Thoughts on Choosing a Prenatal Vitamin

“Are you taking a prenatal?”

Picking a prenatalIdeally, we would all get our nutrients from foods.  However, with food intolerances, food aversions, soil depletion, lack of access to high quality food sources, and food processing, some argue that this just isn’t possible in today’s world.  I won’t argue either way.  All I know is that doctors like it when women who are trying to conceive, pregnant, or nursing take a prenatal vitamin, but they aren’t always helpful in recommending one or up to date on the latest nutrient information.

I have delivered four babies in four different states, and my four different obstetricians never once had a firm prenatal vitamin recommendation.  Often, I just cycled through samples they gave me at different visits or some Walgreen’s over-the-counter product.  The question at OB check-ups always was, “Are you taking a prenatal?”  And my answer usually was, “Yes.”  The doctor’s simple response was, “Okay.”   (Or–“No, I am not taking a prenatal.  I feel too sick.”  “Well, just make sure and get some folic acid.”)  End of conversation.  Never once did the OB request, “What kind?  Let me see it.”  However, I think obstetricians/practitioners need to know of any supplement put in their patients’ mouths so they can have the opportunity to offer guidance.  They may even have some great recommendations and samples based on a patient’s health history needs.  (Or not.)

Anyhow, after the last few folic acid/folate posts, I received a few questions and comments about choosing a supplement for pregnancy.  So I put my fingers to the keyboard and was reminded of what I already knew from my search many months ago for myself at the beginning of our surprise pregnancy.  Choosing a prenatal vitamin supplement is a real bear.  A real maze.  A twisted, contorted game.

The Dilemma

If you read my recent posts on folic acid versus folate, you probably think that it’s probably high time to ditch folic acid in favor of a natural folate in prenatal vitamins (and vitamins in general).  Great.  Now you know.  Now I know.  But what good is knowledge if you don’t know how to act on it in real life?  I tried to pinpoint a good prenatal vitamin with L-methylfolate for myself to take many months ago, but it wasn’t as easy as that.  Let me say it again.  It was not as easy as that.  If I liked the vitamin content profile, then I didn’t like the extra ingredients, for example the use of soy, oats, artificial colors, or vanillin (an artificial vanilla flavor).  If I liked the clean ingredient profile, it didn’t meet the minimum recommended iodine requirements.  Or it didn’t have any DHA.  Or it used ergocalciferol (a plant-based vitamin D) rather than cholecalciferol (the better utilized animal based).  Or the vitamin B 12 was not the methylcobalamin form.  Or it didn’t have any vitamin K2.

What do you do?  You do the best you can.  You choose the best you can.  (And you make EVERY BITE COUNT.  More on my personal experience with that in a subsequent post.)  There is no perfect prenatal out there.  There just isn’t.  I’ll tell you what I looked for.  But this is the story of my thoughts and learning.  Not my medical advice.  Please don’t use my blog posts as medical advice.   You’ll have to figure out for yourself with your practitioner’s help what you need for sure and also where you’re willing to compromise on your prenatal vitamin.

Things I looked for in my prenatal vitamin:

  • Does it use folate or folic acid?  I prefer L-methylfolate or another biological folate.
  • Does it have the recommended dose of iodine?  What is the source of iodine?  I prefer it to have iodine since my iodine sources are limited (I don’t tolerate eggs and dairy well.) and haven’t yet sorted through which source I feel is best for iodine.
  • Does it have selenium to accompany the iodine?  If iodine is taken, then selenium needs to be sufficient as well.
  • Is the vitamin D source from ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3)?  I prefer vitamin D3 (cholecalciferol).
  • Does it have any vitamin K2 in it?  Vitamin K2 is difficult to consume from foods, especially on a dairy-free diet, yet it is very important for health and fetal development.  Many supplements lack this.
  • Does it have the methylated form of vitamin B12 (methylcobalamin)?  I prefer this.
  • Does it have any DHA?  (A type of omega-3)  None of the prenatals I looked at contained DHA.  I made a point to eat DHA-rich foods, and if that wasn’t happening, I supplemented.
  • Does it have biotin?
  • Does it have choline?
  • What extra ingredients does it have?  I don’t see any reason for artificial colors and artificial flavors (like vanillin).  In addition, I am always on the lookout for soy, dairy, and gluten in any supplements due to some sensitivities.  I scan ingredients, also, for added probiotics or FOSs which may not agree with tummy issues.
  • What are the amounts and types of other minerals, like iron, calcium, and magnesium?  Many prenatals don’t have the recommended allowances of these, which can be okay.  However, women need to make sure they know how much of these minerals are in their prenatal vitamins so they can get their needs elsewhere if required.  Some women rely on their vitamins because of food aversions and nausea.
  • What is the vitamin A source and how much is in there?  Striking a middle ground here would probably be wise.  Not too much.  Not too little.  If you eat a lot of vitamin A rich foods, lean on the lower end in the supplement.
  • How many pills need to be taken?  Sure.  One is ideal but probably not optimal for absorption and maximizing nutrients.  For example, the calcium needs of the body cannot be absorbed in one sitting.  It needs to be spread out through the day.

Putting Criteria into Reality

I don’t have a good prenatal to recommend.  Like I said, nothing met all of my criteria.  My most recent obstetrician didn’t mind that I didn’t take a prenatal vitamin as long as I took a “folic acid” supplement.  This was a surprise pregnancy, and by the time I started looking for a prenatal, I was overcome with pregnancy maladies.  (Read:  I am making excuses for not selecting a good prenatal.)

Initially, I took a vitamin B complex with an active form of L-methylfolate made by Designs for Health along with some fermented cod liver oil since we were in the dead of a brutal winter (which would provide vitamin D, vitamin A, and DHA/EPA).  Then, I switched to a Designs for Health multi-vitamin that I already had in my cupboard which would provide some vitamin K2, iodine, zinc, biotin, and choline for baby and me, but it recommended 6 pills per day!  Right.  I was not very compliant with that.  So I eventually picked up a pre-natal from the local health food store, Rainbow Light, and made do with it, but it did not meet all my criteria.  My nutrition overall was strong and well thought out, and I felt the prenatal was more of a safety blanket for me.  Like perhaps to cover my low intake of iodine until I recognized a weak area in my diet.

I went back this week and looked at some prenatal vitamins after reading up on folic acid/folate, and I wished I had had the energy to investigate them all early in that first trimester.  But I didn’t.  So here are some of the vitamins I looked at this week that met a lot of criteria I find important.  I also listed Rainbow Light since I took it and saw a lot of women commenters on other sites mention it.

Do not use this list as a recommendation list.  Use it as a place to start looking, comparing, and contrasting which vitamin might fit you best, and always enlist the help of your physician to make sure you’re not overlooking something.

Nutrient 950 with Vitamin K by Pure Encapsulations

This is not the prenatal from the same company.  The prenatal has folic acid, not folate.

 

Emerald Labs Multi Vit-A-Min Prenatal

  • This has L-5-methyl tetrahydrofolate (L-5-MTHF), vitamin D3, iodine (although a lower amount), selenium, methylcobalamin, and biotin.
  • No DHA or choline.
  • The dose is 4 capsules.
  • With the recommended dose, one does not obtain the recommended daily doses of magnesium and calcium.
  • The ingredient list should be inspected for a person to see if there are any sensitivities to included ingredients, like quinoa and FOS.
  • One source of vitamin A is vitamin A palmitate, rather than simply relying on beta-carotene.  A reader may want to research this a bit.  Especially if they eat many food sources of vitamin A.
  • http://www.ultralaboratories.com/emeraldlabs/Prenatal%20Multi/index.php

 

Thorne Research Basic Prenatal

  • This has calcium folinate and L-5-methyltetrahydrofolate (L-5-MTHF), both biological folates. It also uses vitamin D3, iodine, selenium, methylcobalimin, and biotin.
  • There is no vitamin K2.
  • Calcium and magnesium do not reach the recommended daily doses.
  • The source of vitamin A is also palmitate (and carotenes).
  • The dose is 3 capsules.
  • https://shop.thorne.com/products/womens-health/basic-prenatal

Designs for Health DFH Complete Multi

  • Designs for Health Complete Multi has vitamin D3 (cholecalciferol), vitamin K2, natural folates (5-MTHF and 5-FTHF), methylcobalamin, biotin, choline, iodine, and selenium.
  • The calcium and magnesium are less than recommended allowances.
  • There is NO iron and no copper.
  • Its vitamin A source is carotenoids.
  • The dose is 6 capsules.
  • http://catalog.designsforhealth.com/DFH-Complete-Multi

Optimal Prenatal Vitamin/Vitamin Powder

This vitamin is out of stock reportedly due to popularity, but there is a protein powder designed to be interchangeable.  They are working to get the vitamin back in stock.

Rainbow Light

Rainbow Light is a food-based multivitamin, vegan compliant.  It is what I landed on for a prenatal vitamin due to chance, and it gets good reviews on-line.  It misses some of my criteria.  I landed on it, but I don’t think it’s the best.

  • It’s vitamin D source is D2 (ergocalciferol).
  • It has no vitamin K2.
  • It does not have the methylated form of vitamin B12.
  • It uses folic acid.
  • On the other hand, it does have iodine, choline, and biotin.  It also contains iron.
  • The calcium and magnesium content, like the other brands, is less than the recommended daily doses.
  • It has some added ingredients, like red raspberry leaf, ginger, spirulina, probiotics, and digestive enzymes for readers to investigate.
  • http://www.rainbowlight.com/multivitamins-prenatal-one-multivitamin.aspx

 Conclusion

I think this is a good list of prenatal vitamins/multi-vitamins to start to check out.  Do readers have any others (and thanks to those who gave suggestions)?  Remember, it’s all a game of checks and balances.  Start with a good, strong, well-planned pregnancy diet and make sure your supplement does that–supplements the gaps in your diet.  Run all of your supplements by your doctor.

All the best to you for a happy, healthy family!

~~Terri

 

 

 

13 thoughts on “Thoughts on Choosing a Prenatal Vitamin

  1. All Seasons Cyclist

    Very thorough product review! By the way, our first grandchild should be here on Thursday (they are going to induce our daughter-in-law on Thursday evening). I guess this means that my wife will be a grandmother, but I am still too young to be a grandfather (my wife still tells me to “grow up” all the time).

    Reply
    1. thehomeschoolingdoctor Post author

      I knew it was coming soon! I am so excited for you, your son, your wife, and daughter-in-law! You are too young to be a grandfather. They’ll probably make you hold the baby with a pillow behind it’s head, if they let you hold it at all. 🙂 I can’t wait to hear that all goes well on Thursday. ~~Terri

      Reply
  2. Lindsay

    As usual, reading your post was like reading my mind. Except that I hadn’t gotten around to finding any decent prenatal candidates! I ended up taking a Freeda prenatal with folic acid just because it was what I felt safe with, given my super sensitivity to gluten cross-contamination. It wouldn’t be ideal, but I was too worn out to find a great alternative! I take their vitamin D3, too. I also eventually (once I got around to reordering) took their mag glycinate and K2.

    I had, before I was pregnant, been taking the SCD complete multi from GI Pro Health. Mostly because I decided to try it with the SCD starter pack awhile back. I don’t remember all the details, but I know it had L-5-MTHF in it. No iron and no K2, definitely not enough mag for me. Seems pretty expensive, but at least should be stellar from a gluten free standpoint. It’s not technically a “prenatal”, and it requires 6 capsules a day. I’m kind of thinking I should have stuck with it during pregnancy instead, since I ended up taking extra K2 and mag anyway. Hindsight…

    I tried taking FCLO on and off. I’ve been able to take some of the capsules now, but there was no way I was even going to be able to choke down the capsules during the first trimester. We tried liver last night, as I’ve been meaning to for the last nine months. There’s just no way, even now that I’m waaaay past the first trimester. So I guess I just fail at the best food sources of nutrients!

    Thanks for all your research 🙂 Hope you and baby are doing spectacularly!!

    Reply
    1. thehomeschoolingdoctor Post author

      “…It wouldn’t be ideal, but I was too worn out to find a great alternative!” Exactly! I know what you mean! And throw in a celiac wrench, and it must be so tough for you!

      Tell me about the mag glycinate (if you check back on comments) if you get a chance. Why that form…is it for GI or other…

      I, strangely, was able to get down liver the whole pregnancy. But for some reason, any pill in the first trimester and a half seemed completely not doable! Even the vitamin B complex I took then just about seemed like Mt. Everest every day! Pregnancy is just so crazy! Ideally, all the nutrient tank would be optimized before that first trimester! Right?!

      We are doing great here! ~~Terri

      Reply
  3. IrishMum

    Great information, pity it’s at least 9 years too late for me. Maybe I should have another baby, just so I can take a prenatal vitamin and use all your wonderful information 😉

    Reply
  4. rachelmeeks

    I’ll be shopping for a new brand soon – I’m just too poor at the moment to toss out the kind I already have even though I hate them. BUT I’m also not even pregnant yet so hopefully no harm no foul. I’ll definitely have your list pulled up on my phone when I go back. 🙂

    Reply
  5. Rachael @ mummyflyingsolo

    Thorough as always Terri! My doc is a massive fan of the Thornes. She is very insistent on it in fact because of the folate I believe. Interesting to know where it lacks -though i wonder how much more supplementation I can take? Lol

    Reply
    1. thehomeschoolingdoctor Post author

      If your fingernails turn waxy, it’s from the cellulose in your supplement capsules. (Completely joking.) Thanks, Rachael.

      I think the Thorne looks great too. It really isn’t lacking a whole lot, comparatively. I’d feel good about taking that one.

      Happy weekend to you!

      Reply
    1. thehomeschoolingdoctor Post author

      Send me the spreadsheet when it’s done.

      (Joke)

      Anyhow:

      I think the vitamin D source in this is especially nice for vegans/vegetarians, as it fascinatingly comes from a lichen. Some people don’t like seaweeds due to contaminants and such. I don’t fret much about that too much, although a little (sometimes 🙂 ). I always try to eat food first, so I still like salmon (the gray part) and liver for D.

      The vitamin K2 is about par on course with other premium-in-the-know prenatals. I’d like to see more in quantity and maybe as we learn more, more in the kinds of K2 (there are more than MK-4 and MK-7). I’m thinking pre-conceptual women should be boosting their K2. But as far as prenatals, it’s in the game. I still want to try to eat grass-fed butter, grass-fed yogurt, aged cheeses, eggs, and liver for K2.

      The vitamin B12 as methylcobalamin is the physiologic form. Check. The source of this is not clear to me, but I think it is from bacteria based on Furhman’s comment left on the Amazon reviews. Passes for me.

      Iron: Dose is appropriate. Some studies say don’t want too much. But this amount is fine. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072758/ Quickly googled this certain type of iron in the formulation; seems fine.

      Iodine: From kelp. Some people don’t like kelp. I’m mixed. Some people worry about the consistency in amount of iodine and also in contaminants (which would be true of the calcium in this preparation from Aquamin, I suppose). So depends on who you ask. You asked me, though, didn’t you. Hmm. Passes for me. (However, I think more iodine is needed than this amount but it should start well before pregnancy and the person should be monitored by doctor. See my iodine series/page.)

      Magnesium: Fine. Glycinate is really nice. Oxide not so much.

      Lack of folate: I just don’t like it. Even with the really nice message that we should be eating the sources of all these things in beans, greens, vegetables. That’s true for each nutrient. We should each endeavor to feed our bodies natural, fresh, mostly whole food sources of all these things. I wish a good quality folate would be added.

      Lack of DHA: Totally with you. I don’t like that either. Pregnant women and their babies need omega-3s (that’s the DHA).

      For the most part, it seems like a good quality ingredient vitamin with gaps in the folate, omega-3 (DHA) areas. Also no choline. Low in selenium, magnesium, and calcium–but since women should be eating these in other sources, it’s probably fine, although as the iodine goes up, I like to see the selenium go up with it as they work “together.” I quickly tried to look at each of the kinds of vitamins/minerals that were used, and I saw no glaring issues that bothered me.

      I’d encourage women/men to just really, really focus on whole, real, fresh foods. Try not to fret too much about macronutrients like fat, carbohydrates, and protein (unless you really feel like you need to–and some may need to and I know that) and really, really try to incorporate greens (spinach, kale, Romaine, arugula), power veggies like broccoli and cauliflower, almonds/Brazil nuts/walnuts/macademias/peanuts (as tolerated), power fruits like blueberries/mangoes/cherries/oranges/etc, the most naturally fed animal products you can (pasture-fed beef, free-to-roam the farm chickens and their eggs, pasture-fed lamb, pigs free to root in a big area and fed appropriate substances like nuts and apples, wild-caught seafood that isn’t too heavy in metals), dairy that is the least processed you can get (but raw milk worries me) which usually means it comes with its fat and fat-vitamins included, and grains and seeds which you know suit your body and which are as freshly ground as you can get—fresh ones, I believe, are very good for health. When you know you have food sensitivities or choose to have diet restrictions, then make sure you know exactly what your supplement regimen will need to be. Ask for help if needed.

      And lastly, from out of nowhere, on vitamin E. Studies have scared on vitamin E and pregnancy. But I think vitamin E is important, but not via supplementation. From nuts and seeds. Liver. Whole, real foods. I tracked some people’s nutrition daily, and every day they were low on vitamin E, potassium, and often magnesium. So that just stuck in my head. But again, I like whole food.

      Jake, I don’t know if I offered you anything. Sounds like you’re on this. The best to you.

      Anyone reading, always fact check and confer with your favorite, concerned health care provider.

      Terri

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s