even longer if you plan to have another baby soon -- now, that's an overwhelming choice that makes picking a vitamin seem like a breeze.

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