What to look for in a Prenatal Multi

Kelly Benton – Pregnancy & Baby Nutritionist 

So you are planning a baby, or maybe already pregnant.. firstly, congratulations! One of the first things you may go out and do is purchase a prenatal multi or folate supplement, only to get to the shelf and be hit with an overwhelm of choices and ingredients, not knowing which one to choose.

I am here to help! Read on for my tips on what to look for when choosing which one is right for you.

Let’s start by covering when and why you should be taking a prenatal..

A prenatal supplement is intended to complement a typical diet, to ensure that an adequate intake of essential vitamins and minerals is achieved. If you enter pregnancy with sufficient nutrient stores, it also acts as a kind of ‘insurance’ during the first trimester when you are likely to be experiencing some degree of nausea or vomiting and therefore normal food intake is reduced.

Ideally you should start taking a prenatal supplement 3 months prior to conception and continue after birth, until breastfeeding is ceased. Why we want to start before you conceive is to ensure you are entering pregnancy with good nutrient stores, as certain nutrients can be quickly depleted as pregnancy progresses. It also takes 3-4 months for an egg to mature, so to improve egg quality, diet and lifestyle changes 3-4 months out from conception (even better if it is 6 months) is important.

So what should you look for? I’ve called out the below nutrients which I like to pay particular attention to, either because they play a critical role in reducing complications in your baby, or that I see commonly lacking in the diet / low levels during pregnancy.

Folate:

Folate is a B-group vitamin which plays an essential role in DNA synthesis. In pregnancy, it is crucial for preventing neural tube defects, which can occur early on in the first trimester. Folic acid is the synthetic form of folate that you will find in most over-the-counter supplements. Look for one containing at least 400 micrograms of folic acid (1), or folate equivalent such as methyl folate, 5-MTHF, MTHF, L-5-MTHF, levomefolate calcium, 5-L-methylfolate, follinic acid or calcium folinate. Your folate requirements may be higher than this if you have a higher BMI, have diabetes, or family history of NTD’s, so in this case working with your pregnancy healthcare team is best.

Iodine:

Iodine is necessary for proper thyroid function and plays a key role in conception. Your baby relies on your thyroid hormones until around 20 weeks gestation (2). Low iodine consumption is becoming increasingly common, since many women are switching from table salt (which is enriched with iodine) to Himalayan pink salt (which does not contain iodine). The National Health and Medical Research Council (NHMRC) recommends all pregnant and breastfeeding women supplement daily with at least 150 micrograms of iodine (3).

Choline:

Choline is becoming more widely recognised as a nutrient of importance during pregnancy. It is a relative of the B vitamins and plays a significant role in development of the neural tube and in brain development. Many of the traditional prenatal formulations don’t contain choline, but some of the newcomers to the market do, so if you can find one that does, fantastic! The RDI for choline in pregnancy is 440mg (4). If you are someone who eats eggs, 2 per day can give you around half of your needs. Aiming for around 200mg from a supplement would be great as a top up.

Vitamin D:

Vitamin D is necessary for the regulation & absorption of calcium in bones, as well as playing an important role in immune function. Studies have reported up to 55% of women are deficient in vitamin D during pregnancy, those with a higher BMI and pregnancy during winter or spring being at the greatest risk (5).

The best way to obtain vitamin D is through regular, safe sun exposure. Aim for 20mins of sun daily, exposing the belly and thighs (the largest areas of skin for maximum absorption).

Before supplementing with Vitamin D, it is a good idea to have your levels tested via a blood test, especially if you are pregnant during winter. Your results will determine how much vitamin D should be supplemented.

The best form to look for is cholecalciferol and should be in a fat-based capsule, as vitamin D is a fat-soluble vitamin, so requires fats for absorption. You also want to make sure you have enough vitamin D to enrich breastmilk when baby is born, so I recommend speaking to a Nutritionist to make sure this is covered!

Iron:

Iron is another common nutrient which women tend to be deficient in during pregnant. It is estimated that only 20% of women begin a pregnancy with sufficient iron stores (6). Iron is an essential component of blood, transporting oxygen from our lungs to tissues and is necessary for growth and development.

Similar to vitamin D, have your iron levels checked via a blood test before commencing a supplement, and monitor throughout pregnancy.

When choosing a form of iron, iron bisglycinate has a high rate of absorption, with fewer side effects than more commonly found forms such as ferrous fumarate (7).

Be mindful of nutrient interactions when you take an iron supplement. Calcium, zinc and caffeine inhibit iron absorption, whilst vitamin C increases absorption. Avoid taking an iron supplement 2 hours before or after drinking coffee and consume supplements with vitamin C-rich foods (such as strawberries or oranges).

Docosahexaenoic acid (DHA):

This is my favourite nutrient because it provides SO many benefits for mother and baby, both in pregnancy and postpartum. DHA is an omega 3 fatty acid found in fatty fish such as salmon, sardines, cod, trout, mackerel and herring. It is best known for its role in brain development and cognitive function. Maternal DHA levels have been found to positively impact upon baby’s behavioural attention scores, visual recognition, memory, language and hand / eye coordination (8, 9). Plus, they have been found to reduce the risk of postpartum depression (10).

In a study of over 12,000 women, it was found that 95% were not meeting their daily requirements of DHA (11). If you don’t get enough fatty fish (it’s recommended you have 2 serves weekly), or you are plant-based, high quality Omega 3 supplementation is strongly recommended in pregnancy and postpartum (aiming at least 300mg per day coming from DHA). Look for a high-quality product that uses small, wild-caught fish (such as sardines or anchovies), with no synthetic nutrients added. If you are vegetarian, look for marine algae called Schizochytrium.

I hope that helps give you some guidance on where to start. Supplements should not replace a balanced and varied diet of nutrient-dense, whole foods, they are only designed to “add” to areas where your diet may be lacking. There is no one-size-fit’s all approach when it comes to supplements (we are all special, unique beings), so always seek the advice of a healthcare professional, your pregnancy care team or nutritionist / dietitian before taking any new supplement.

Kelly Benton is a nutritionist specialising in maternal and baby nutrition. She is a mother of two (1 and 3 years old), right there in the thick of it with you. After experiencing maternal nutrient depletion through her first pregnancy and postpartum period, Kelly saw a need to educate and empower other women to proactively take health into their hands so they can have a more positive experience. Kelly is available for 1:1 consults, to book please visit her website or Instagram page.

References:

1: Food Standards Australia and New Zealand (FSANZ) (June 2016). Folic acid / folate and pregnancy. https://www.foodstandards.gov.au/consumer/generalissues/pregnancy/folic/Pages/default.aspx

2: Leung A. Thyroid function in pregnancy. J Trace Elem Med Biol. 2012 26(0): 137–140.

3: National Health and Medical Research Council (NHMRC) (January 2010). Iodine supplementation for pregnant and breastfeeding women. NHMRC Public Statement.

4: National Health and Medical Research Council (NHMRC). Nutrient reference values for Australia and New Zealand. Updated 2017.

5: Davies-Tuck M, Yim C, Knight M et al. Vitamin D testing in pregnancy: Does one size fit all? Aust N Z J Obstet Gynaecol 2015 55(2): 149-55.

6: McMahon L. Iron deficiency in pregnancy. Obstet Med. 2010 Mar; 3(1): 17–24.

7: Bumrungpert A. Efficacy and Safety of Ferrous Bisglycinate and Folinic Acid in the Control of Iron Deficiency in Pregnant Women: A Randomized, Controlled Trial. Nutrients. 2022 Feb; 14(3): 452.

8: Dunstan JA, Simmer K, Dixon G, et al. Cognitive assessment of children at age 2½ years after maternal fish oil supplementation in pregnancy: a randomised controlled trial. Archives of Disease in Childhood - Fetal and Neonatal Edition 2008;93:F45-F50.

9: Morse NL. Benefits of docosahexaenoic acid, folic acid, vitamin D and iodine on foetal and infant brain development and function following maternal supplementation during pregnancy and lactation. Nutrients. 2012 Jul;4(7):799-840. doi: 10.3390/nu4070799. Epub 2012 Jul 24.

10: Markhus MW, Skotheim S, Graff IE, Frøyland L, Braarud HC, Stormark KM, Malde MK (2013) Low omega-3 index in pregnancy is a possible biological risk factor for postpartum depression. PLoS One. 2013 Jul 3;8(7):e67617. doi: 10.1371/journal.pone.0067617.

11. Zhang Z, Fulgoni VL, Kris-Etherton PM, Mitmesser SH. Dietary Intakes of EPA and DHA Omega-3 Fatty Acids among US Childbearing-Age and Pregnant Women: An Analysis of NHANES 2001-2014. Nutrients. 2018 Mar 28;10(4):416. doi: 10.3390/nu10040416.