Prenatal vitamins and minerals

Prenatal multivitamin: Indications, Side Effects, Warnings

What are prenatal vitamins?

Can you take prenatal vitamins if you are not pregnant?

The word prenatal itself denotes anything relating to pregnant women and their unborn child. Prenatal vitamins are important part of prenatal healthcare. These basically consist of range of vitamins and minerals that are vital for the healthy development of the baby. These are similar to other multivitamins that are usually available in market but the composition is different.

Why prenatal vitamins are important?

According to American Dietetic Association, prenatal vitamins have been recognized for the healthy pregnancy outcome. These vitamins should be an important part of the child bearing women, not only to have a safe pregnancy but also these help to cover any nutritional gaps in the mother’s diet. It also aids in filling up the deficiencies of mother’s body. The fetus during this time period, if supplied with the required nutrients in sufficient amount, will lead to the healthy proper development of the organs and body parts.

Those mothers who are going through a complicated pregnancy or suffering from other health issues concomitantly are often prescribed to take these vitamins on a regular basis. Many women, start taking these vitamins just before conceiving as it makes easier for the woman to conceive when her body is sufficient in nutrients. Neural tube defects such as Spina Bifida can develop in an embryo even before a woman comes to know about her pregnancy.

What’s in a prenatal supplement that I can’t get from food?

Prenatal vitamin combinations that are available in market are variable, each depending on the nutritional focus. For instance, one manufacturing company have prepared the combination focusing on the anemic pregnant women thus keeping the iron content in the combination a slightly higher in amount than other minerals and vitamins.

Obtaining nutrients from food should be the first priority, but because nowadays food that is available is processed. During the processing of food, certain important vitamins and minerals are removed and if the expecting mother constantly consumes processed food, she might get deficient in vitamins. However, certain important compounds needed by the body are not available in these multivitamin supplements, such as fiber. These are available only through food. It is important to bring this in the knowledge of child bearing mothers that these prenatal vitamins are not used to correct a poor diet; instead it supplements a good one.

Folic Acid use during Pregnancy

Folic acid is a synthetic derivative of a B vitamin, folate. Folate helps in the production of red blood cells and helps in the development of the spinal cord and brain of the fetus. Birth defects especially due to folate deficiency occur within the first 3-4 weeks of pregnancy, thus making it necessary to have enough folate in body before this phase to prevent any defects.

Pregnant women are at increased risk for folate deficiency due to too little stores, increase maternal, fetal demand on folate stores and inadequate dietary sources. During pregnancy, the daily requirement for folate increases from 100-150µg to 200-400µg.  The CDC recommends that the woman should start taking folic acid every day a month before getting pregnant and on a daily basis during pregnancy. During the forth – ninth month of pregnancy the recommended dose is increased up to 600 µg. Good sources of folate are green vegetables. Folic acid itself helps the body with production and maintenance of new cells and helps to prevent any possible changes in DNA that would lead to cancer. Folic acid has been consigned in A pregnancy category by FDA. It is also used to treat megaloblastic anemia. Studies have failed to reveal any harm caused by Folic acid to the mother or child when the dose is increased. However if the mother is deficient in folic acid, it may lead to problems of brain (anencephaly) and spinal cord (spina bifida). Folic acid is actively excreted and colostrum and breast milk but no adverse effects have been observed in infants feeding on mothers’ milk.

Iron use during Pregnancy

In those who have reached puberty, gradually the iron stores become depleted and reach on the lower end of the margin. This is due to the loss of iron from the body due to menstrual cycle. According to the survey conducted by WHO, an estimated 35-75% of women in developing countries and 15% in industrialized nation get anemic during their pregnancies. The requirement of iron in body increases during pregnancy by almost 1g, over the normal body store of 2- 2.5g in adult women. Iron is needed most during the early second trimester and peaks in the second half of pregnancy. Fetal and placental requirement for iron stores are met according to the need, even if the mother is anemic the fetus will not suffer. If iron stores are depleted or very low, then iron is not available for the synthesis of red blood cells (RBCs), the maternal RBCs won’t increase, hence decreasing the hemoglobin. During pregnancy, dietary sources and maternal stores alone are not sufficient to meet the pregnancy demands. In later pregnancy, stores are exhausted. It becomes a necessity for the mothers to be to take supplemental iron too. For a pregnant woman, 27mg of iron are required per day. Iron has been categorized under the pregnancy category C, which means that it should only be administered when benefits dominate over risks. Use is contraindicated in the first trimester of pregnancy. Moreover, if the daily intake is more 45mg, it will cause the blood levels of iron to rise increasing the chances of bringing harm to the mother or child or even both. According to studies, increase in serum iron levels has caused gestational diabetes or oxidative stress that has thought to play an important role towards the infertility, preeclampsia and even miscarriage.

Calcium use during pregnancy

Calcium is the most abundant mineral present in the body which is necessary for various functions such as bone formation, muscle contraction, enzyme and hormone functioning. Calcium absorption is maximum during the period of pregnancy. A dietary intake for calcium of 1200mg/day is recommended by WHO and FAO. Inadequate consumption will cause the calcium stores to deplete over time when the demand increases. As a result of depletion of Calcium, severe adverse effects are observed on mother and fetus. These effects include osteopenia, tremor, muscle cramping, paresthesia, delayed fetal growth, poor fetal mineralization and low birth weight. Calcium also reduces the risk of hypertension and preeclampsia. If the intake of calcium mineral is not available then the babies will take it from mother’s bones leading to the impairment in mother’s bones. In babies, it helps to develop a normal heart rhythm and blood clotting abilities. Supplemental calcium should not increase more than 500mg. It comes in different salt combinations such as Ca citrate, lactate, gluconate etc. All pregnant women, particularly those having hypertension and osteopenia in their family histories should take these supplements daily, esp. from 20th week of pregnancy till the end. However, like iron, Calcium is also assigned under pregnancy category C, only prescribed when benefits are more as compared to risks. A total intake of calcium from food, supplements and even water should never exceed 2500mg per day otherwise it will cause constipation, iron and zinc absorption is hindered and increases the chance of formation of kidney stones in mother.

Vitamin D use during pregnancy

Vitamin D is a steroid vitamin and derived from water soluble, pro-hormone. The most important subtypes of vitamin for the development of human are vitamin D2 and D3. Vitamin D2 is responsible for the absorption of mineral including Calcium, iron and zinc from the stomach, whereas vitamin D3 is commonly present as supplements. Vitamin D is a vital component in the prenatal vitamins. Women bearing child should be given these supplements not only for their own well being but also for the complete development of baby’s organs and body parts. According to the studies, vitamin D has proved to be beneficial in immune system, healthy cell division and better bone formation. It is usually given along with Calcium supplements to enhance their absorption and metabolism. Most prenatal vitamins contain about 400IU. High risk women are advised to take at least 1000 units each day. High risk population includes those which have increased skin pigmentation, are minimally exposed to sunlight or are obese. Deficiencies of vitamin D have been recently contributed towards preeclampsia, gestational diabetes, preterm birth, and low birth weight. Sunlight is the major source for vitamin D. According to FDA, it has been allotted under category C, limiting its ucalcse only when there is deficiency and according to the case of the patients, benefits outweigh risks. Babies born with vitamin D deficiency develop rickets gradually if no measures are taken to fill the gaps. Low maternal vitamin D levels have also caused fetal lung development failure and childhood immune disorders such as asthma. Hypovitaminosis D is also associated with impaired glucose tolerance and has caused diabetes in general population. Studies have reveled fetal abnormalities when vitamin is taken in excess. Abnormalities similar to supravalvular aortic stenosis syndrome are developed in babies. A major drawback is that the precise amount of ingested vitamin D and time of exposure to sunlight that will cause hypervitaminosis D is not known to any degree of certainty. So when the diet is balanced, supplementation is not required. How does vitamin D aid in calcium absorption?

Vitamin E use during pregnancy

Vitamin E is an anti-oxidant which means that it slows down the processes that damages the cells of our body. This allows for the proper function of many organs in the body.

Vitamin E usage in pregnancy helps avoid gestational diabetes and preeclampsia in the mother. In the fetus, it helps maintain cellular structure and this is vital since at that stage the cells are dividing very rapidly. There is also decreased incidence of low birth weight babies with vitamin E usage. It also promotes eye development.

Recommended dose in pregnancy is 400 IU with vitamin C 1000 mg daily. Taking excess vitamin E may cause harm to the mother and fetus. Similarly since it is excreted in human breast milk, it should not be taken when breastfeeding premature babies.

Vitamin E shows interactions with the following drugs

  • Warfarin, heparin, anti-platelets such as clopidogrel and NSAIDs such as aspirin: Vitamin E may increase the risk of bleeding when taken with these drugs
  • Cyclosporine: Vitamin E increases the absorption of cyclosporine. This will cause increased side effects of cyclosporine on the body
  • Medications metabolized by the: Vitamin E increases metabolism of these drugs, as a result more drug will now be required for achieving the same effect.
  • Medications for cancer (Chemotherapy): Vitamin E decreases their effect on the body as it is an anti-oxidant.
  • Medications used for lowering cholesterol (Statins and niacin): Exact cause is unknown

Thiamine use during pregnancy

Thiamine or vitamin B1 is a water soluble vitamin which combines with adenosine triphosphate (ATP) to form a coenzyme, thiamine pyrophosphate, which is required by our bodies to properly use carbohydrates

During pregnancy, it plays an important role in the development of fetus, particularly the development of nervous system. It is also given during the management of hyperemesis gravidarum (uncontrolled, intractable vomiting during pregnancy).

Thiamine has been put into pregnancy category A by FDA i.e.it should only be used during pregnancy when benefit outweighs risk. The recommended daily allowance (RDA) for thiamine during pregnancy is 1.4 mg/day (regardless of a woman’s age). Women carrying twins or more fetuses need to take more. Thiamine is not excreted in breast milk so it may be taken in lactation without fear of harming the baby. Natural food sources of vitamin B-1 include pork, peas, pastas, yeast, and even some dairy products.

Vitamin B1 shows interactions with antihypertensive and antidiabetic drugs. In both cases the effect of these drugs is enhanced which will result in hypotension and hypoglycemia respectively. Minor interactions may be seen with P450 inhibitors since thiamine is metabolized by liver.

Riboflavin use during pregnancy

Riboflavin, or vitamin B2, functions as a coenzyme, meaning that it is required for enzymes of our body produce energy.

It is a water-soluble vitamin that promotes your baby’s vision, growth, and healthy skin. It is also needed for the muscle, bone, and nerve development of the fetus.

Usually you can get all the vitamin B2 you need through your diet as it can be found in certain foods such as milk, meat, eggs, nuts, enriched flour, and green vegetables. Riboflavin is LIKELY SAFE for mother and baby when taken in the amounts recommended. The recommended daily dose for pregnant women is 1.4 mg per day and 1.6 mg per day for breast-feeding women. When taken by mouth in larger doses and for short-term only, riboflavin is POSSIBLY SAFE. Some studies argue that riboflavin is safe when taken at a dose of 15 mg once every 2 weeks for 10 weeks.

Vitamin B2 shows interactions with the following drugs

  • Drying medications (Anticholinergic drugs): These drugs increase the time riboflavin stays in the intestine increasing its absorption.
  • Medications for depression (Tricyclic antidepressants): After chronic use of these drugs, they decrease the amount of riboflavin in the body.
  • Phenobarbital: It increase how quickly riboflavinis broken down in the body
  • Probenecid: It increases absorption of riboflavin in the body

Niacin use during pregnancy

Vitamin B3, also called niacin, is present in two forms – nicotinamide and nicotinic acid. Both compounds are precursors of the coenzymes  NAD and NADP. NAD is important in catabolism of carbohydrate, protein, fat, and alcohol, as well as cell signaling and DNA repair, and NADP is important in anabolism reactions such as fatty acid and cholesterol synthesis.

During pregnancy niacin helps ease nausea, subside a painful migraine and improves digestion. It is also beneficial for the fetus as it helps to keep the skin, nervous system and mucous membrane healthy and is critical for brain development.

The recommended amount of vitamin B3 during pregnancy is 18mg per day but you can take up to 35mg per day. Intake of more than 35mg has not been studied in pregnant women, therefore it is not recommended. The U.S. Food and Drug Administration (FDA) assigns oral niacin Pregnancy Category C meaning that it has not been fully studied on pregnant humans and animals.
Niacin shows drug interactions with the following drugs:

  • Alcohol
  • Allopurinol
  • Carbamazepine
  • Clonidine
  • Antidiabetic drugs
  • Medications used for lowering cholesterol such as Statins, ezetimibe, and bile acid sequestrants such as colestipol
  • Primidone
  • Probenecid
  • Aspirin

Vitamin B12 use during pregnancy

Vitamin B12, also called Cobalamin, also functions as a coenzyme, meaning that its presence is required for enzyme-catalyzed reactions.

Vitamin B12 has several functions when given to a pregnant mother. In the mother, it is essential for the synthesis of fatty acids and myelin, which help in maintaining the normal neurological function and central nervous system (CNS). It aids in harvesting energy from food substances by metabolizing carbohydrates, proteins, and fats and thus improves your mood, energy levels and stress levels when you are expecting. In the growing fetus, it aids in functioning and development of red blood cells, brain, and nerves and at micro level plays role in DNA synthesis. It also plays a major role in fetus brain development and neural tube formation

The recommended daily dose of vitamin B12 is 2.6 mg during pregnancy and taking vitamin B12 along with folic acid is effective. Natural food sources for vitamin B12 include milk, eggs, meat, fish, poultry and shellfish.

The only major drug interaction of vitamin B12 is with chloramphenicol. Vitamin B12 is needed for producing new blood cells whereas chloramphenicol might decrease new blood cells. So taking chloramphenicol for a long time might decrease the effects of vitamin B12 on new blood cells.

Zinc use during pregnancy

Zinc is another trace mineral present in many foods. It is required by over 200 metalloenzymes, including carboxypeptidase A, carbonic anhydrase, alkaline phosphatase, alcohol dehydrogenase and RNA polymerase. It is also required to maintain structure in cell membranes, proteins, and nucleic acids.  Physiological functions that are dependent on zinc include cell growth and division wound-healing, host immunity, sexual maturation and reproduction, dark adaptation and night vision, taste acuity, and possibly olfactory acuity

The recommended daily allowance of zinc during pregnancy is 11 mg; although the upper intake limit is 40 mg. Red meat and fortified cereals are good sources of this nutrient. Shellfish, poultry, beans, nuts, whole grains, and dairy products are also other natural sources for zinc.

Zinc interacts with the following drugs:

  • Tetracycline and Quinolone antibiotics: Zinc might decrease how much antibiotic the body absorbs. If you’re taking zinc, take antibiotics at least 1 hour after.
  • Cisplatin: It is a chemotherapeutic drug- zinc increases the effects and side effects of cisplatin
  • Penicillamine: Penicillamine is used for rheumatoid arthritis and Wilson’s disease. Zinc decreases the amount of penicillamine your body absorbs and decrease the effectiveness of penicillamine.
  • Amiloride: It is a diuretic. It increases the amount of zinc that is present in the body.

Iodine use during pregnancy

Iodine is used by the thyroid gland for iodination of thyroglobulin molecule, which is then broken down by enzymes to release thyroid hormones. These hormones play an essential role in the development of CNS, skeletal system and muscles. These hormones also play a vital role in metabolism. So deficiency of iodine will result in hypothyroidism, short stature and course facial features.

The recommended daily allowance of zinc in pregnancy is 220 mg and 290 mg for lactating/breastfeeding women.  Iodine is LIKELY SAFE when it is taken in recommended amounts by the oral route; however Iodine is POSSIBLY UNSAFE when taken by mouth in high doses.

prenatal vitamins and minerals in pregnancy

Iodine interacts with the following drugs:

  • Antithyroid drugs: Taking iodine along with antithyroid might decrease the thyroid too much
  • Amiodarone: It contains iodine so taking iodine supplements along with amiodarone might cause excess iodine in the blood.
  • Lithium: Lithium causes hypothyroidism. Simultaneous use of lithium with iodine may have synergistic hypothyroid effects.
  • ACE inhibitors, Angiotensin receptor blockers (ARBs) and potassium sparing diuretics: These classes of drugs cause potassium retention. Most iodine supplements contain potassium therefore concomitant use of potassium iodide along with these drugs might cause hyperkalemia.

Essential fatty acids use during pregnancy

Essential fatty acids are those fatty acids that cannot be produced by the body so they must come from your diet. The two primary EFAs alpha-linolenic acid (omega-3) and are linoleic acid (omega-6).

Omega-3 fatty acids are essential for fetal CNS and PNS development, the timing of gestation and birth weight of the baby.  Omega-3 fatty acid eicosapentaenoic acid (EPA) may play an important role in DHA transplacental transport and intracellular absorption

Docosahexaenoic acid (DHA), an omega-3 fatty acid is a major structural fat in the human brain and eyes. About 93% of all omega-3 fats in the retina and 97% of all omega-3 fats in the brain are DHA.

It is particularly important during the third trimester of gestation and up to 18 months of life.

Another thing to keep in mind is that the balance between omega-3 fatty acids and omega-6 acids is important too.

Pregnant women likely have an increased need for essential omega-3 fatty acids compared with women who are not pregnant. Fish is an excellent source of both EPA and DHA, but its serving is restricted to 2 per week due to risks of mercury poisoning. Each serving should not exceed 6 ounces and may contain shrimp, salmon, pollock, catfish, scallops, or sardines.

A good alternative are the fish oil supplements, which contain either both EPA and DHA, or DHA alone. Algae-derived DHA-only oils are good, mercury-safe means of supplementing the diet of a pregnant woman.

When should I start taking prenatal vitamins?

It is recommended that you should start taking prenatal vitamins even before you are pregnant. This ensures that the health of the mother is at an optimum level even before she conceives. Taking them while you’re trying to conceive is always great and has proven to decrease the prevalence of congenital anomalies. Usually mothers are already taking one of the many multivitamins available OTC. Although this too is sufficient before pregnancy, but once pregnancy is confirmed, you should switch to pregnancy-specific vitamins since they contain the right amount of each vitamin unlike the other multivitamins which are known to have decreased amount of folic acid.

However, if you’re pregnant, and have not started taking your vitamins, and are now panicking by reading the above paragraph, then please don’t. All is not lost- there are a number of people who are not taking prenatal vitamins when they find out that they are pregnant. The best course of action is that you should just start immediately.

Do prenatal vitamins have any side effects?

All medicines may cause side effects, but majority of mothers who are taking prenatal vitamins have no, or just minor side effects. Consult your doctor if any of these most common side effects persist or become bothersome:

  • Constipation
  • dark or green stools
  • diarrhea
  • loss of appetite
  • nausea
  • vomiting
  • stomach cramp
  • pain
  • GI upset

Serious side effects with these vitamins which are reported by less than 5% of all mothers taking these vitamins:

  • Severe allergic reactions characterized by any of the following: rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue
  • black, tarry stools
  • blood or streaks of blood in the stools
  • fever
  • severe or persistent nausea
  • stomach pain
  • Vomiting; vomit that looks like blood or coffee grounds.

Please note that this not a complete list of all side effects that may occur. Therefore it is recommended that you report your doctor or midwife any of the side effects which you feel are due to these vitamins.

Can prenatal vitamins upset my stomach?

Prenatal vitamins, particularly iron may cause GI disturbances in some mothers. These disturbances vary in intensity. Common disturbances include diarrhea, flatulence, bloating, dyspepsia or nausea. However due to the immense importance of these vitamins for the fetus, it is never recommended to leave your prenatal vitamins to stop these side effects. The recommendations which are given in such a case are as follows:

  • Change your brand.
  • Try taking them after a meal rather than on an empty stomach.
  • Dairy products interfere with the absorption of vitamins and minerals; therefore avoid taking your vitamins with milk.
  • Smoothies made without dairy or Juices with no added sugar maybe used more often. The juice, a liquid can help reduce constipation the prenatal vitamins may cause. Similarly, smoothies made with fruit add fiber, which also help relieve constipation.
  • Iron is the most offensive agent out of all the prenatal vitamins. Anemic women do not need more than 30mg of iron per day. So reducing the amount of iron in a non-anemic patient is also desirable.

What if my Prenatal Vitamin Makes me Nauseous?

The common nausea causing ingredients in prenatal vitamins are iron and folic acid.

During pregnancy, your blood volume increases by about one third so extra iron is need for extra blood production. Without it you will face symptoms of anemia such as fatigue and lethargy. The folic acid is included to reduce the risk of birth defects of the brain and spinal cord. So it is essential to take your vitamins, but to reduce the feeling of nausea following can be done.

  • If you are not anemic and your vitamin contains extra iron, switch to one with less
  • Break the tablet in half and take it in divided doses
  • New studies indicate that vitamin B6 helps relieve nausea in some women during pregnancy so make sure that your prenatal vitamin contains vitamin B6.
  • Finally, if you just can’t stomach prenatal vitamins, try to make sure you at least get you take 400 micrograms (mcg) of folic acid daily if you’re trying to get pregnant, and 600 mcg when you are pregnant. Use various calculators present on the internet to calculate whether you are taking sufficient iron and folic acid in your diet.

Prenatal vitamins interactions with other drugs

A list individualized of drug interactions is given in the description of the various vitamins and mineral above, however for convenience purposes we have made a list of drugs which will cause interactions with your prenatal vitamins.

Known drug interactions of prenatal vitamins exist with methyldopa, chloramphenicol and other vitamin/nutritional supplements. It decreases the absorption of other drugs such as penicillamine, levodopa, bisphosphonates (for example, alendronate), quinolone antibiotics (for example, ciprofloxacin, levofloxacin), thyroid medications (for example, levothyroxine), and tetracycline antibiotics (for example, doxycycline, minocycline).

If your multivitamin also contains folic acid, inform your health care provider if you take anti-seizure drugs.

Contraindications during prenatal vitamins and minerals use

Prenatal vitamins are contraindicated when mother has any of the following conditions:

  • Diverticular Disease
  • Ulcer from Stomach Acid
  • Ulcerated Colon
  • Inflammation of the Lining of the Stomach and Intestines
  • Several Blood Transfusions,
  • Iron Metabolism Disorder causing Increased Iron Storage
  • Increased Bodily Iron from High Red Blood Cell Destruction, Hemolytic Anemia
  • Known allergic to iron supplements

Why is vitamin A harmful for the baby? Are there any other vitamins that can harm my baby?

Vitamin A is needed for epithelial growth. Its deficiency leads to xeropthalmia of eyes, anemia, and lowered immunity. In children it causes growth retardation and development. However a problem arises when vitamin A is consumed too much.

Studies have shown that taking an excess amount of vitamin A in pregnancy may cause congenital anomalies that include deformities of the skull, eyes, heart, and lungs. These studies were performed using very high amounts of water-soluble, synthetic forms of vitamin A which is from non-food sources

A number of food products are fortified with preformed vitamin A, therefore pregnant women should avoid so the best way to avoid this teratogenic effect is avoid synthetic forms and take it from food sources (A number of food products are fortified with vitamin A). If vitamin A is present in other multivitamins or prenatal supplements that contain more than 1,500 mg (5,000 IU) of vitamin A, then those supplements should be replaced with other supplements immediately.

Apart from vitamin A, no other vitamin is known to cause fetal anomalies.

Is beta carotene during pregnancy safe?

Vitamin A exists in two forms. Preformed vitamin A and provitamin A carotenoid.

Performed vitamin A, also called retinol or retinoids, are found in animal products, such as milk, eggs, liver, fortified food products and vitamin supplements, including prenatal vitamins.

Caroteniods are found in carrots, cantaloupes, spinach, kale and sweet potatoes. Beta-carotene, alpha-carotene and beta-cryptoxanthin are the caroteniods that can be converted to vitamin A in the body include. Beta-carotene is generally the preferred carotenoid for vitamin A consumption, because it is converted to vitamin A more efficiently than the other carotenoids and hence the most safe for use in pregnancy.

Is Vitamin A Dangerous for My Pregnancy and Baby

What if I accidentally take two prenatal vitamins on the same day?

Accidentally taking two prenatal vitamins in a day is actually not that uncommon. A number of women do that. The good news is that doing so is pretty harmless as long as you don’t make it a habit. Even vitamin A is harmless if this accident happens 1, 2, or 3 times in a pregnancy, and that is one vitamin that is actually teratogenic when taken in excess.

Our bodies are designed to absorb only a fixed amount of nutrients that we eat. The rest is defecated. And even if an excess is absorbed, then our kidneys filter out the blood of those nutrients, so all that extra vitamin is excreted as urine. Therefore two vitamin pills for one day have no effect on either the mother’s body or on the fetus.

An easy way to overcome this problem is to buying a small 7 day pill-case. Each case has about 7 compartments, one for each day. Fill up that case every 7 days, and if you see that the compartment is empty for a particular day, it would mean that you have already taken your vitamin for that day.

Which brands of prenatal vitamins are best?

A physician will usually make a recommendation on this regard and write a prescription for you. On the other hand, over-the-counter vitamins are also available at the pharmacy.

While there are many brands available, a good multivitamin will contain all the vitamins in appropriate quantity, choose a prenatal vitamin that includes:

  • folic acid
  • iron
  • calcium
  • vitamins D, C, A, and E
  • zinc
  • copper

Other criterion on which to base your choice should include:

  • raw ingredient quality: is it food-based, organic or synthetic
  • Manufacturing protocols: does the company employ FDA approved methods in manufacturing.
  • Value for money: it shouldn’t be very expensive
  • Lab test results and rating: what do independent labs say about them
  • Customer feedback

Some of the top rated and hence most commonly used prenatal vitamins are:

  • Baby and me by MegaFood
  • Baby and me 2 by MegaFood
  • Zahler prenatal vitamin + DHA
  • Perfect prenatal vitamin by new chapter
  • Vitamin Code Raw Prenatal by Garden of Life
  • Thorne Research Basic Prenatal Multivitamin
  • Maxi Pre-Natal by Country Life
  • Pre-Natal Care Multivitamins by TwinLab
  • Prenatal One Multivitamin by Rainbow Light
  • Prenatal Multivitamin by Nature Made
  • Gummy Prenatals by Vita Fusion
  • Once Daily Prenatal Multivitamin by Solaray
  • Prenatal Multivitamins by Spring Valley
  • Complete Prenatal System by rainbow light

Top Prenatal Vitamins

Best over the counter prenatal vitamins vs prescription

MegaFood Baby And Me Prenatal Multivitamin

Baby And Me by MegaFood is a food based an organic vitamin. A lot of people avoid taking synthetic vitamins in their pregnancy, so this is ideal for them. Since it is organic, there is a less chance of getting nauseas or other GI disturbances after their consumption. Customers have reported a number of advantages of using this vitamin.

The most common positive comment about this brand was how mothers feel more safe in using an organic vitamin brand, which contains folate instead of folic acid (folic acid is more spurious for your stomach than folate). Some users also reported a significant difference in growth patterns of their nails and hair.

On the other hand, there was also a lot of critique present for this vitamin. The pill is very large and hence difficult to swallow for some. It has a bad smell, and may also cause your urine smell. The dosage is 4 pills daily, so overall it may become expensive to use. There is also the fact that the idea of taking 4 pills a day could be real bummer for some mothers.

MegaFood has also introduced Baby and Me 2, whose dosage is only 2 pills per day it is expensive than its predecessor.

Garden Of Life Vitamin Code Raw Prenatal Multivitamin

Vitamin code has one of the best customer feedbacks on the internet. Amazon customers give it a rating of 4.5 out of 5 stars and lab-door scores it at 86 out of 100.

The fact that the ingredients are comprised of raw whole-foods makes digestion and absorption much easier. It is classified as an organic and non-GMO vitamin.  So you should give this vitamin a try if you’re having dyspepsia with your current vitamin.

Extracts of dozens of different fruits, vegetables, and sprouted seeds are also included to cover up any deficiencies in dietary intake of nutrients present in these fruits and vegetables..There is also addition of ginger root and active bacterial culture to reduce the incidence of morning sickness and stomach troubles that sometimes accompany pregnancy.

Users complaining of constipation with this vitamin are common because it contains iron (though it’s the amount recommended by WHO). There are complaints about its taste as well.

Zahler Prenatal Vitamin + DHA

Zahler’s prenatal vitamin formulation is another highly rated prenatal vitamin. Amazon users give it 4 stars and labdoor scores it at 82.6. It contains a concentrated dose of many of the critical vitamins and minerals for pregnant women. The various forms of vitamin B are present at anywhere from eight to sixteen times the recommended daily dosage for pregnant women.

Apart from vitamin B complex other essential vitamins and minerals are also provided at 200% of their daily intake or more. So while the recommended dosage is 2 softgels a day, there is no reason you can’t go with only one softgel and fulfill your daily needs.

Almost all of the minerals are present as easily absorbed salts amino acid chelates, therefore the bioavailability of the ingredients is very high.

The capsule is made from gelatin, two oils, and natural coloring. This simple and natural formulation results in fewer side effects than a number of other multivitamins.

The inclusion of omega 3 fatty acid DHA in an amount of 250 mg is an unusual aspect of the formulation.  However it must be noted that while all other vitamins are present above the level of recommended daily intake values, the 250mg amount of DHA is lower than recommended and therefore must be taken in diet.

Thorne Research Basic Prenatal Multivitamin

Basic prenatal vitamin from Thorne Reseach is another top selling prenatal vitamin formulation. Amazon users give it 4.2 stars and labdoor scores it 81.8.

A unique point about its formulation is that vitamin B12 levels are through the roof at 3,333% of your recommended daily intake.

Vitamin B12 is one of the essential vitamins for preventing neural tube defects, a very serious birth defect that can occur when intake of these vitamins is low so it’s likely their intent is to increase blood levels of vitamin B12 as rapidly as possible during pregnancy, especially since neural tube defects can occur within the first few weeks of conception.

Another possible reason for such high levels could be that recent scientific research has questioned the levels of the recommended daily intakes for vitamin B12. New studies have found that there is still an increased risk occurs with the current recommended levels of vitamin B12 intake   and hence there should be an increase in the recommended dose.

Other essential vitamins and minerals are present in the expected 100-250% of the recommended daily intake. However metal mineral content is pretty high: 45 mg of iron (on the high end), 200 mg of calcium (could inhibit iron absorption somewhat), and moderate amounts of other minerals.

New Chapter Perfect Prenatal

New Chapter’s Perfect Prenatal multivitamins is another top of the line formualtion. Customer feedback on amazon gives it a whopping 4.5 stars.

The vitamins are fermented with amino acids, live probiotics, and other co-factors. The net effect of their presence is that they enhance the absorption of the vitamins. These prenatals come with enzymes which aid the digestive process. The multivitamins are certified by NSF International depicting a high quality production method.

New Chapter flagship vitamins are not derived from real. Their method of production simply involves converting conventional vitamins into a more “natural” form through a culturing process involving yeast. Furthermore, although the company claims that the formulation contains organic fruits and vegetables, the truth is that organic bled is no more than 5% of the total capsule volume. 95% of the ingredients are non-organic ingredients.

This formulation is missing some key ingredients like calcium and Omega-3 fatty acids, so their supplementation is needed through another source to prevent congenital anomalies in the baby.

Prenatal vitamins overdose

An overdose on prenatal vitamins is a rather uncommon presentation in the emergency room. However, it is a real possibility and hence here we discuss the possible causes of overdose. It is important here to mention that almost all cases of overdose are accidental, and so they may happen to anyone if care is not taken. Also note that it is usually a chronic case, rather than acute poisoning.

Perhaps the most common cause of overdose is when you choose to supplement your diet with synthetic nutrients and are not keeping track of the daily amounts you take. Therefore it is important to let your health care provider know about your diet so that he can prescribe you that vitamin which is suitable for you.

Another cause of overdose is forgetfulness, the mother forgets that she has already taken her dose for the day and takes another. When this happens for more than a couple of weeks, signs of toxicity will start to appear.

Toxicity of vitamin A is particularly harmful for the fetus.

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About Miljan Krcobic 215 Articles
My name is Miljan Krčobić. I was born on 14th of November 1989. in Negotin, Serbia, where I finished elementary and high school. In June 2015 I graduated from the Faculty of Pharmacy in Belgrade and thus acquired the title Master of Pharmacy. From the July of 2015 to January 2016 I worked in a pharmaceutical company Hemofarm a.d.(Member of STADA group) based in Vrsac, Serbia, as an expert associate for GMP compliance within the sector Quality Assurance. I am currently working in a pharmacy called Zivkovic in Negotin. As a freelancer I write medical articles on Elance and Upwork.