How to Pick Out a Prenatal
Medically reviewed by Jaime Seeman, MD, board certified OB/GYN
Before we dive into the details let’s start with the question:
What is a prenatal supplement?
The nutrients needed to prepare and supply a woman’s body with nutrients to adequately develop the placenta, baby and mom throughout pregnancy.
It is important to note that there are no nutrient minimums set by the FDA in a prenatal. Many companies market skeleton formulas as “prenatals” that are missing vital nutrients and/or contain suboptimal dosing of key pregnancy nutrients.
A prenatal is your 401k for your child’s future. You are optimizing the life of your future child. Setting up proper gene expression, cell health, tissue and organ development and more. The nutrient status a woman has before and during pregnancy impacts the long term health of the child .
Why a prenatal?
Diet is Not Enough
Your nutrient needs are higher during pregnancy . No matter how healthy your diet is, it's important to have a nutritional insurance policy with a prenatal supplement. This is especially key for early pregnancy when the neural tube develops and closes before most women know they are pregnant. It also helps ensure the baby gets adequate nutrients despite any appetite suppression that may occur with morning sickness.
Reduce Risk of Birth Defects
One of the most crucial reasons for taking a quality prenatal supplement is to reduce the risk of birth defects such as neural tube defects and congenital heart defects. The American College of Obstetrics and Gynecology (ACOG) recommends supplementing with folate at least one month before planned pregnancy to help prevent major birth defects. 
Reduce Autism Diagnosis
Several studies, including a 2019 Journal of the American Medical Association, have shown that women taking a quality prenatal with the correct forms of folate and other key nutrients are less likely to have a child diagnosed with autism spectrum disorder. 
Reduce Risk of Preterm Birth
Preterm birth is defined as a baby being born before 37 weeks gestation. Women taking a prenatal during pregnancy have been shown to have a lower risk of preterm labor. 
A quality prenatal is a vital aspect of a healthy pregnancy
What should I look for in a Prenatal?
1. Vitamins and Minerals Included
- ALL 8 B vitamins
- Key Minerals - iron, calcium, magnesium, zinc, selenium, copper, chromium, molybdenum
- High dose of choline
- Vitamins A, D, E, K
2. Nutrient Forms and Doses
- Bioavailable forms – methylated B vitamins, chelated minerals
- Dose – more is not always better. Dose should always match the unique need for pregnancy. A good prenatal should be formulated to provide adequate nutrients levels but not overdo it. For example, a recent study showed that too much vitamin B6 can increase risk for hip fracture and heart disease and may lower prolactin levels . Biotin recommendations were lowered from 300mcg to 30mcg due to evidence of too much biotin causing DNA damage.
3. Other Ingredients
- Below the Supplement Facts you will see “other ingredients”
- Chemical additives, preservatives, food dyes and fillers can have a negative impact on nutrient absorption and your health. Find a product free of these synthetic ingredients.
- Just because a prenatal contains the right dose and form of nutrients doesn’t mean you will absorb it. The delivery of the nutrients is crucial.
- Tablets are made by taking raw materials and pounding it together under heat and pressure. It is a more concentrated form but tends to pass through the GI tract very poorly absorbed.
- Gummies are nice but do not always provide a stable form of nutrient delivery and very rarely contain all of the needed nutrients.
- Capsules are preferable due to easy breakdown of capsule and release of nutrients in the stomach. Capsules can also be opened and added to juice, smoothie, oatmeal or other food when swallowing a capsule is not tolerated.
6 Key Prenatal Nutrients
1. Folate (vitamin B9)
This is one of the most important pregnancy nutrients. It is used in very early pregnancy for the development of the neural tube that develops into the baby’s spinal cord, spine, brain and skull.  Folate is used for DNA production, cellular growth and development of the baby throughout pregnancy. Folate plays an important role in red blood cell health and helps prevent anemia of women during pregnancy. Mothers supplemented with folate had decreased risk of postpartum depression.  
NOT ALL FORMS OF FOLATE ARE CREATED EQUALLY.
Folate is an umbrella term for several forms of vitamin B9.
Folic acid = synthetic, oxidized version of vitamin B9
Methylfolate = biologically active form of folate used by body
Up to 50% of the population have mutations called SNPs in the enzymes (DHFR, MTHFD1 and MTHFR) that regulate the conversion of folic acid to methylfolate. Changes in these genes can slow conversion, making supplementing with active folate even more important. On top of that, folic acid has been shown to block cellular receptors for active folate entering cells.
The bottom line
Folic acid is a no- no.
Make sure your prenatal contains 600-800 micrograms of methyfolate (sometimes listed as 5-methyltetradhyrofolate or 5-MTHF)
Methylfolate is much more expensive to use in a formula. Cheap prenatals typically use folic acid to cut corners.
And remember folate is found in food too!
Food sources of folate: dark leafy greens (spinach, Swiss chard, kale), Brussel sprouts, broccoli, strawberries, legumes and lentils
This was the biggest change to prenatal nutrient recommendations in 2018. Choline recommendations are now 450mg daily and 3rd trimester needs climb to 800mg daily.
Choline has been ranked at the same level of importance as folate for prevention of neural tube defects and proper brain development.   Choline is a B-vitamin derivative used in many methylation pathways for brain health, liver/gallbladder health and cell membrane integrity. For more info on choline check out Vitamin IQ’s Mommy Brain article.
90-95% pregnant women are deficient in choline! 
When looking for a prenatal, it is important to select one with a large amount of choline. DOSE IS IMPORTANT! One of the top selling prenatals has choline but has 12mg. This is an example of a marketing technique but grossly inadequate dosing for optimal health.
Trimethylglycine (TMG) is a substance that is used in the same methylation pathway as choline that functions in a similar manner and may be seen in prenatal formulas. A mix of choline and TMG is a perfect way to meet the need for methyl groups in pregnancy.
Food sources of choline: egg (YOLKS!), chicken leg, liver, Brussel sprouts, mushrooms
3. Bone Nutrients
Pregnancy involves developing a new skeleton! It is important to get all nutrients needed for bone development – calcium, magnesium, vitamin D3 and vitamin K2. Vitamin D3 and K2 direct calcium where to go in the body. We want calcium in our body and teeth but not in our vascular system. Calcium also protects the developing baby from lead exposure. Calcium is very bulky and hard to get 100% daily value in a supplement so it's important to also incorporate calcium-rich foods in your diet as well.
Food sources of bone nutrients: dairy especially cultured dairy (calcium + K2), almonds, broccoli, salmon, mushrooms.
4. Methylation Nutrients
Methylation is a process in the body that produces methyl groups (CH3) which is a simple yet profound molecule. It’s like the central circle of a spider web that connects many vital biochemical reactions. These pathways are extremely active in pregnancy to support the development of a new life and it is crucial to have adequate amounts of these key nutrients in the active forms.
Key methylation nutrients
- Folate (methylfolate)
- B12 (methylcobalamin)
- B6 (pyrodoxial-5-phosphate)
- B2 (riboflavin-5-phosphate)
- Zinc (chelated)
- Magnesium (chelated)
Blood volume increases by 50% in pregnancy! This increase in blood volume increases the need for iron to make more red blood cells that contain oxygen-transporting hemoglobin. Adequate iron stores ensure adequate oxygen delivery to the developing fetus, placenta and mother. Iron needs increase significantly in the 2nd half of pregnancy so beginning to supplement iron before and in the early stages of pregnancy is a great strategy.
Supplementing with a gentle, chelated form of iron such as iron bisglycinate can help to alleviate some of the side effects women experience with iron supplementation such as nausea and constipation.
It is also important to focus on iron-rich foods (heme and non-heme sources) in your diet such as:
- Red meat
- Fortified cereals and grains
6. Vitamin A
This nutrient is highly misunderstood and google searches contain inaccurate information from outdated studies decades ago. So let’s breakdown the facts.
Vitamin A has 2 forms
1. Beta Carotene
This is technically a precursor to vitamin A that must be converted into the active form of vitamin A. This is found in plant foods such as carrots, peppers, butternut squash and sweet potatoes.
Beta-carotene must be CONVERTED to the active form of vitamin A that is regulated by the gene BCMO1 (the enzyme is also called BCMO1).
Have you heard the term “carrots are good for your eyes?” Well only if this enzyme works well! The rods in the retina of the eye require vitamin A in the trans-retinol form for night vision. Many women have decreased function of this enzyme and require more retinol forms of vitamin A from their diet or supplementation.
2. Retinal/Retinoic acid
This is the fat-soluble, active form of vitamin A that plays a crucial role in:
- Fetal eye development
- Iron transport and metabolism
- Immune system function
- DNA production
- Lung health
- Night vision
This preformed vitamin A is found in pastured dairy products, liver, fish oils like cod liver oil and HUMAN MILK! That’s right, your breast milk contains preformed vitamin A for your baby’s development and wellbeing. 
More recent studies have shown that responsible dosing (not to exceed 10,000IU’s daily) with preformed, active vitamin A to:
- Women supplemented before, during and after pregnancy. Child’s pulmonary function improved in preformed vitamin A supplementation but NOT beta-carotene. 
- Women supplemented with preformed vitamin A in pregnancy and postnatal periods was associated with improved school performance and child’s executive functions. 
- In Denmark, 25% increase in vitamin A intake in pregnant women was associated with a decreased risk in of type 2 diabetes in offspring. 
The bottom line.
Vitamin A is a bell shaped curve. Too little of this crucial nutrient can lead to many health issues and too much (above 3,000mcg RE daily or 10,000IU in pregnancy) could be problematic.
VitaminIQ’s prenatal contains 50% beta-carotene (650mcg) and 50% preformed vitamin A palmitate (650mcg RE) to ensure adequate vitamin A levels for mom and baby.
Meeting Your Unique Nutrient Needs
You should feel empowered with information regarding why a prenatal is crucial, how to pick out a quality product and the roles of key nutrients for a healthy pregnancy.
VitaminIQ’s prenatal was intelligently formulated with you and your baby in mind. If you have any questions, please reach out to our expert team and we will be happy to answer your questions. info@vitaminIQ.com
To your best health,
The VitaminIQ Team
- Checkley W., West K.P., Jr., Wise R.A., Baldwin M.R., Wu L., LeClerq S.C., Christian P., Katz J., Tielsch J.M., Khatry S., et al. Maternal vitamin A supplementation and lung function in offspring. N. Engl. J. Med. 2010;362:1784–1794. doi: 10.1056/NEJMoa0907441.
* This article was medically reviewed by Dr. Jaime Seeman, MD, board-certified OB/GYN. This article does not serve as personal medical advice and we recommend that you talk with your doctor when making decisions about your health.