There is no such thing as a “perfect” prenatal vitamin

As a society we are led to believe that taking a prenatal vitamin during pregnancy will provide all the nutrients we need for a happy and healthy birth outcome. Although most prenatal vitamins do provide calcium, vitamin A, vitamin B1 (thiamine), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), vitamin B7 (biotin), vitamin B9 (folic acid) or folate, vitamin B12 (cobalamin), vitamin C, vitamin E and vitamin D,¹ there are three critical nutrients that your prenatal may lack, or be missing entirely. In other words, there is no such thing as a “perfect” prenatal vitamin that can meet all of your prenatal needs.

Vitamin D supports a healthy pregnancy

You have probably heard of the benefits of vitamin D for bone, brain, cardiovascular, immune, metabolic, and or respiratory health, but did you know that vitamin D is also critical for maintaining a healthy pregnancy? Emerging research strongly links vitamin D to a reduced risk of pregnancy complications including preeclampsia, gestational diabetes, preterm birth, and C-section delivery.^3–6 Unfortunately, research also indicates that an estimated 33% of pregnant women in the U.S. are deficient in vitamin D.² To learn more check out, “The Importance of Vitamin D during Pregnancy”.

The majority of prenatal vitamins contain vitamin D within the range of 400 IU (10 mcg) to 1,000 IU (25 mcg), however these values may not be enough. In a study examining the vitamin D levels of women consuming a prenatal supplement with 600 IU/day and two glasses of vitamin D fortified milk, researchers found that 76% of moms and 81% of newborn babies were deficient in vitamin D (levels <  20 ng/mL).⁷ This raises the question: how much vitamin D do you need to increase your levels? In a study comparing doses of 400, 2000 and 4000 IU/ day in pregnant women from early pregnancy (12–16 weeks) to delivery, researchers found that 4000 IU was the most effective at safely increasing vitamin D blood levels.⁸ Does this mean that every pregnant woman needs 4000 IU of vitamin D? Not exactly.  The best thing to do is to get your vitamin D levels tested and talk to your doctor about what dose is right for you. 

Choline benefits pregnancy and beyond

Although choline doesn’t get a lot of attention, it is a nutrient with a number of impressive, long lasting benefits. For example, higher maternal choline intakes have been shown to reduce the risk of neural tube defects (independent of folate intake) while also improving cognition and lowering levels of circulating cortisol.^9,10 This is significant because lowering a baby’s production of cortisol could, over their lifetime, reduce their risk of certain stress-related disorders.¹⁰ In terms of improving cognition, research finds that children who received additional choline in utero showed increased attention span, memory, and problem solving at age seven.¹¹

For mom, the benefits of increased choline intake are linked to a reduced risk of certain complications during pregnancy and an increase in placenta and liver function during pregnancy.¹³ The benefits of choline during pregnancy make it one nutrient you’re going to want to make sure is on your prenatal vitamin’s supplement facts panel. 

Although the recommended Adequate Intake (AI) of choline for pregnant women is 450 mg/d, studies show that only 10% of pregnant women in the U.S are actually meeting the AI.¹⁴  Partly to blame for this is that many prenatal vitamins may provide insufficient choline support. A recent study evaluating the top 25 prenatal vitamins found that none contained the daily-recommended choline intake for a pregnant woman, and over half contained none at all.¹⁵ To help remedy this, make sure you are consuming enough choline through your diet, and supplement as needed. If you’re aiming to get your choline from food first, one of the highest sources of choline are eggs. However, the yolk is where the choline lives (about 147 mg per egg yolk), so you won’t get your choline from an egg white omelet. See the chart below for more choline sources and their amounts.¹⁰ You will notice that animal sources contain the greatest amounts of choline, so vegans and vegetarians run an even greater risk of choline deficiency. Therefore, it’s critical that vegans and some vegetarians supplement with choline during pregnancy.   

DHA and healthy development of the fetus

DHA, an omega-3 fatty acid, is one of the key building blocks for fetal development. During pregnancy the fetus obtains DHA through the mother, and it is imperative that the mother has adequate DHA stores to support both her and her developing baby’s needs. If the mother already has a low DHA status, the fetus’s reliance on her for DHA can put her at a heightened risk of DHA deficiency, and importantly,  place her infant at risk of missing out on some of the nutrient’s key benefits.¹⁶ To learn more about the multitude of DHA benefits during pregnancy see “Why Do I Need DHA During Pregnancy?”.

According to the American Pregnancy Association, pregnant women should ingest a minimum of 300 mg of DHA a day. Because many prenatal vitamins do not contain DHA, this means pregnant women need to obtain their daily minimum through fatty fish or fish oil. Given that pregnant women are advised to limit consumption of low-mercury fish to 2-3 times per week, incorporating a fish oil supplement containing at least 300 mg/d can help support your DHA needs if your prenatal is lacking. However, your individual needs may not be met by 300 mg/d, making it important to talk to your doctor and get tested. You can determine your needs through a simple blood test to find out what dose is best for you. 

In summary, even though we are taught to fully trust a prenatal vitamin to deliver all the nutrients needed during pregnancy, remember to double check the label. Key nutrients like vitamin D, choline, and DHA can often be lacking or nonexistent in many prenatal vitamins. While there is no such thing as a “perfect” prenatal vitamin, if you do your research, have a discussion with your doctor, and supplement accordingly, you’ll be well on your way to having a healthy and happy pregnancy.