with input from Alison Boden, MPH, RDN dietitian and functional nutritionist focused on reproductive health, @nourishing_radiance

For women with well balanced diets, the science is inconclusive whether prenatal vitamins are vital to support a healthy pregnancy. So don’t freak out if you didn’t start taking them before you found out, or if you miss a day. If you’re reading this and are thinking about having a baby, starting on a prenatal now is a good idea, though.

Prenatals can fill in the gaps of where you’re lacking in your diet, but they obviously aren’t a replacement for eating well. They can certainly help you when all you want is grilled cheese in the first trimester, though.

What are the key nutrients in a prenatal that are different than other multivitamins?

A couple of key nutrients we want to clue you into here are folate, vitamin A, iron and iodine. They are needed in extra amounts during pregnancy and decrease the risk of birth defects and support a healthy pregnancy. Folate is needed especially in the first trimester for healthy nervous system development of your baby. Eating enough and taken a supplement can decrease risk of a serious birth defect called Neural Tube Defect. Vitamin A is needed for the growth and development of the baby’s organs, eyes and skeleton and so is in higher amounts in prenatals versus regular multivitamins. Iron supports healthy red blood cells and sending oxygen around to not only your body but supplies the baby with oxygen. Iron is a mineral that many women are low in going into pregnancy, so it’s something we also keep an eye on and test each trimester with your doctor or midwife. Lastly, Iodine is a mineral needed to support thyroid function - an organ that controls growth and development.  

When should you start taking a prenatal, and how long do you continue taking it?

We’d recommend starting your prenatal as soon as you decide you want to conceive. This is because the baby’s neural tube (eventually brain and spinal cord) develops super early in pregnancy, and extra folate is important for this process.

A quick note on folic acid/folate: folic acid is the synthetic version of folate (in a lot of prenatals). Folic acid has to be converted to folate by the body to use it- and up to 40% of the population has trouble with this conversion (have a genetic mutation - MTHFR). If you can, choose a prenatal with active (methylated) folate vs. folic acid just to be sure.

Are there any other supplements to consider taking in addition to the prenatal vitamin (and why)?

A few other nutrients are needed in higher amounts during pregnancy but don’t tend to be included in higher doses in prenatal vitamins. Check your particular prenatal though, because some of these are starting to be included in different brands. Focusing on food sources of these nutrients or supplementing with additional amounts is a great idea. Choline is a vitamin that is important for the development of baby’s brain and nervous system, and can be found in egg yolk, meat and smaller amounts in leafy greens. Omega-3 fats from fish oil are needed for brain and eye development, and taking additional amounts of this via supplement can also safeguard mom from becoming deficient. Vitamin D is typically in a low dose in prenatal supplements as well, and we see higher doses correlated with improved immunity in mom and possibly a lower risk of pre-term delivery with higher doses. If you don’t live in a warm climate or get a lot of outdoor time then adding this to the mix is a great idea. 

How do I know what prenatal vitamin is right for me?

Our favorites have been Metagenics Pregnancy Wellness. We love Metagenics because it includes really high quality fish oil supplements which we love. BUT, there are a ton of pills to take each day. Needed just launched their prenatal which is in powder form, which could be helpful for mamas who can’t stomach taking capsules.

Keep in mind that not all prenatals are created equal and the FDA doesn’t regulate vitamins. Labdoor is a new startup that evaluates vitamins - specifically, if they have any harmful ingredients/contaminants. They also check on product integrity (if they actually have what the labels say they have). They give each vitamin a rating - and rank them, which we’ve found to be really helpful.

Nausea (especially in the first trimester) is a real thing, we get it. If you can’t stomach taking your prenatal, here are a few suggestions. 

Always take with food. This may make it go down much easier!

Take at night. If the morning is a bad time for nausea, save your supplements for the time of day where you feel best, which might be in the evening or before bed.

Split up the dose. Some of the recommended supplements from above require multiple pills per day. If taking them all at once is making you feel bad, split up the dose throughout the day. This is recommended for improved absorption anyway. 

Try a different brand. Some are just a bit harder on your stomach. If you try all of the above and still can’t keep them down, try switching.

Try a liquid or chewable. Sometimes a pill is just not going to happen! Smarty Pants has a chewable gummy that has good quality ingredients. 

How long should I consider taking a prenatal? Should I continue taking them when breastfeeding? I will need different nutrients then, won’t I? 

If breastfeeding, take a prenatal or switch to a multivitamin for the duration of breastfeeding. Even if not nursing, continue to take your supplement for at least the first few months after delivery. Adding in a bone density supplement (like Jarrow’s Bone Strength) is also a great idea since bone density can temporarily go down in the first few years postpartum.