A Doula's Comprehensive Guide of What to Look For In A Prenatal by Carson Meyer

One of the first, and often the only, health recommendations newly pregnant women are given by their health care providers is to start taking a prenatal multivitamin. Since a majority of women are deficient in many of the vitamins and minerals recommended for a health pregnancy, this is important advice. However, there is so much more information that should go with this advice to assure mother and baby are getting the necessary nutrients for optimal health from both healthy food sources and supplementation.

With thousands of prenatal multivitamin brands and formulas to choose from, it can be difficult to know how to decipher which prenatal will offer the greatest benefits. It also may surprise you to learn that prenatal multivitamins are not FDA regulated. There are a number or supplements out there marketed to pregnant women that not only contain insufficient dosage, but actually contain ingredients with known contraindications for pregnancy.

When it comes to prenatal vitamins it is important to note that there is really no such thing as a perfect prenatal that checks every box and encompasses enough nutrients to meet all of your needs. However, there are high quality options available, and additional supplementation can be achieved through high quality food sources. It is important to remember that prenatal vitamins do not take the place of a healthy diet! In fact, a healthy diet is arguably the best way to support your growing baby and body. Choosing organic fruits and veggies, wild caught fish, grass fed meat and pasture-raised chicken and eggs will not only reduce your exposure to unwanted toxins and antibiotics, it will also promote more nutrient absorption.

Conventional farming practices over the past few decades have reduced nutrient levels in foods. Startling studies show that fruits and vegetables produced thirty years ago have up to eight times more nutrients than food produced today. Due to our deteriorating environment and industrial food complex, most women now require supplementation as a steadfast way to promote adequate intake of the vitamins and minerals needed for a healthy pregnancy and postpartum. 

When shopping for a prenatal multivitamin, the first thing to do is look for brands that offer multiple capsules or doses throughout the day. It is impossible to fit proper dosage into a small pill, which is why it is best to avoid one-a-day prenatals. Although they are convenient, chances are they do not contain enough nutrients. The next thing I look at is the “additional ingredients” section. Is the product packed with sugars, food colorings or hydrogenated oils? Steer clear or ingredients like aspartame, silicon dioxide (E 551) and monosodium glutamate (MSG) to name a few. Prenatals can be taken by capsule, tablet, powder or gummy. Gummies, although delicious, generally contain an array of sugary additives, thus making them less recommended. If taking a capsule or tablet leads to nausea, a powder form might be best for you. Plus, powder forms generally allow for more nutrient absorption! 

Below is a list of just a few of the many vitamins and minerals that play a key role in optimizing a healthy pregnancy and baby. These are the general recommendations for pregnancy support, but please keep in mind that each and every body is unique and may require more or less of what is listed here. If you have access to a functional medicine doctor who can do an extensive blood panel, you can become more informed on the supplementation recommendations that best suit your needs. Always consult with your healthcare provider when introducing new supplements to your daily health care regimen.

Magnesium 350mg/day:
Magnesium is a mineral that can be used to support mothers' sleep when taken in the evening. It can also ease muscle cramps and gestational hypertension, as well as relieve morning sickness and constipation. The National Health and Nutrition Examination Survey found that over 50% of American women of reproductive age don’t consume enough magnesium-rich foods to meet daily requirements. Magnesium glycinate, malate and citrate are best absorbed in the body. Foods that contain high levels of magnesium are pumpkin seeds, oats, sunflower seeds, spinach and unsweetened cacao powder.

D3 2,000-4,000 IU:
Every day we learn more and more about how crucial vitamin D is when it comes to our immunity, mental health and overall longevity. On average, about 50% of women are deficient in vitamin D mostly because we are not getting nearly enough sunshine in our daily routines. Adequate vitamin D levels have been shown to cut risk of preterm birth by HALF, protect against infection, promote proper placenta development and function and reduce the risk of gestational diabetes and preeclampsia. Babies born with low vitamin D levels are shown to have increased incidents of autoimmune disease, asthma and poor language development. 

Every single food source of D3 contains fat and cholesterol, which makes sense since vitamin D is a fat soluble vitamin. Take vitamin D3 with healthy fats for best absorption. In addition to supplementation, add more wild salmon, mackerel and sunshine to your life. The app D Minder can help you decide on the most optimal time to be outside without sunscreen for you to receive the best absorption of the sun’s healing rays! 

Iron: 
Roughly 20% of women begin pregnancy with the sufficient iron stores needed to maintain a healthy pregnancy, and those following a strict plant-based diet are at a higher risk of being anemic. Iron deficiency can lead to heavy fatigue, depression, hair loss, preterm delivery and delayed cognitive development for baby. 

Iron rich foods include spinach, liver, kidney, octopus and lentils. Consuming iron with vitamin C increases absorption in the body. Did you know that broccoli is one of the highest nutritional sources of vitamin C? Try to avoid taking iron with calcium, dark tea or coffee. This can decrease your iron absorption. I recommend getting your iron levels checked before deciding on a daily dose. If your prenatal multivitamin doesn’t include iron then you can easily supplement separately depending on your individual needs.

Folate 600 - 800 DFE:
You have likely been told about the importance of folate in preconception and pregnancy when it comes to reducing risk of miscarriage, neural tube defects and lip and tongue ties. However, not many are aware of the difference between synthetic folate (folic acid) and folate (natural form of B9). Folic acid is more affordable, which makes it more desirable to manufacture. However, folic acid does not cross the placenta the way methylated folate does. It is especially important to choose methylated folate over folic acid if you have the MTHFR mutation. It is also recommended to avoid foods enriched with folic acid since it has been shown to block the body’s receptors of active folate. Some foods rich in folate are lentils, chicken liver and beans. 

*Methylated “active” form of folate: methyltetrahydrofolate (pronounced methyl-tetra-hydro-folate) and/or L-Methylfolate or Folate

Zinc 11 mg/day:
Zinc is another important mineral that helps support immune function, reduce risk of low birth weight and may even reduce risk of chronic disease for future generations. Around 80% of pregnant women worldwide have inadequate levels of zinc. Zinc supplementation is especially important for those who follow a plant-based diet due or those who recently came off the birth control pill. Taking zinc in the last trimester of pregnancy may also be helpful in reducing the risk of GBS and intrauterine infection. Foods rich in zinc are oats, beef and cabbage seeds. To maximize absorption of zinc in plant foods, soak, sprout, and/or ferment them.

Choline 450 mg/day minimum:
According to the National Health and Nutrition Examination Survey, 90% of women are not meeting their needs for choline. Choline is essential for baby’s brain development. Some studies show it may even play a role in enhancing memory function. Choline also supports maternal liver function and placenta health. Choline bitartrate or sunflower lecithin are the preferred source of supplementation. The greatest natural food source of choline is pasture-raised eggs with yolk. Two large pasture-raised eggs contain 294 mg of choline, more than half of the daily recommendation! Pasture-raised eggs also have higher levels of vitamins A, E and omega-3 fats - consuming them is highly recommended for pregnant and postpartum mothers.

Carson Meyer is a dear friend of Your Zen Mama and Los Angeles based birth doula, birth photographer & childbirth educator offering in person and virtual classes for parents. Carson is dedicated to supporting parents through a healthy and peaceful pregnancy, birth and postpartum period, in the environment that best suits their needs and her virtual online circle Growing Together is wildly popular for good reason. You can find out more at carson-meyer.com and follow Carson on social @ccmeyer.