Multivitamins are designed to meet the micronutrient needs of the general public and may help prevent deficiencies of certain nutrients.
Prenatal vitamins are a special type of multivitamin. Prenatal means “before birth,” and the term is often used to describe the care given to people during pregnancy. Therefore, prenatal vitamins refer to multivitamins that are uniquely formulated to emphasize key nutrients that support a healthy pregnancy.
The American College of Obstetricians and Gynecologists recommends that pregnant people take a prenatal vitamin. While research into prenatal nutrient requirements continues to evolve, studies have shown that the blood levels of most vitamins decrease during pregnancy. Therefore, taking a prenatal vitamin while pregnant can help support normal nutrient levels.
A healthy diet that provides plenty of nutrients is important to meet the increased demands of pregnancy. However, many people may not be able to meet all their needs through food alone. According to the 2020-2025 Dietary Guidelines for Americans, nutrients such as folate, iron, and vitamin D should be supplemented during pregnancy.
Let’s review some of the nutrients to look for in a prenatal vitamin and discuss why they are important for pregnant people.
Vitamin A is a fat-soluble vitamin, which means that it needs fat to be absorbed into the body. Vitamin A is needed for the normal function of a variety of body systems including the immune, reproductive, and cardiovascular systems.
Vitamin A is found in foods as two main types: retinoids and carotenoids. Retinoids are found in animal products and carotenoids are found in plants. Carrots, spinach, and sweet potatoes are rich in a carotenoid called beta-carotene. Liver, dairy, and eggs are rich in retinoids.
The daily recommended amount of vitamin A is 770 mcg RAE (micrograms of retinol activity units) for pregnant adults and 750 mcg for pregnant teens.
During pregnancy, adequate levels of vitamin A are essential for the growth of cells and organs. High doses of retinoids can be toxic to the body, so it’s usually best to look for beta-carotene when supplementing during pregnancy.
Vitamin C (ascorbic acid) is an antioxidant that can help protect cells from damage. Vitamin C can support skin and connective tissue health because it helps the body make collagen.
Vitamin C is found in citrus fruits (such as oranges), bell peppers, kiwi, strawberries, and broccoli. Heat can lower the amount of vitamin C in foods, so including raw fruits and vegetables in the diet can help meet needs.
It’s recommended to get 85 mg of vitamin C during pregnancy and 80 mg for pregnant teens.
During pregnancy, vitamin C can support cell growth. Research suggests that vitamin C deficiency during pregnancy is associated with preterm birth and pregnancy-related blood pressure issues.
Choline is a nutrient that is needed to maintain a healthy brain and nervous system. It also helps support the cells in the body.
Animal products (including meat, eggs, and dairy) and plants (especially potatoes and cruciferous vegetables) contain choline.
In 2018, the United States Food and Drug Administration (FDA) set the daily value of choline at 550 mg. The daily value (DV) is the recommended amount of the vitamin to consume each day.
The National Institutes of Health (NIH) recommends a choline intake of 450 mg per day for pregnant people (including pregnant teens).
Research has found that most pregnant women in the U.S. are not eating the recommended amount of choline. Since choline may improve pregnancy outcomes, looking for a prenatal that contains choline can help support intake during pregnancy.
Vitamin D is a fat-soluble vitamin that is important for healthy bone growth and immune function. It also helps the body absorb calcium.
The body makes vitamin D in response to sun exposure on the skin. But cold temperatures and long working hours can reduce sun exposure. Older people and those with dark-colored skin do not make as much vitamin D.
Vitamin D is naturally found in fatty fish and fish liver oil. Beyond that, the food supply is fortified with vitamin D from milk and breakfast cereals.
During pregnancy, it’s recommended to get 15 mcg (800 IU) of vitamin D per day.
Research suggests that vitamin D deficiency during pregnancy can increase the risk for preterm birth and miscarriage. Most prenatal vitamins include vitamin D since it’s difficult to meet vitamin D needs via foods and making vitamin D from the sun can be variable.
Vitamin E is a fat-soluble vitamin and antioxidant. It can provide immune system support and helps keep blood vessels healthy.
Sunflower oil, safflower oil, and wheat germ are rich in vitamin E. Nuts and seeds, especially almonds and sunflower seeds, also provide vitamin E in the diet. Vitamin E is sometimes added to foods like breakfast cereals and fruit juices.
The recommended intake of vitamin E is 15 mg per day during pregnancy, the same as for adults. But this increases to 19 mg per day during breastfeeding
Low vitamin E intake during pregnancy is associated with preterm birth and pregnancy-related blood pressure issues. However, very large doses should be avoided.
Folate is a B vitamin that is found naturally in beef liver, fruits, vegetables, nuts, and beans. The body needs folate in order to make healthy cells and DNA.
A synthetic form of folate, called folic acid, is added to foods such as bread, pasta, rice, and cornmeal. It is also added to fortified breakfast cereals. While folic acid is often used in dietary supplements, some supplements contain folate in the form of methylfolate.
Folate needs increase from 400 mcg DFE (micrograms dietary folate equivalents) to 600 mcg DFE daily during pregnancy. Folate is added to prenatal vitamins in order to meet the increased needs.
Folate is important in lowering the risk of neural tube defects, which are serious problems with a baby’s brain (anencephaly) or spine (spina bifida). These issues can happen early in pregnancy, so it’s advised that anyone who has a chance of becoming pregnant get at least 400 mcg of folate per day.
Iodine can be found in fish and dairy products. It’s also added to salt (called “iodized salt”), but note that regular sea salt is not a source of iodine. The label will state whether or not iodine has been added.
The needs for iodine increase from 150 mcg for adults to 220 mcg during pregnancy. Researchers suggest that this increased need is due to stimulation of the thyroid gland and to support fetal thyroid production. Iodine is also needed for proper development of the bones and brain.
Iron is a mineral that helps the body make a protein in red blood cells called hemoglobin. Hemoglobin carries oxygen throughout the body.
Iron is found in foods as either naturally-occurring iron or fortified products such as bread and breakfast cereals. Iron naturally occurs in foods as either “heme” or “nonheme” iron. Heme iron is found in animal products (like meat, chicken, and fish) and nonheme iron is found in plant foods like beans, spinach, and nuts.
During pregnancy, iron needs go up because the amount of blood in a pregnant person’s body increases. It’s essential to meet iron needs during pregnancy because iron deficiency can lead to anemia (lack of blood cells). It also puts the baby at risk for premature (early) birth, low birth weight, and issues with brain development.
It’s recommended to get 27 mg of iron per day during pregnancy and 9 mg of iron while breastfeeding. This increases to 10mg of iron per day for breastfeeding teens. Prenatal vitamins often include iron in order to help meet these needs.
Zinc is a mineral that supports the cells of the body and promotes a healthy immune system.
Oysters have high amounts of zinc, but most people in the U.S. are not eating these regularly. Meat, fish, and poultry are also good sources of zinc. Some breakfast cereals are fortified with zinc.
Pregnant adults need 11 mg of zinc per day and 12 mg are needed while breastfeeding.
Zinc is needed during pregnancy and breastfeeding to support the growth of the baby. Zinc deficiency in lower-income countries has been shown to lead to preterm birth and other pregnancy complications.
While it’s clear that meeting nutrient needs during pregnancy is very important, we do not fully understand if specific nutrients help with fertility.
Research into this area suggests that folate, omega-3 fatty acids, and vitamin D may be beneficial. They have also found that antioxidants may support sperm health. There was an intriguing study which found that folate supplements improve the outcomes of assisted reproductive technology treatment.
Meeting nutrient needs through a well-balanced diet, and supplementing as needed, is likely a good idea for both partners to help support the chances of conceiving.
The science around prenatal nutrition is rapidly evolving. At this point, there is good evidence to support the use of prenatal vitamins to ensure proper intake of nutrients such as folate, iron, vitamin D, and others. Those who are pregnant should work with their healthcare providers to determine their individual diet and supplementation needs.