How to Choose a Prenatal Vitamin
Interestingly, as I checked in several pregnancy and prenatal nutrition books, I found that there was not a consensus on prenatal vitamins: several books went so far as to explain that if mother's diet is excellent, prenatal vitamins are unnecessary. Most of the my sources, however, did suggest using prenatal vitamins almost as insurance:
The Harvard Medical Guide to Healthy Eating During Pregnancy has a helpful chapter called "Dietary Supplements - What's Good and What's Not". In this chapter, the author explains that
"Most physicians recommend taking a prenatal vitamin to ensure that pregnant women are not deficient in nutrients. This is an important point, because the goal of taking a vitamin is not to 'boost' the levels of any one nutrient to excess but to bring abnormally low levels of nutrients to a normal level. A reputable supplement with the right amount of vitamins and minerals can serve as a safety net in case the foods you eat fail to supply a critical nutrient that your baby needs, or if nausea and vomiting are preventing you from eating a balanced diet" (92).and
Peggy O'Mara writes in Having a Baby, Naturally :
"Taking a prenatal vitamin can help ensure adequate vitamin levels, although it should not be used as a substitute for a good diet. Experiment with the best time of day to take your supplement, because taking it on an empty stomach may contribute to nausea. Taking it with a meal is usually best" (11).
Okay, so that's why many doctors and midwives recommend taking prenatal vitamins... now, which one to take? Here are some guidelines:
First, take a prenatal supplement, meant specifically for pregnant or breastfeeding (lactating) women. Prenatal vitamins have been modified to correspond with pregnant women's needs, and will work better than a traditional multivitamin.
The Harvard Medical School Guide to Healthy Eating During Pregnancy offers these additional considerations:
"It is safest to choose a supplement from a large, reputable manufacturer at a retail pharmacy, because these companies will be under higher scrutiny to provide a safe product than small companies that sell products over the Internet or in smaller stores. Choose a formula specifically designed for pregnant women, and check to see that it provides the level of vitamins and minerals that you need. You can ask your doctor to recommend an over-the-counter vitamin or to prescribe one through your pharmacy. Some people may also choose not to take a multivitamin, instead preferring individual supplements of the nutrients they need most. In this case, it's important to make sure you are getting the right dose, because individual-nutrient supplements are often sold as doses above the recommended daily dose" (93).
According to this same book, here is a list of Dietary Reference Intakes During Pregnancy, for women 19 years old or older:
Vitamin A: 770mcg (2,560IU)
Vitamin D: 5mcg (200IU)
Vitamin B6: 1.9mg
Vitamin B12: 2.6mcg
Panthothenic acid: 6mg
Biotin: 30 mcg
Vitamin C: 85mg
Vitamin E: 15IU
Elizabeth Somer writes in Nutrition for a Healthy Pregnancy that
"the secret to supplementation is to do it sensibly. Choose a multiple vitamin and mineral that supplies at least 400mcg of folic acid and approximately 100-200 percent of the Daily Value for all other nutrients. If you don't consume daily at least two calcium-rich foods, such as nonfat milk and fortified soy milk, and lots of magnesium-rich whole grains, wheat germ, and legumes, then consider supplementing your multiple with extra calcium (500mg) and magnesium (250mg) since no one-pill multiple contains enough of these two minerals. In addition, you will need additional iron if blood or tissue iron levels are low" (10).
Here is Mothering's response to "I'm looking for a really good prenatal vitamin and wondered what your suggestions would be."
I have used DaVinci Laboratory's Ultimate Prenatal Vitamins for 20 years with excellent results. It is in a base of herbs so consult with your midwife or doctor about your own health needs in this area. Some vitamin shops carry this product although it was formerly for professional use only. Ask your doctor to order it for you if you cannot find it locally visit their website at www.davincilabs.com Wishing you a beautiful pregnancy and birth experience.
So there are a few caveats about prenatal vitamins:
1. Don't assume all prenatal supplements (or supplements in general) are safe.
The author of the Harvard Medical School Guide to Healthy Eating During Pregnancy cautions that "dietary supplements are regulated differently from either food or medications. The responsibility for ensuring a supplement's safety lies with the manufacturer, not an overseeing agency such as the FDA . . . supplements that contain the same ingredient have been found to vary widely in quality and content. This doesn't mean that all supplements are dangerous; most reputable companies know that ensuring a safe, consistent product is in their best interest. But you can't assume that everything sold on your pharmacy's shelves [or online!!] has been tested for quality and safety" (92).
For example, you might want to check out a vitamin on this list before you buy it: Survey Data on Lead in Women's and Children's Vitamins. I was shocked to notice a significant overlap between health food store vitamins and the vitamins on the list for the highest lead content.
2. Prenatal vitamins sometimes cause nausea in pregnant women, especially in the first trimester. If your prenatal vitamins make you nauseous or add to your morning sickness, consider switching brands or - what I've found anecdotally to help the most women - take them at night after dinner rather than in the morning on an empty or nearly empty stomach. The Midwifery Today e-newsletter had an article about this common problem just recently: Nausea and Prenatal Vitamins
3. While taking prenatal vitamins can be "insurance" against a nutritional deficit, it's critically important to eat a balanced, healthy diet during pregnancy. Our bodies absorb nutrients much better from food than from vitamins, and many times the combinations involved in foods or traditional recipes combine together to work better in our bodies. Also, there are lots of important phytochemicals in fruits, vegetables and whole grains that are not available (yet?) in prenatal supplements.
Several of the books mention iron, calcium, and folic acid as three nutrients in prenatal vitamins that are particularly important, because many pre-pregnant and pregnant women do not get adequate amounts of these nutrients through the foods they eat. We'll start with those next week. In the meantime, these are the books I used to compile this information, and would recommend reading as additional resources:
The Pregnancy Book, by William Sears, MD and Martha Sears, RN
The Harvard Medical School Guide to Healthy Eating During Pregnancy, by W. Allan Walker, MD
Nutrition for a Healthy Pregnancy, by Elizabeth Somer, MA, RD
Having a Baby Naturally, by Peggy O'Mara
Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine