Choosing Your Perfect Prenatal Multivitamin
As you begin your preconception journey, it's important to start taking a prenatal multivitamin. Here's the thing - there are SO many to choose from. You've got your pick at your pharmacy, at health food stores, and online - and some of them with the most beautiful branding.
Choosing your perfect prenatal can be difficult, and oftentimes people will simply choose the cheapest option, or one recommended by a friend. When it comes to a supplement that you'll likely be taking until you stop chest/breastfeeding - you want to ensure you're taking something that has quality ingredients and sufficient dosages.
Forms of Vitamins and Minerals
Active vs. Inactive
The B vitamins in many prenatals are in their inactive forms. While they can be converted to the active form, it can be difficult for some people. Moreover, active B vitamins are often better absorbed and therefore better utilized by the body.
Look for these ingredients:
Vitamin B2 – choose riboflavin-5-phosphate
Vitamin B6 – choose pyridoxal-5-phosphate
Folic acid – choose methylfolate (more below)
Vitamin B12 – choose methylcobalamin
Folate vs. Folic Acid
As you probably know, one of the most important vitamins to take during preconception is folate. This important B vitamin is needed for neural tube defects. In addition, studies have shown that taking folate in the preconception period may increase chances of becoming pregnant and hopefully result in a live birth.
Methylfolate is the active form of folic acid, and while it does the same thing as folic acid, the active form may be better absorbed and used. When choosing a prenatal, look for about 600 mcg in folate levels, although in some cases such as a neural tube defect in a prior pregnancy, a higher dose of folate is required.
Iron
During pregnancy some people will stop taking their prenatal because it causes nausea and/or vomiting, constipation, and stomach pain. This isn't great because as seen above a prenatal (especially the folate) is important during early embryonic development.
The form of iron in prenatals is typically the reason why people stop taking them - usually it's in the ferrous sulphate form which is poorly absorbed. Look for iron glycinate instead which is easier on the digestive system. Iron is also better absorbed with vitamin C - another common ingredient in your prenatal.
Iron is really important in pregnancy as blood volume increases during the second and third trimester, thus leading to a decrease in iron. A deficiency results in low energy, cold hands and feet, hair loss, and restless leg syndrome.
Oxide vs. Citrate
When taking a look at the ingredients list, look for citrate forms of vitamins and minerals if possible. Most ingredients are found in the oxide form, but this form isn't always absorbed well.
Dosage
Because there are tons of prenatal multivitamins on the market, the dosage of vitamins and minerals vary greatly. At the end of the day, they all provide the amount that you need throughout preconception and pregnancy.
However in professional brands you may see a larger amount of B vitamins, important because these are needed for energy (you will be/are growing a baby!), developing brain and nervous system of your baby.
Some brands contain more vitamin B6, which is a first line treatment for nausea and vomiting in pregnancy. Taking too much vitamin B6 is possible, so be aware of the following symptoms: change in sensations to fingers and toes, rashes, walking, reflexes, nervousness, insomnia, feeling ‘wired.’ Before adding more vitamin B6 to your first trimester supplements, speak to your doctor. Or even consider other first line treatments like ginger or acupuncture.
Additional Ingredients
A simple multivitamin with only vitamins and minerals will do the trick. Some brands, particularly those inexpensive formulas found at the pharmacy contain additives. These may not matter to you, but they may have negative effects on the body. A common endocrine disruptor, BHT is found in some brands. Moreover unnecessary colours are also found in some prenatals like: FD&C Red #40 Aluminum Lake, FD&C Blue #1 Aluminum Lake, FD&C Yellow #6 Aluminum Lake, D&C Red #27 Aluminum Lake, FD&C Blue #2 Aluminum Lake.
Some prenatals found at health food stores contain proprietary herbal blends. While a good thought, these are also unnecessary because it doesn't outline how much of a particular herb you’re getting.
Probiotics may also be found in prenatal vitamins, which can be unnecessary. They may be added in to promote gut health and prevent group B strep (a bacteria tested for in the 3rd trimester). But the strains often aren't protective or used to help prevent GBS in pregnancy. In which case, you may want to consider taking a separate probiotic supplement in the second or third trimester depending on your history of vaginal/urinary tract infections or a previous positive GBS test.
Final Thoughts
As you can probably see, there's a lot more involved in choosing a prenatal than picking the lowest-price option. However, if that's all you can manage at this point that's okay because it will have all the recommended dosages of what you need.
If you can opt for a professional brand which has better absorbed forms of ingredients and limits any unnecessary ones, that would be a great option. Typically these would be a 2 or 3 capsules per day product, which isn't as convenient as a 1 capsule per day, but you can likely take all 3 capsules at once.
If you have any questions about the right prenatal supplement for you, or any questions in general about vitamins and minerals during your pregnancy, reach out to a Naturopathic Doctor. We can help you figure out what would be the best supplements for you to take during your pregnancy.
References
Kominiarek, M. and Rajan, P. (2016). Nutrition Recommendations in Pregnancy and Lactation. Medical Clinics of North America, 100(6), pp.1199-1215.
Sebastiani, G., Herranz Barbero, A., Borrás-Novell, C., Alsina Casanova, M., Aldecoa-Bilbao, V., Andreu-Fernández, V., Pascual Tutusaus, M., Ferrero Martínez, S., Gómez Roig, M. and García-Algar, O. (2019). The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Nutrients, 11(3), p.557.