Should we all be taking prenatal vitamins?

Last week when wandering the drugstore supplement aisle, I picked up a bottle of prenatal vitamins. (Well, actually five bottles. There are so many brands to choose from and ingredients to squint at, it’s impossible to only inspect one). After all, the New Year is ripe with health resolutions and reflection. I’ll also be turning 30 in 2018. The holiday and milestone have me considering my life and goals—you know, the serious, sentimental stuff. Having witnessed friends and family struggle to conceive, I can’t help but wonder about my own fertility. My partner and I want kids, but not for the next three to five years.

Though I left without purchasing, it got me thinking: Why are these pills so important for pregnancy and what do they do, anyways? Could taking a prenatal vitamin now improve my chances of getting pregnant later? Should I swap my multivitamin for a prenatal? Are they the same thing? Also, what about vitamin quality? I try my best to steer clear of harmful ingredients like pesticides.

I consulted two women’s health experts to indulge my latest supplement curiosity and suss out how to think about prenatal vitamins before pregnancy, when triying to conceive, and now when I'm considering starting a family in the future.

The why

“Although many women have well-rounded diets, most are unable to absorb adequate amounts of some essential vitamins and minerals needed to help support a healthy pregnancy,” says Dr. Kyoko Pena-Robles, who specializes in prenatal care, reproductive health, and menstrual disorders at One Medical Health in San Francisco, CA. “Prenatal vitamins help ensure that expecting mothers receive these essential vitamins during pregnancy.”

In other words, while it’s recommended that eating a healthy diet is the best way to consume important nutrients, it’s normal, even likely, to fall short. According to Pena-Robles, research shows that we don’t absorb enough folic acid, a nutrient needed during pregnancy from food sources. This is why she recommends folic acid supplementation to patients.

The what

Turns out, there’s a difference between my daily multivitamin and a prenatal vitamin. The latter usually contain larger quantities of nutrients critical during pregnancy, like iron and folic acid. Kara Earthman, a Women’s Health Nurse Practitioner (WHNP) in Hendersonville Tennessee, puts it plainly: “When you're pregnant, you need more vitamins and minerals than you would need when you're not—obviously, since there's an extra human in there!”

According to both Earthman and Pena-Robles, folic acid, iron, calcium, and vitamin D are four of the most important ingredients in prenatal vitamins. (For a more comprehensive list and overview, check out this article.) First, getting at least 400 micrograms of folic acid through a supplement prevents neural tube defects. “Folic acid is a biggie,” says Earthman. “We want patients to have folic acid early on in pregnancy, ideally before pregnancy, in order to encourage healthy fetal development and minimize the risk of conditions like spina bifida.”

When you’re pregnant, the amount of blood circulating in your body increases to support the baby. Iron is responsible for carrying the oxygen in your blood to your body’s cells. A prenatal vitamin with plenty of iron, 25 to 30 micrograms, allows oxygen to get adequately transported to the mother and the fetus. Lastly, vitamin D and calcium work hand in hand to support the baby’s developing bones and teeth. “I recommend prenatal vitamins that provide 2000 IU of vitamin D and 1200 milligrams of calcium daily,” says Pena-Robles.

In terms of selection, Pena-Robles suggests considering your lifestyle and habits before brand. “I have never been aware of any evidence-based recommendation regarding the best prenatal vitamin brands,” she says. “I think it’s dependent on the individual. For example, some women have a difficult time taking large pills or forget to take their vitamins. In these cases, I recommend a gummy vitamin or a once-daily vitamin.”

Down the line during a pregnancy, the gummy route can also be useful if women are suffering from nausea or vomiting during the first trimester of pregnancy. But Pena-Robles warns that gummy prenatal vitamins typically don’t have enough iron, so a separate iron supplement may be needed.

The what, continued

Though there may not be a clear winner in terms of brand, quality is still an important consideration. The FDA is not authorized to review dietary supplements for safety and effectiveness before they are marketed to consumers. Pesticides have been found in some supplements containing botanical or herbal ingredients. On top of this, in 2015, the New York State Attorney General’s office investigated top-selling supplements at leading retailers like Target and Walgreens. They found that four out of five of the products didn’t contain the ingredients listed on the label. Often, cheap fillers like powdered rice or substances that may cause allergic reactions were used.

Labdoor is a resource that offers consumers more insight into prenatal vitamin quality. After performing a chemical analysis of a supplement in a FDA-approved lab, Labdoor produces a quality score for the product. This score takes into consideration label accuracy, product purity, nutritional value, ingredient safety, and projected efficacy. When in doubt, ask your doctor for their recommendation based on your preferences.

The when

Most women find out they are pregnant between weeks four and seven. But according to the Mayo Clinic, neural tube defects can start forming during week six. This is why both experts say it’s ideal for prenatal vitamins to be consistently taken before pregnancy.

“It's best to start taking prenatal vitamins at least one to two months before beginning to try to conceive,” says Earthman. “Popping a prenatal vitamin won’t immediately get your blood levels to where they need to be—it takes some time. Folic acid is especially important to begin taking earlier than conception, because the fetal brain and spinal cord are formed within the first trimester—the first 13 weeks of pregnancy.”

Pena-Robles adds, “There is also an association between vitamin D deficiency and an increased risk of first-trimester miscarriage. Increasing iron stores prior to pregnancy may also decrease risk of subsequent anemia in early pregnancy.”

If you’re not looking to get pregnant anytime soon (like me), taking a prenatal vitamin can still be beneficial, but not for fertility. “I’m not aware of any strong evidence supporting the idea of taking prenatal vitamins to support fertility,” says Pena-Robles. Earthman agrees with this, too.

Rather, getting the recommended daily quantities of folic acid, vitamin D, and iron is beneficial in the case of an unplanned pregnancy. The aforementioned risks or symptoms may be less likely when these vitamins and minerals are already abundant. Folic acid, according to Pena-Robles, is particularly vital. “I advise that all reproductive-aged women, regardless of whether they are trying to conceive or not, get the daily recommended amount of folic acid until they reach menopause,” she says.

In addition to having key nutrients in your system if an unexpected pregnancy occurs, Pena-Robles notes that most women do not get enough calcium or vitamin D through food and drink intake. She says, “Taking a prenatal vitamin or multivitamin with the ideal quantities of calcium and vitamin D are both good options and beneficial for all women in most cases.”

The bottom line

Taking a prenatal vitamin is perfectly healthy for someone not looking to conceive. While it won’t support fertility, it will replenish folic acid, iron, vitamin D, and calcium stores in the body. This can help keep you strong and prevent potential health complications in an unexpected pregnancy. “If you're not on a reliable form of birth control and are sexually active, it's not a bad idea to have these nutrients in your system, just in case,” says Earthman.

After speaking with Earthman and Pena-Robles, I investigated my own supplement situation. I realized my current multivitamin, New Chapter Every Woman’s One Daily Multi, already provides me with the recommended daily intake of folic acid and vitamin D. However, it doesn’t have nearly enough calcium or iron to support a pregnant woman or one trying to conceive. Since neither situation applies to me (plus, I have an IUD) and I get plenty of iron and calcium in my diet, I’m going to stick with my multivitamin. If my diet was lacking or I wasn’t on active birth control, I might consider swapping to a prenatal vitamin.

Though I’ll be passing by the prenatal vitamins in the supplement aisle for the time being, I’ll hopefully be back (not to mention well-prepared) in a few years.

English Taylor is a San Francisco-based women’s health and wellness writer. English covers everything from tampons to taxes (and why the former should be free of the latter). Follow Englishand her work at https://medium.com/@englishtaylor.

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“Prenatal Vitamins: Why They Matter, How to Choose.” The Mayo Clinic. 13 Sept. 2016, https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-vitamins/art-20046945. Accessed 29 Dec. 2017.
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English Taylor

English Taylor is a San Francisco-based writer and birth doula. Her work has been featured in The Atlantic, Healthline, LOLA, and THINX. Follow English’s work at https://medium.com/@englishtaylor.

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