What You Should Know About Your Prenatal Vitamins

The world of prenatal vitamins is a busy one, and the aisles of our local pharmacies can be a daunting place. What's safe to take? What's best to take? When should I start taking what?

With a growing health awareness amongst pregnant women, more of us are wanting to know exactly what's going into our vitamins, and why.

So we asked naturopath and women's health and fertility specialist Lucy Fitzgibbons a thing or two about the world of prenatal vitamins, and why investing in good quality supplements is always worth it.

"Having fewer, but higher quality supplements is preferable to one that 'has it all'." – Lucy Fitzgibbons

What are your top tips for choosing a good quality prenatal multivitamin?

There are 3 main criteria I use when looking for the perfect prenatal supplement:

1. How much of each nutrient is actually in the vitamin?
   Formulations that include a lot of nutrients, but at token amounts won't be too helpful here. So it's important to read the label carefully. Does the formulation contain a therapeutic dose of the essential nutrients?
2. Look for quality forms of the nutrients included.
   Is the nutrient included in an easy to absorb form, or has a cheap, synthetic version been used instead? The latter is more common than you'd think. Quality forms will be gentler on your stomach, with some synthetic forms causing more irritation, nausea and stomach problems than you'll want in pregnancy.
3. Where is the vitamin made?
   Australian supplements adhere to TGA guidelines, which ensure the most stringent manufacturing standards are upheld. If it's made in Australia, you know that what's on the label is what you are getting. American supplements are regulated under 'food' guidelines which does not give me confidence that supplements will have a therapeutic effect.

What are the essentials you'd always recommend?

Having fewer, but higher quality supplements that are suited to your needs is more preferable to one that 'has it all'.

The key nutrients I look for in a prenatal are:

1. Activated folate (folinic acid, calcium folinate, levomefolate calcium, quatrefolic, 5-MTHF) over folic acid
   These activated forms are the top quality supplemental forms of folate, and for good reason. They're the closest thing we have to the food form of folate. They provide the easiest pathway to absorption in the body, and the fastest way to raise maternal folate levels, which is important to decrease the risk of neural tube defects.
2. Choline
   Look for a prenatal that contains choline. This lesser known B vitamin is equally as important as folate in preventing neural tube defects, with a growing body of scientific literature supporting its essential role in foetal development.
3. Zinc
   Zinc is required for over 300 essential functions in the body. In pregnancy it's important for the construction of baby's cells, supporting the immune system and reducing poor maternal outcomes.
4. Iodine
   This essential nutrient for foetal growth and development has an increased requirement of more than 45% in pregnancy. It's required for maternal thyroid hormone production, which is needed for normal foetal brain development.
5. Vitamin D
   The recommended daily dose of Vitamin D in pregnancy ranges from 400IU–2000IU. It's important for foetal bone development, and maternal health. Adequate levels are an important factor in establishing a pregnancy. Yet some supplements tick this off the list by including as little as 200IU. You would probably get more Vitamin D walking from your home to your car.
6. B vitamins
   Adequate B vitamin levels are required to perform a number of supportive roles in pregnancy. Best taken in conjunction with other Bs, these vitamins are known for supporting foetal brain development, preventing congenital heart defects and treating molecular deficiencies which can cause miscarriages and birth defects. From a maternal health perspective, the Bs provide a natural energy lift, ease discomforts associated with leg cramps, moderate moods and alleviate symptoms of nausea and vomiting.
7. Selenium
   There's growing evidence to suggest maternal selenium levels influence pregnancy outcomes. In particular, supplementation may help prevent miscarriage, preterm labour, preeclampsia, gestational diabetes, postpartum thyroiditis and neural tube defects, amongst other conditions.

Additionally, consider including Omega 3 DHA in your routine, as 90% of Australian women don't meet DHA requirements during pregnancy, and probiotics, particularly the well researched strain LGG Lactobacillus Rhamnosus, which is recommended to reduce the risk of infant eczema.

Any advice on nutrients to consider further before routinely supplementing?

1. Iron
   I try to avoid prescribing iron in the first trimester, as it can worsen nausea. But if you find you need to supplement here, I recommend taking iron separately from your multi, as this way it will be better absorbed. Also look at the form of iron used in your supplement. Avoid any that uses ferrous fumarate, as this causes constipation and irritation. Instead, opt for a more tolerable form, such as iron bisglycinate, which is gentler on the stomach.
2. Copper
   I'd avoid prenatal supplements that include copper. Copper naturally rises during pregnancy and supplementation may be unnecessary, as too much copper can displace zinc, and a zinc deficiency in pregnancy can be harmful.
3. Magnesium
   Check which form of magnesium your prenatal includes, and avoid magnesium oxide. This form is a laxative, and is not useful for increasing magnesium levels. Instead, opt for forms such as magnesium citrate, magnesium amino acid chelate or magnesium bisglycinate.
4. Minerals interact with one another
   Minerals can affect one another's absorption when taken together, limiting their overall effectiveness. They can essentially cancel one another out. The most obvious example is taking calcium and iron together in a multivitamin, which I don't recommend. Best taken separately, it's worth looking out for a multi that doesn't list both ingredients in their formulation.

There's lots of advice out there, but if you're finding it hard to find your way, it's helpful to nut this out alongside a health practitioner. Depending on the person and their blood test results, I'll advise if they need additional supplementation beyond the above key nutrients. But in most cases, consider the above a guide to good prenatal support, which can be found in quality prenatal multivitamins.