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Best and Worst Prenatal Vitamins

The Best and Worst Prenatal Vitamin article has been the most requested article that I have written so far. I didn’t want to disappoint with this article, so I put extensive time and research to outline everything needed for healthy development, the optimal amounts of every nutrient based on research, and correct forms of the nutrients for building healthy babies worldwide. By taking these steps, I believe we can begin to reduce the disease statistics dramatically in one generation.

The Importance of Prenatal Nutrition

Our risk factors for heart disease, high blood pressure, cancer, diabetes, allergies, asthma, mental illness, PCOS, and obesity have been consistently been linked in research studies to prenatal nutrition during the first 9 months of pregnancy.

Women who take multivitamins may be less likely to experience ovulatory infertility; women who take six or more tablets had the lowest relative risk for infertility. This shows you the importance of supplementation from the beginning of conception.

At Nutrition Genome, I do programs for couples before conception to outline the most beneficial diet for future parents based on their unique genetics and biochemistry. This preparation has the potential to shape the gene expression of the child during pregnancy and even extend to the grandchildren. It also gives the mother sufficient reserves so that her health isn’t dramatically altered.

Epigenetics is the study of how this expression occurs from our diet, environment, relationships and stress. What you eat has an epigenetic effect on your genes. According to David Williams, principal investigator for the Linus Pauling Institute at Oregon State University, “DNA expression can be altered at any age, but the fetus is especially susceptible because these pathways are very active as tissues grow and differentiate.” In other words, a mother’s eating habits, exercise regime, stress levels and environment actually have the power to shape the gene expression passed down.

Prenatal Vitamin and Mineral Research

According to the 2009 statistics from the U.S Department of Agriculture, here is the list of nutrients that women are commonly low in:

Vitamin E: 86%
Folate: 75%
Calcium: 73%
Magnesium: 68%
Zinc: 42%
Vitamin B6: 35%
Iron: 34%
Vitamin B12: 30%

I have created a chart for the optimal levels of vitamins and minerals during pregnancy. You will not find a supplement that hits all of these perfectly, but it will allow you see what you might be missing. Below this chart is a very detailed summary of the research used to come to reach these conclusions. You can treat this like a mini prenatal vitamin and mineral guide. You can also scroll right to the bottom if you just want to know my prenatal recommendations.

prenatal-guide-wide

 

Vitamin A as Retinol (3,000-10,000IU from your diet)

There has been a major scare over the past few years regarding vitamin A and teratogenic (birth defects) effects on the fetus, lowering vitamin A recommendations for pregnant women and leading to multiple supplement companies to keep lowering their vitamin A content, or completely switching to beta carotene. Read this section carefully and educate yourself, because it will be challenged by your doctor. 

The American Pediatrics Association cites vitamin A as one of the most critical vitamins during pregnancy and the breastfeeding period, especially in terms of lung function and maturation. According to the European Journal of NutritionThe German Nutrition Society (DGE) recommends a 40% increase in vitamin A intake for pregnant women and a 90% increase for breastfeeding women. They also state that “pregnant women or those considering becoming pregnant are generally advised to avoid the intake of vitamin A rich liver and liver foods, based upon unsupported scientific findings.”

Up until the 1950s, a relatively large number of studies showed that laboratory animals (pigs, rabbits, chickens, rats, and mice) fed vitamin A–deficient diets gave birth to malformed offspring and spontaneous abortion. A 2000 study on pregnant mice found that high (100 mg/kg) and moderate (50 and 25 mg/kg) doses of vitamin A as retinyl acetate resulted in significant facial, heart and thymus abnormalities. Finally, neural defects and craniofacial malformations were found in children born in regions where glyphosate-based herbicides (sprayed on GMO crops) are used due to glyphosate-incuded endogenous retinoic acid activity.

The truth is, both vitamin A deficiency and toxicity can cause birth defects.

Studies that Found Safety

#1 A 1997 study found that women consuming doses of vitamin A between 8,000 and 25,000 IU from supplements and fortified cereals were no greater in the major malformations group or the group with neural tube defects than in the normal control group. The researchers concluded, “If vitamin A is a teratogen, the minimum teratogenic dose appears to be well above the level consumed by most women during organogenesis.”

#2 A study found that human epidemiologic studies do not establish at what level vitamin A becomes teratogenic; however, pharmacokinetic data presented in this paper indicate that blood levels of retinoids from women taking 30,000 IU/d of preformed vitamin A are not greater than retinoid blood levels in pregnant women during the first trimester who delivered healthy babies.

#3 A clinical trial was carried out in Hungary in which a supplement of 6000 IU of vitamin A did not increase the incidence of fetal malformations.

#4 According to the American Journal of Clinical Nutrition, up to 20 case reports of the relationship between a high vitamin A intake and an adverse pregnancy outcome in humans were published in the past 30 years. These reports are of limited use for establishing a quantitative link between vitamin A intake and teratogenic events, however. Furthermore, the pattern of the observed malformations is not always consistent with the retinoic acid syndrome, thus calling into question the origin of these malformations.

Studies that Raised Caution

Teratogenesis of high vitamin A intakes has been reported in several animal species. The pattern of birth defects sometimes called “retinoic acid syndrome” includes central nervous system, craniofacial, cardiovascular, and thymus malformations. Similar abnormalities were observed in humans when pregnancies occurred during therapeutic treatment with retinoic acid, especially isotretinoin (Accutane). This synthetic form of vitamin A used for acne is well known to cause birth defects.

This study concluded that among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, an estimated 1 infant in 57 had a malformation attributable to the supplement.

According to the American Journal of Clinical Nutrition:

The teratogenicity of high vitamin A intakes during pregnancy remains unclear and it is unlikely that new findings will shed light on this issue over the next few years. Human clinical trials are not ethically possible, so we must rely on those already performed, on forthcoming epidemiologic trials, and on our knowledge of vitamin A metabolism and functions, which is largely derived from animal studies. This information clearly shows that the teratogenicity of vitamin A is biologically and physiologically possible, yet its real occurrence in humans seems limited.

One drawback in all human studies is that the specific effects of vitamin A intake cannot be determined. Most of the information comes from the use of supplements or, at best, supplemented foods, that are taken on a regular basis and in moderate doses. However, data from animal studies clearly show that one single, high dose of vitamin A can be teratogenic, provided it is given at a critical period of embryonic development.

Beta Carotene is Not Vitamin A

If you look at the label on prenatal vitamins you will see vitamin A listed, but next to vitamin A you will find (as beta-carotene). This is true of many regular multivitamins as well. Assuming a vitamin A conversion rate for beta-carotene for juice is 4:1, and fruit and vegetables between 12:1 and 26:1; the total vitamin A contribution from beta-carotene intake represents 10-15% of the RDA. This does not take into genetic variants of BCMO1 that decrease the conversion another 57%, dietary fat intake (the conversion requires fat) and thyroid disorders.

If the vitamin A supply of the mother is inadequate, her supply to the fetus will also be inadequate, as will later be her milk. The major problem is that post-natal supplementation will not correct this issue. A clinical study in pregnant women with short birth intervals or multiple births showed that almost 1/3 of the women had plasma retinol levels below 1.4 micromol/l corresponding to a borderline deficiency. Vitamin A deficiency is the western world should no longer be ignored.

That being said, I believe prenatal vitamins should use D. Salina or vegetable sourced beta-carotene and mixed carotenoids and vitamin A is best from the diet.

Conclusion for Vitamin A

From my research, it appears that vitamin A in the form of supplements given at a large dose or a high intake of glyphosate from processed food during a time of key embryonic development is the key understanding of toxicity. Natural vitamin A from food – or even from supplements less than 10,000 IU in relationship to vitamin D intake does not appear to have any evidence that proves causation of toxicity. Vitamin A helps protect against toxicity of vitamin D, and vitamin D helps prevent against toxicity of vitamin A. The absence of this understanding is also a major omission in this studies.

For numerous generations, liver was recommended once a week during pregnancy. I know my mom ate liver once a week, took vitamin A supplements and ate a lot of eggs while she was pregnant with me. Approximately 3.5 oz. of liver has 52,000 IU of vitamin A. Since vitamin A is fat-soluble and stored in the liver, once a week would give you your weekly dose of vitamin A.

If you didn’t like liver, taking 1 tsp. virgin cod liver oil daily would be equivalent to approximately 21,000-35,000IU per week. Even three bright orange pastured eggs per day (vitamin A is higher in pastured eggs) could give you up to 3,000IU per day, or 21,000IU per week.

The optimal dosage of vitamin A would be very hard to determine since it also probably changes person to person. However, a dose of 3,000-10,000IU daily and 3.5 oz. of grass-fed liver once a week does not appear to pose any toxicity risk while appearing to supply optimal vitamin A. In my opinion, this is a more responsible recommendation than wrongly thinking you can get all the vitamin A you need from beta-carotene.

Vitamin C (400mg-500mg 1-2x a day)

According to data from the US National Health and Nutrition Examination Survey (NHANES), 31% of US adults do not meet the estimated average requirement for vitamin C, and this is for an RDA that has been drastically reduced over the years. If you read studies on our Paleolithic ancestors, they obtained approximately 400mg per day. Today, the RDA is only 60mg and is wrong.

Having a low intake of vitamin C during pregnancy may be associated with high blood pressure, swelling of the hands, feet and face, upper respiratory infections, pre-eclampsia, anemia, and low birth weight. Large quantities of ascorbic acid are utilized by the female during conception and are necessary to formation and integrity of the fetal membranes. Vitamin C also reduces blood lead levels, important due to today’s water and air quality.

During pregnancy, plasma levels of vitamin C normally fall approximately 10 to 15%. A combination of vitamin C from a prenatal and from the diet should hit 400-500mg daily. This need may be higher for those prone to respiratory infections, low immunity, and high stress.

If you are experiencing infertility, one study showed that the rate of pregnancy was significantly higher in the vitamin C supplementation group of 750mg: 25% within six months, while only 11% of the untreated women became pregnant in the same time period.

Vitamin D3 (Vitamin D level between 40-50ng/ml, 2,000IU-4,000IU)

The largest randomized controlled trial to date from the Medical University of South Carolina took 256 pregnant women and separated the group into two groups, 2,000 and 4,000 IU daily starting 3-4 months of pregnancy. A control group of 400IU was not allowed because the ethics committee felt that this would endanger the women and their newborns.randomized controlled trial to date from the Medical University of South Carolina took 256 pregnant women and separated the group into two groups, 2,000 and 4,000 IU daily starting 3-4 months of pregnancy. A control group of 400IU was not allowed because the ethics committee felt that this would endanger the women and their newborns. This is the amount women have taken with just a prenatal vitamin! 

The results showed that the 4,000 IU group had 2.4 times higher of having an infant in the 50th percentile of birth weight compared to the 2,000 IU group. Lower vitamin D levels were predictive of preterm delivery, infections, and other complications.

In this posthoc analysis, achieving a 25(OH)D serum concentration ≥40 ng/mL significantly decreased the risk of preterm birth compared to ≤20 ng/mL.

In a very recent 2016 study, pregnant women with low vitamin D levels at 20 weeks more likely to have a child with autistic traits.

Get your vitamin D levels tested early. 

Vitamin E (22-30mg as d-alpha tocopherol and mixed tocopherols)

One study concluded that “consumption of high doses of Vitamin E (over 400IU) during the first trimester of pregnancy does not appear to be associated with an increased risk for major malformations, but may be associated with a decrease in birth weight.” What is interesting about this is that research has associated low birth weights with an increased risk of heart disease later in life, something vitamin E is associated with preventing in the right dosage.

Another study found that supplemental vitamin E (400IU) from the second trimester of pregnancy did not appear to affect the risk of pregnancy outcomes and occurrence of preeclampsia.

While vitamin E shares an antioxidant commonality with vitamin C, it does not appear to warrant the same use of higher doses. Low dietary intake of vitamin C was associated with a trend towards an increased incidence of either severe pre-eclampsia or eclampsia. A small increase in the incidence of severe disease was also seen in the group of women with a high intake of vitamin E from supplements and dietary sources.

Based on the available evidence, I think 22-30mg is the correct amount, not 400IU or higher.

Vitamin K1 and K2

Vitamin K is essential for the formation of at least three proteins involved in blood clotting as well as of other proteins found in plasma, bone, and kidney. Vitamin K deficiency primarily affects the blood clotting process. Newborn infants are at high risk of deficiency because breast milk contains inadequate concentrations of vitamin K and their intestines are not yet colonized with vitamin K-producing bacteria.

Studies have found that the blood thinning drug Warfarin – which depletes vitamin K – has been shown to cause birth defects. This shows the importance of vitamin K that hasn’t been fully elucidated yet. Vitamin K2 is believed to be instrumental in teeth and bone formation.

Vitamin K is provided by the diet and gut bacteria. There is no known toxicity for K2 and therefore an upper limit hasn’t been established. The optimal amount is still being determined for pregnancy, but a conservative amount of vitamin K2 from supplementation is currently in the 65 mcg-100mcg range, depending on your diet.

B1 Thiamin (1.4mg to 2mg)

Conventional treatment for gestational diabetes increases the proportion of infants born with a low birth weight, a risk factor for cardiovascular disease and diabetes in later life. During pregnancy, approximately 50% of the women develop a biochemical thiamine deficiency. The need for thiamine goes up in the third trimester. Causes of thiamine deficiency include a milled grain-based diet, high alcohol intake, gastrointestinal disorders and prolonged cooking of foods.

Thiamine is essential for glucose oxidation, insulin production by pancreatic beta-cells and cell growth. Research has stated that thiamine supplementation is a good preventative and treatment of gestational diabetes because it improves their glucose tolerance and stimulates the intra-uterine growth, thereby preventing a low birth weight to ensue from conventional therapy which only improves glucose tolerance.

B2: Riboflavin (1.4mg to 2.4mg)

Riboflavin deficiency has been implicated in preeclampsia.

Riboflavin plays a special role in MTHFR 677 where it has been found to stabilize the enzyme. Studies have shown that the MTHFR 677 TT genotype is associated with high homocysteine when riboflavin (B2) status is low. Many doctors will see a homozygous MTHFR 677 and automatically give high amounts of methylfolate (1-5mg) without looking at riboflavin, B6, B12 or choline status. Often, 400-800mcg of methylfolate is sufficient and more than this can cause anxiety issues depending on variants in other genes.

B6 (2.2mg to 10mg as Pyridoxal-5-Phosphate)

Pyridoxal phosphate (PLP) is the physiologically active form of vitamin B6 and is a coenzyme in over 100 known reactions. In multivitamins, B6 is often labeled as pyridoxal hydrochloride, which is not absorbed as well as PLP. PLP is expensive, and many companies do not use it because it increases the price of their product. PLP is worth the money.

An epidemiological study done at Tufts University in 2008 found that a substantial percentage of the population had inadequate B6 statusStudies have also consistently shown that in comparison with nonpregnant controls, pregnant women have lower plasma levels of vitamin B6.

It has been suggested that low B6 is associated with gestational diabetes and ”pregnancy depression”—described as pessimism, crying, tension without sleep, or appetite disorders. Vitamin B6 plays a very important role in mental health, needed in the formation of histamine, serotonin, and dopamine.

All forms of vitamin B6, especially PLP, cross the placenta into the fetal blood where its concentrations are two to five times higher than those in maternal blood. The most substantial decrease in plasma PLP levels is found between the fourth and eighth months of pregnancy, paralleling the period of most intensive growth of the fetus.

B6 is higher in organ meats than muscle meats and is needed for amino acid metabolism. Therefore a high lean protein intake low in B6 increases the need for B6. This is also true of vitamin A. The elevation of estrogen during pregnancy also increases the need for B6. The deficiency of B6 leads to nausea, which can be treated successfully with B6 supplementation.

If you have been on birth control for a long period of time, B6 needs may be higher. Long-term use (>30 months) of oral contraceptives containing high levels of estrogen was associated with significantly lower maternal and umbilical cord serum vitamin B6 levels than those in women who took no oral contraceptives, and evidence indicates that their vitamin B6 reserves may be decreased in early pregnancy.

B7 Biotin (300mcg)

The need for biotin increases with pregnancy and deficiency has been linked to birth defects. At least one-third of women develop marginal biotin deficiency during pregnancy, and there are prenatal vitamins that do not contain any biotin. The highest levels of biotin are actually found in organic pastured egg yolks.

B9 (600-800mcg as Methylfolate)

Folate is one of the most well-known nutrients during pregnancy for preventing spinal bifida. Due to its role in DNA synthesis, a deficiency has widespread consequences in fetal development. Folate and choline are methyl donors, and the addition of a single methyl group can change an individual’s epigenome.

Folic acid is a synthetic version of folate that does not exist in nature. In a study titled Is Folic Acid Good for Everyone?, the author argues that folic acid could interfere with the metabolism, cellular transport, and regulatory functions of the natural folates that occur in the body by competing with the reduced forms for binding with enzymes, carrier proteins, and binding proteins. The folate receptor has a higher affinity for folic acid than for methyl-THF—the main form of folate that occurs in the blood and might inhibit the transport of methyl-THF into the brain.

A new study from John’s Hopkins University looked at 1,391 mother-child pairs in the Boston Birth Cohort, a predominantly low-income minority population. The researchers found that very high circulating folic acid doubled the risk of autism, and B12 levels that were very high tripled the risk of autism. If both levels are extremely high, the risk that a child develops the disorder increases 17.6 times.

Homozygous variants in MTHFR 677 or a combination of a heterozygous MTHFR 677 and 1298 may put you at a higher need for folate. These variants also require B2 (riboflavin), B12, B6 and choline to normalize the methylation cycle. You want to choose folate as methylfolate and B12 as methylcobalamin.

If you were advised to take a high amount of methylfolate (1-5mg) and had a bad reaction, niacin is actually given due to niacin’s ability to quench excess methyl groups. It makes much more sense to give methylfolate as part of a B-complex because it includes niacin and other B-vitamins that provide balance.

B12 (2-10mcg as Methylcobalamin)

Cyanocobalamin is the synthetic B12 form found in cheap multivitamins and fortified foods. Cyanocobalamin must be converted to methylcobalamin and requires the split of a cyanide (the toxin) molecule from cobalamin. Like folic acid, the ability to make this conversion is impaired in many people.

As mentioned above, one study found that very high circulating folic acid doubled the risk of autism, and B12 levels that were very high tripled the risk of autism. If both levels are extremely high, the risk that a child develops the disorder increases 17.6 times.

As I explored in my Best and Worst Multivitamins article, this study was done in a predominately low-income minority population and was most likely due to a diet high in processed fortified foods along with supplements containing folic acid and cyanocobalamin.

I will give you my theory on why this may have occurred, which I haven’t seen explored yet. One, synthetic folic acid can bottleneck and block folate receptors, creating high circulating levels. Two, cyanide is one of the air toxins found to have a statistical significance on autism risk and high oxidative stress is found in children with autism. Three, a study found that young US children with autism and their mothers had unusually low levels of lithium compared to neurotypical children and their mothers. I will explain how this relates to excessive cyanocobalamin.

Cyanocobalamin is composed of cyanide and cobalamin and splits off cyanide, which can block the electron transport chain of the mitochondria (powerhouse of the cell and sensitive to oxidative stress). Lithium is a carrier of B12 into the mitochondria. Excessive cyanocobalamin could theoretically both disrupt the electron transport chain into the mitochondria, deplete methyl groups for methylation, increase mitochondrial oxidative stress, and cause very low lithium levels trying to keep up with the high circulating blood levels of B12 that are struggling to make it into the mitochondria. Mitochondrial dysfunction is one of the medical disorders that has been consistently associated with Autism Spectrum Disorders.

Zinc (15mg)

Studies have estimated that 82% of pregnant women in the world may have inadequate intake of dietary zinc! Why is this happening? Drop in liver and shellfish consumption, zinc from plants is poorly absorbed, grains high in phytic acid will actually block zinc uptake, and very high amounts of copper or iron in the diet will compete with zinc at absorption sites.

Zinc deficiency can lead to congenital abnormalities, poor immunity, abortions, intrauterine growth retardation, premature birth, and preeclampsia. Oxide forms of zinc should be avoided.

Copper (1mg)

Copper plays a role in the brain, tendons, skin development, increasing iron absorption and processing oxygen. Too much can cause preeclampsia and intrauterine growth retardation while low serum levels have been linked to pathological pregnancies and miscarriage. Serum copper increases during pregnancy and is doubled at full term with peaks at the 22nd, 27th and 35th gestational week.

There is a balance between zinc and copper levels that is very important (approximately 15mg of zinc to 1mg of copper). Adequate zinc will push down excess copper, but too much zinc will push it too low. Conversely, insufficient zinc will lead to elevated copper levels.

A form of copper called “cupric oxide” in prenatal vitamins should be avoided. If the type of copper is not listed, ask the company if it is cupric oxide.

Iron (18-30mg)

Iron requirements are reduced during the first trimester, increases for the second and third trimester of pregnancy due to oxygen requirements and infant storage during the breastfeeding phase and is especially high after delivery. Iron deficiency can lead to postpartum depression, fatigue, and poor breast milk production or quality.

It is recommended to enter pregnancy with higher levels of iron and ferrtin levels to meet your requirements fully. Approximately 40% of women entering pregnancy with insufficient iron reserves and unfavorable iron status, and 25% get iron deficiency anemia.

Women suffering from iron deficiency anemia during the first two trimesters are twice as likely to deliver early and three times the risk of having a low birth weight. Iron deficiency during the third trimester also affects the hippocampus; involved in learning, memory, and cognition, leading to cognitive dysfunction that could continue to adulthood.

Research has stated that “the amounts that can be absorbed from even an optimal diet, however, are less than the iron requirements in later pregnancy.” I wonder if this would be true if women ate liver once a week? In 3.5 oz. of liver, there is 17.7mg of iron. In 3.5 oz. of beef, there is 2.6mg.

Nevertheless, many women would rather have another option and supplementing is recommended. You want the right dosage for your levels. Remember that too much iron can be constipating, taking vitamin C at the same time helps iron absorption, copper increases iron absorption, and vitamin A helps mobilize iron storage.

The main forms of iron you want to avoid are gluconate and sulfate, which are constipating. I recommend Iron Bisglycinate. A 2014 double-blind study found that 25mg of Iron Bisglycinate was as effective as 50mg of ferrous sulfate for pregnant women. They also experienced lower gastrointestinal complaints and their babies had slightly higher birth weights.

Choline (450mg to 930mg)

As of June 17th, 2017, the American Medical Association voted to support evidence-based amounts of choline in all prenatal vitamins, noting that most prenatals currently contain little if any choline.

Choline plays an important role in the liver, gallbladder, vulnerability to toxins, preventing spinal cord and brain defects, and the future mental health of the child. Genetic polymorphisms in PEMT may alter the dietary requirement for choline and increase the likelihood of developing signs of deficiency (fatty liver, gallbladder issues during pregnancy) when choline intake is inadequate.

The choline pathway is actually enriched with DHA, which of course also plays a prominent role in brain development. One analysis found that a higher choline intake (930 compared with 480 mg/d) augmented the rise in choline/DHA in nonpregnant women and choline needs are increased during the third trimester of pregnancy. The researchers found that a higher choline intake along with supplementary DHA acted synergistically to produce the greatest enrichment of choline and DHA in red blood cells. This is a major find for mental health. 

An article from NPR came out this month that explored whether or not supplementing with the choline could enhance brain growth in the developing fetus and prevent mental illness. One group of moms-to-be were given phosphatidylcholine and the other group was given a placebo. The dosage was large; 900mg total. However, this is also close to the amount recommend during the 3rd trimester of pregnancy. After birth, infants were given either 100 milligrams of liquid phosphatidylcholine or a placebo once a day for approximately three months. A test was administered at 5 weeks old testing simultaneous clicking sounds while measuring brain activity.

The results published in 2013 in the American Journal of Psychiatry by Freedman’s group show that 76 percent of newborns whose mothers received choline supplements had normal inhibition to the sound stimuli, while 43 percent of the newborns did not. Those who do not have a normal inhibition to the sound stimuli have been found to have an increased risk for attention problems, social withdrawal and, later in life, schizophrenia.

The results show that choline might steer the infant brain away from a developmental course that predicted mental health problems.

Omega-3 Fatty Acids (400-600mg DHA)

Omega-3 fatty acids are vitally important during pregnancy as they are critical building blocks of fetal brain and eyes, but are also crucial for preventing postpartum depression. DHA is transferred from the mother to the fetus at a high rate during pregnancy, thereby depleting maternal stores. This is a very important point to understand for all vitamins and minerals transferred from the mom to the fetus. If an expecting mom does not have sufficient reserves, this can drastically affect her health pregnancy.

A recent study found that an estimated 106,000 high-risk preterm births could be avoided in the US and 1,100 in Australia alone every year if women supplemented with DHA.

The studies demonstrating the greatest efficacy have used doses in the range of 1–2 g/day of fish oil. One study found that Mexican women that supplemented with 400mg of DHA delivered babies who weighed more and had larger head circumferences.

The lowest concentrations of DHA were found in North America and Canadian breast milk. Levels of DHA averaged only 0.17% of total fatty acids in contrast to the highest levels found in Japan where DHA represented 0.99% of the total milk fatty acids.

I believe fish oil should be supplemented separately if adequate DHA is not obtained in the prenatal.

Iodine (150-300mcg)

Data from the National Health and Nutrition Examination Survey suggest that more than half of pregnant women have urinary iodine concentrations below 150 mg/dL. Inadequate iodine intakes during pregnancy result in fetal loss, stillbirths, cretinism, and mental retardation of the newborn infant.

As of 2015, The US Council for Responsible Nutrition’s new guidelines calls for all dietary supplement manufacturers and marketers to begin including at least 150mcg of iodine in all daily multivitamin/mineral supplements intended for pregnant and lactating women in the United States. The optimal dose may be 200-300mcg. If you have suffered from hypothyroidism, this makes sufficient iodine along with selenium, zinc, vitamin C, vitamin A and vitamin D that much more important.

A study in 2009 found that 51% of US prenatal multivitamin brands did not contain any iodine and, in a number of randomly selected brands, the actual dose of iodine contained in the supplements did not match the values on the label.

Fluoridated water displaces iodine, creating a higher need for this crucial mineral and filtering fluoride.

Selenium (60-70mcg, 200mcg for infertility)

Selenium is a primary mineral needed by glutathione, our master antioxidant system. It also blocks the uptake of mercury and plays a significant role in the reproductive system. Selenium deficiencies may lead to gestational complications, miscarriages and the damaging of the nervous and immune systems of the fetus.

As you will see in the study below, 200mcg of selenium was used along with magnesium to resolve infertility. Selenium has also been found to resolve infertility in men.

Magnesium (400-600mg)

Magnesium plays a special role in regulating blood sugar, preventing muscle spasms, increasing energy, preventing preterm contractions and fertility.

In one study, six women with a history of unexplained infertility or early miscarriage and who had failed to normalize their red cell magnesium (RBC-Mg) levels after four months of oral magnesium supplementation (600 mg/day) were investigated for red cell glutathione peroxidase activity.

They were compared with six age-matched women with a history of unexplained infertility or miscarriage who did normalize their RBC-Mg levels on magnesium supplementation. The six non-normalizers had significantly lower glutathione levels than the six normalizers.

After a further two months of 200 micrograms daily oral selenium as selenomethionine and oral magnesium supplements, all six women normalized their magnesium and RBC-selenium levels. All 12 previously infertile women have produced normal healthy babies all conceiving within eight months of normalizing their RBC-Magnesium levels.

Calcium (1000mg)

During pregnancy, a woman’s body provides daily doses between 50 and 330 mg to support the developing fetal skeleton. A recommendation in the US and Europe has continually been 1,000mg, while the average intake is 800mg in young women. Vegetables high in calcium, calcium rich mineral water (Gerolsteiner), and dairy can reach your daily calcium targets. Since calcium blocks lead uptake, getting adequate calcium is crucial.

Calcium absorption and utilization are tightly regulated. For example, many foods that contain oxalic acid bind to calcium; often found in foods that contain calcium. Too much calcium affects the absorption of magnesium, while higher amounts of magnesium increase the absorption of calcium. Calcium deficiency is rare in pregnancy but appears in cases of hypoparathyroidism, severe dietary inadequacy and in individuals who are unable to eat foods high in calcium.

Calcium needs go up in the third trimester and during labor. For this reason, I recommend Gerolsteiner Mineral Water (let it go flat) as an electrolyte drink during labor.

Worst Prenatal Vitamins

The search for a high-quality prenatal vitamin is not an easy feat. Especially since the FDA tested 324 multivitamin-multimineral products that targeted pregnant women or small children for the presence of lead, and found that only 4 of them, or 1% tested lead-free. However, the air, water, and soil contain lead and it is in our food. What you want to look for are very low levels when multivitamins use whole foods. The safe upper limit for lead according to the FDA is 25mcg per day for pregnant women, but I think this amount should be much lower.

Lead is of particular concern during pregnancy because it causes fetal brain damage, limited IQ, and can lead to behavioral and learning disabilities in young children. Research has also found that lead exposure has a multigenerational effect all the way down to your grandchildren. Then add in food dyes, poor forms of vitamins and toxic additives, and it is no wonder it is so hard to find a good prenatal vitamin.

There is an argument that lead is present in the soil and therefore is naturally higher in supplements that contain whole foods. While this may be true, I have seen companies able to source whole food ingredients with much lower lead levels than competitors. Seek out these companies. Calcium blocks lead uptake while vitamin C lowers blood levels of lead. Calcium is often absent in multivitamins and vitamin C is often too low or whole food based, which has a very short half-life. These are both important to keep lead levels low.

1. One A Day Women’s Prenatal

A very common recommendation. One of the first things you will see is a list of food dyes: Red 40 Dye, Red 40 Lake, Yellow 6 Lake, and DL-Alpha-tocopheryl Acetate – the synthetic form of vitamin E that is continually problematic in studies.

What is wrong with food dyes? These food dyes have been found to inhibit mitochondrial respiration; the powerhouse of your cell that houses maternal DNA and I talked about in detail under the B12 section. Red 3 causes cancer in animals, with evidence that other dyes also are carcinogenic. Three dyes (Red 40, Yellow 5, and Yellow 6) have been found to be contaminated with benzidine or other carcinogens. At least four dyes (Blue 1, Red 40, Yellow 5, and Yellow 6) cause hypersensitivity reactions, and numerous studies found Yellow 5 positive for genotoxicity.

An advisory panel to the Food and Drug Administration recently acknowledged that synthetic food dyes can exacerbate the conditions associated with ADHD and other behavioral problems. While the consumption of synthetic food dyes has increased five-fold since 1955, the number of children diagnosed with ADHD increased from 150,000 in 1970 to 5.4 million by 2007.

A 2007 study in Lancet found such a strong correlation to synthetic food dyes and hyperactive behaviors in children, that they contacted the British government concluding that the harm done by artificial food dyes to children’s IQ was similar to the impact of lead on their developing brains and that banning these additives would result in a 30 percent reduction in the prevalence of ADHD in children.

2. Centrum Specialist Prenatal Complete Multivitamin Supplement

Centrum made my worst list for Best and Worst Multivitamins, and their formulation for a prenatal is also as disappointing. Aside from having the wrong forms of folate and B12, you will also find corn starch, synthetic vitamin E, polyethylene glycol (essentially plastic and the main ingredient in Miralax, not FDA approved for children, and some families have reported concerns to the FDA that some neurologic or behavioral symptoms in children may be related to it), polyvinyl alcohol (synthetic polymer), sodium benzoate (when combined with vitamin C as found in this formula you create benzene, a known carcinogen), sodium selenate (a form of selenium considered to be highly toxic and induce DNA damage) and sucrose.

3. Vitafusion Prenatal

This formula uses folate as folic acid, B12 as cyanocobalamin, is missing iron, B1, B2, vitamin K and numerous minerals like selenium, iodine, copper, manganese, and boron. It uses a very small amount of EPA (50mg) and DHA (15mg) that isn’t nearly close to enough for a pregnant woman. It also has glucose syrup, sucrose, and natural flavors, which should always be confirmed to be MSG free. Quite honestly, this should not be allowed to be marketed as a prenatal vitamin.

4. Rainbow Light Prenatal One Multivitamin

This is also a very popular prenatal multivitamin. It contains only 400IU of vitamin D2, which is too low and not as effective as D3, folate as folic acid, B12 as cyanocobalamin and magnesium in the oxide form (only 4% is absorbed).

Based on reviews on Amazon, there also appears to be some serious issues with quality control since three different reviewers all found black substances on the pills.

5. NatureMade PrenatalMulti

This uses 400IU of vitamin D, folate as folic acid, B12 as cyanocobalamin, a poor form of zinc, is missing copper, selenium, iodine, manganese, boron and choline.

Best Prenatal Vitamins

Remember that your prenatal will also require a separate DHA fish oil product. There was a California Proposition 65 lawsuit against CVS Pharmacy, GNC, NOW Health Group, Omega Protein, Pharmavite (Nature Made brand), Rite Aid Corp., Solgar, and Twinlab Corp for selling fish oil laced with PCB’s, which are one of the most dangerous environmental pollutants. PCB’s are strongly tied to cancer and multiple birth defects. You want to choose your fish oil wisely. 

I recommend Nordic Naturals Prenatal DHA. If you would prefer to use cod liver oil, I recommend virgin cod liver oil. In many cases you also need more vitamin D (check your levels), choline (eggs are your new best friend), calcium and magnesium.

Just like plant-based protein powders, you are going to have a wide range of opinions regarding digestion of prenatal vitamins for the same reason one person craves a food that repels another.

Remember to take your prenatal with food so that you absorb the carotenoids and fat-soluble vitamins A, D, E and K.

1. Naturelo Prenatal Whole Food Multivitamin

Cost: $39.95 for 60 servings
Serving: 3 capsules daily

Naturelo holds the title for the best and worst multivitamin article. This prenatal product was just launched on January 4th, 2017. It is by far the most impressive prenatal formula on the market. Naturelo actually reached out to me to review their formula before they launched it. While their initial formula was excellent, I offered some suggestions to improve it. They decided to delay their December launch and make every change I suggested. The customer service for questions and openness to suggestions has really made this company stand out to me. I am excited that women now have access to a product of this quality and at this price.

This product is also available to be shipped to the UK.

screen-shot-2017-01-05-at-6-27-25-pm

As you can see from the label, many of the recommendations in this article are followed in this formula. You will not find alarmingly high amounts of any vitamins or minerals in the wrong form. It is GMO-free, yeast free, soy free, gluten free and has zero artificial ingredients or harmful additives.

Natural full spectrum carotenoids
30IU of vitamin E with mixed tocopherols
Vitamin K2 in the right dosage
4mg of B6 as P-5-P
800mcg of methylfolate
10mcg of methylcobalamin
Correct amounts of all the other B-vitamins
200mg of magnesium citrate and 350mg of calcium
15mg of zinc amino acid chelate
18mg of iron
150mcg of iodine
60mcg of selenium
100mg of choline

This prenatal will provide you with a tremendous foundation. You may require more vitamin D (check your levels early), dietary calcium, DHA from fish oil and dietary choline.

2. MegaFood Baby and Me 2

Cost: $51.27 for 60 servings
Serving: 2 tablets daily

This product follows many of the PaleoEdge guidelines with high-quality whole food based ingredients in the right form. It has been tested to be exceedingly low in heavy metals, no harmful additives and is pesticide and herbicide free. The formula uses a combination of whole foods, synthesized nutrients like methylcobalamin and choline, and brewers yeast. Brewers yeast is used to make bread and beer and is naturally high in B-vitamins, chromium, and selenium.

There is another version of the “Baby and Me” formula, but this one is superior.

300mg of choline, rare to find in a prenatal
600mcg of methylfolate from broccoli
10mcg of methylcobalamin
8mg of B6 as P-5-P
30IU of natural vitamin E in the mixed tocopherol form
18mg of iron
150mcg of iodine
15mg of zinc chelate
50mcg of selenium

Formulation Improvement and/or Additional Nutrition Needed

  • It contains 600IU of vitamin D and you may need 2,000IU to 4,000IU
  • Does not contain any magnesium or calcium, however, most prenatal’s will not provide nearly what you need for both
  • You may need more iron
  • You will need DHA supplementation

3. Front Runners Baby’s Best Start Prenatal

Cost: $20.85 for 30 servings
Serving: 2 capsules daily

What I like about this one:

27mg of iron
800IU of vitamin D
800mcg of methylfolate
10mcg of methylcobalamin
150mcg of iodine
75mcg of selenium
10mg zinc citrate
1mg copper glycinate chelate, not cupric oxide

Formulation Improvement and Additional Nutrition Needed

  • Vitamin D: You may need 2,000-4,000IU of vitamin D
  • A low dose of B6 in the suboptimal form: Should be P-5-P instead of pyridoxine HCL in a higher amount. This is my major criticism of this product, and I have let the company know.
  • Vitamin E: Should include mixed tocopherols and ideally tocotrienols in the 20-30mg range
  • 15mg of zinc citrate would be preferable
  • Missing vitamin K, choline and DHA

4. Optimal Prenatal Chocolate Powder by Seeking Health

Cost: $42.95
Serving: 30 servings of powder

This formula is designed for those who can’t or do not tolerate swallowing pills. It is also a stronger formula that I have only recommended for those who have had trouble getting pregnant, keeping a pregnancy, certain food allergies and their Nutrition Genome Report has shown multiple genes and health issues requiring higher amounts of specific vitamins and minerals. Choose the chocolate version that I have listed here. After reviewing the Certificate of Analysis of each powder, the vanilla version – while technically still in the safe range – has a higher level of arsenic.

This formula does not contain copper and has very little iron. This may be a good thing if you have elevated copper levels and your iron intake and levels are optimal.

Here is a summary of some of the dosages:

2,000IU of vitamin D
200IU of vitamin E
5,000IU of both beta-carotene and retinyl palmitate (if you do not eat eggs, dairy or use cod liver oil, this form of vitamin A is necessary)
20mg of B6 as P-5-P and pyridoxine hydrochloride
800mcg of methylfolate
150mcg of methylcobalamin and adenosylcobalamin
475mg of calcium malate
250mg of magnesium malate
250mcg of iodine from Icelandic kelp
20mg of zinc bisglycinate
250mg of choline

There are also compounds that are added for digestion (L-carnitine, Betain HCI, ginger root), detoxification (milk thistle) and provides 15mg of pea protein.

5. Thorne Basic Nutrients Prenatal (New Formula)

Cost: $24.61 for 30 servings
Serving: 3 capsules daily

Thorne recently updated their prenatal formula. The most impressive part of this formula is the combination of folinic acid and methylfolate. Folinic acid is connected to the MTHFD1 enzyme, a step before the MTHFR enzyme in the methylation cycle. Supporting both downstream and upstream folate metabolism is the optimal combination because that is how nature designs folate-rich greens. The dosage is 1mg at 1:1 ratio (500mcg of each), making this formula a good choice for those with issues in the MTHFD1 and MTHFR gene as found in the Nutrition Genome Report.

Thorne also updated all their minerals to bisglycinate chelates, which are more stable and have a higher absorption rate. It uses 45mg of iron bisglycinate and 25mg of zinc bisglycinate for those who want a prenatal that addresses low dietary iron or iron levels and zinc intake.

You should be aware that there are some high levels of vitamins like B12, and therefore may only be best for those with absorption issues. While the formula is mostly well designed, some have reported that it makes them nauseous.

prenatal

Formulation Improvement and/or Additional Nutrition Needed

  • Does not contain the mixed tocopherols for vitamin E
  • Contains 1,000IU of vitamin D, but you may need more depending on your current level
  • Contains low levels of magnesium and calcium
  • Does not contain vitamin K2, only K1
  • You will need additional DHA and choline

Other Articles of Interest

The Best Children’s Multivitamins
The Best and Worst Multivitamins and How to Design Your Own

158 Responses to Best and Worst Prenatal Vitamins

  • Hi Alex;
    Regarding the Seeking Health product, I believe you have the statement about iron and copper reversed. It has very little copper at 0.75 mg per serving (8 pills) and no iron.

    Thanks again for the great work!

    • Hi Marty,

      The product I have listed here is actually the Optimal Prenatal Powder, which differs slightly from the Optimal Prenatal capsules. The powder does not contain any copper and has 4mg of iron. You are correct about the capsules having no iron and 0.75mg of copper.

  • Alex, when will the Naturelo Prenatal be available? Thanks for your excellent articles on the best and worst vitamins. Very helpful!

    • Hi Melanie,

      The Naturelo Prenatal was slated for December 15th, but it is now delayed until January 4th. They reached out to me for my opinion of their formula and I offered ways they could improve it. They decided to make those changes, so that’s why the release date got pushed later.

  • Hi Alex;
    The Naturelo Prenatal is now listed on their webpage. Be great to get your assessment of it and any additions that may compliment the formula (e.g. omega 3, more choline, more vitamin D3 etc.).

    thanks,
    Marty

    • Hi Marty,

      Yes, I’ve been a little behind lately due to multiple projects. I plan on completing the analysis on the Naturelo Prenatal this week.

    • Hi Marty,

      I was able to update the article with the information about the Naturelo Prenatal last night. Cheers.

  • I’ve already had my baby – he is 4 months old now. I took New Chapter Prefect prenatal all through my pregnancy (I notice those don’t come up in your reviews…I would be curious to hear how you would rate that company – theirs are the cultured variety). I switched to Seeking Health capsules just after my son was born, as I discovered Dr. Ben Lynch’s website and was very impressed with his research. I’m glad they got on your list. My question is – how long after giving birth would you recommend taking a prenatal? I’m almost out of my Seeking Health, and debating whether to keep purchasing prenatals or just go with a good multi. I’m still breastfeeding exclusively, and plan to do so for at least 2 years. Would you recommend a prenatal as long as I’m still breastfeeding? Thanks for your well researched articles!

    • Hi Alison,

      Yes, I would recommend using the prenatal until you are finished breastfeeding. You are very welcome. Glad you found the article and found it informative.

      • Regarding New Chapter Perfect Prenatal, the company was bought by Proctor and Gamble a few years back. If you look at the label, you will see some very cheap and poorly absorbed forms of vitamins used in the culture (magnesium oxide, zinc oxide, cyanocobalamin and folic acid and pyridoxine hydrochloride). So this isn’t one I would recommend.

        • Thanks Alex….that is good to know! Glad I switched. Thankfully I was also taking fermented cod liver oil, dessicated liver capsules plus a separate magnesium citrate supplement, so hopefully this provided some additional support. I ditched the extra folic acid after reading Dr Lynch and just upped my greens! I will go with the Naturelo one you reviewed above, it looks like the company has put much more thought into their quality.

  • Hey Alex, I was going to buy another probiotic and was looking at at this one. https://www.amazon.com/gp/aw/d/B01LVYP1U6/ref=mp_s_a_1_6_a_it?ie=UTF8&qid=1484403740&sr=8-6&keywords=NATURELO

    What do u think? Thanks!

  • Hi Alex,

    As I told you before I have been taking Front Runner’s baby’s best start prenatal for 3 months and I just found out I’m pregnant :)!!
    I just wanted to ask you do you know if they were tasted by a separate lab? I just want to make sure now that I’m pregnant I’m taking the best possible care.
    I am also taking Nordic Natural prenatal DHA separately.
    Thank you in advance!

    • Hi Cannelle,

      Congratulations!! It is tested within their lab and is subject to FDA regulations, however, it is not tested by an independent third party.

  • Thanks Alex, is megafood tested by a third party lab?

  • I know you recommend them so obviously you believe in them but do you think it’s still ok to take even though they are not tested?

    • Hi Cannelle,

      They followed up with me and clarified their first answer, and said it is tested within their own lab by a third party. They are a small company and I haven’t been given any indication that they are not holding high standards to testing their product.

      • Hi Alex,

        Thanks a lot for your answer. I also reached out and this was their answer:
        The lab provides in-house 3rd party testing for our supplements. The in-hourse labs are fully accredited and follow USP guidelines and are ISO certified.
        We have total confidence in the manufacturing lab as they produce exceptionally high supplements and worked with the FDA to create guidelines for all supplement manufacturers.
        I definitely feel confident now.
        Thanks again!

  • To supplement DHA, what fish oil would you recommend?

  • Hi,

    Great article, thank you for your honest advice. I must admit after spending hours online looking for something I am still very unsure what supplement would suit our situation.

    My husband (44) and I (37) have been trying to conceive for a few years, much to our disappointment it’s not happened naturally. Even though our tests have all came back normal. Our diagnosis ‘unexplained infertility’. We’ve currently started IVF, now day 8 of Buseraline (Down regulating shots). I also suffer with Superficial Endometriosis and gastric problems (IBS and I did have H Pylori). I tried antibiotics they didn’t agree so opted for an alternative route and stuck to a healthy balanced diet, which has helped. I’m not completely over it, but better than before. It’s all bearable, hopefully it stays like this as I can tolerate it.

    Quick question about prenatal supplements: I need to change from Pregnacare liquid to another. As it’s not agreeing with me. (I can’t swallow pills but ok with liquid or capsules dispersed in liquid). I eat a nutrient dense and healthy diet. Looking for a folate/whole food/possible dha has all key nutrients. Kind on the system. Can take 1/2 a day as opposed to 4+

    Are certain supplements that aren’t standard like Rosita cod liver oil, 5 HTP progesterone cream, vitex, etc wise to take for conception? I see lots of women taking all in ones while others take individual supplements.

    Apart from Naturelo, I have also seen the below.Which would be best given my circumstances?

    http://www.wildnutrition.com/assistant/healthy-fertility/food-grown-fertility-womens

    http://www.zitawest.com/product/vitafem/

    https://www.amazon.co.uk/dp/B01KGHLD52/ref=wl_it_dp_o_pC_nS_ttl?_encoding=UTF8&colid=23G6L0WCLFKZJ&coliid=I3I2W1LTISWOA1

    https://www.amazon.co.uk/dp/B00IOU0DJ6/ref=wl_it_dp_o_pC_nS_ttl?_encoding=UTF8&colid=23G6L0WCLFKZJ&coliid=I1IZP7W6XK9O0T

    Many thanks

    • Hi Marg,

      What to take to increase fertility really depends on what the women or man needs. For example, progesterone and Vitex are needed for women with low progesterone, while other women may need help with their thyroid for fertility.

      I have written a few articles on fertility that you can read here: http://nutritiongenome.com/how-nutrigenomics-can-help-infertility/
      http://nutritiongenome.com/mthfr-a1298c-pon1s-connection-infertility/

      1. Wild Nutrition: This one claims that the folic acid as naturally occurring folate. I would double check with the company on whether it is synthetic folic acid or folate like methylfolate. Folic acid is not natural. I’m impressed the formula uses cordyceps mushrooms. They do not classify the forms of each vitamin so it is hard for me to determine if they are using the right form of B12, zinc etc. From a first glance, this looks like the best one of the four if the folate is indeed natural and the correct forms of other vitamins and minerals are used.

      2. Zitawest: I’m not crazy about the additives like soy oil and corn starch. It also uses dl-alpha-tocopheral which is synthetic vitamin E. You want to avoid that form.

      3. Prenatal Assist: This uses zinc oxide, cyanocobalamin, and folic acid. All poor forms. Also only has 400IU of vitamin D.

      4. Prenatal Multi + DHA: Also uses zinc oxide, cyanocobalamin and has low vitamin D (400IU). It is better to purchase EPA and DHA fish oil as a separate product so you get the right dosage. This only has 27.3 mg of DHA which isn’t nearly enough.

      • Hi,

        Many thanks for your prompt response, I will definitely read your other related articles. The only other few things that I may consider taking along with my nutrient dense and balanced diet.

        Maca, L’Arginine,Coq10 ubiquinol,Royal jelly,Vitamin D, Omega 3,6,9, Folate,Aspirin
        Green smoothies ,Leafy greens powder, Raspberry leaf tea.

        Do you recommend my OH supplements too? This was found to have the most zinc (40mg), the most folic acid (800µg), the highest dose of the super-antioxidant Pine Bark Extract (100mg) as well as the highest dosages of both amino acids Arginine and Carnitine (500mg each) of superior Carnipure™ quality.
        http://www.amitamin.com/uk/shop/fertilsan-m.html/?___store=uk_en&acc=c20ad4d76fe97759aa27a0c99bff6710.

        In summary is what I’ve addded as extra ok/safe to use?
        You mention the DHA/EPA, which brand would you recommend?
        Which male supplements are top?
        I have contacted WN asking for an ingredients composition. I will probably hear back Monday. Will keep you posted.

        • Hi Marge,

          Definitely read the first article link, which goes into the research on some of those nutrients you have mentioned. That level of zinc is right at the threshold of the safe upper limit, so it isn’t something I would feel comfortable taking for an extended period of time. Along with diet, 15mg of zinc from supplementation is sufficient for most people with a healthy digestive system. The form of folate is still synthetic folic acid, which may block folate receptors for people with common variants in the MTHFR and DHFR genes (could affect fertility). Methylfolate is a better form that occurs in food.

          For EPA/DHA, I recommend the Nordic Naturals prenatal DHA. Take a look at the Nutrition Genome article I linked for the most important nutrients for male fertility.

  • Hi,

    Many thanks. The link I sent previously was a supplement I saw for my husband to use. Would those levels of zinc & folic still apply?

    I’m still awaiting a reply from Wild Nutrition regarding the female supplement and its ingredient composition. I will forward to you just to double check it’s safe to use. Failing that I will order the Naturelo if it’s available in UK.

    Your advice has been very helpful, very much appreciated. Do you offer a service to work with couples regarding nutrition and pregnancy etc. If so I’d like to find out more.

    • Hi Marg,

      Yes, that would still apply for your husband.

      You are very welcome. Yes, my genetic nutrition practice is called Nutrition Genome. I have done infertility programs for couples by doing a nutrigenomic analysis, which helps you see where your vitamin, mineral or other compound needs may be higher for fertility (or sensitivities that may affect fertility). This helps you customize your nutrition/supplement plan based on your genetics and biochemistry. You can read more about it here: http://nutritiongenome.com/about/

  • Ok I will have to contact them again. Looking at this it says
    Mineral enhanced yeast (no live yeast used). As for folate or B can’t see specifics other then naturally occurring folate. It’s all so vague which has got me thinking.

    Failing this I’ve no idea what other supplement is good or safe to use. All of the U.K. ones seem to have folic, not enough of one thing or too much of another. Synthetically processed with crap added.

    Naturelo are my only option. Hopefully they ship to UK.

    Leaves me asking what do I choose for my husband then?

    • Hi Marg,

      If you choose Naturelo he can use the Men’s multivitamin from them. They do ship to the UK. I have been searching for local alternatives in the UK, but I haven’t seen a viable prenatal option that I would recommend.

      • Great I will order them. Many thanks for your time. It’s been of great use. Your knowledge in this misty area is invaluable I will make sure to spread the word. As I’m sure there are many couples out there confused as to what to take at such an important time in their lives. Best wishes

  • Hi Alex,
    I am taking frontrunner Health with Nordics Natural DHA. Do you think I need to supplement with something else like vitamin D? If so which one do you recommend?
    I get sunlight daily walking around (I live in Tahiti).
    Thanks 🙂

    • Hi Cannelle,

      No, I wouldn’t worry about vitamin D if you are in Tahiti! Those vitamin D guidelines are mainly for women who are deficient, in a climate without much sun or are not able to get outside enough. Make sure you are getting enough calcium and magnesium. I’m not sure if your water is higher in minerals there, but those are two important minerals that are needed in higher amounts.

      • Hi Alex,
        Ok thank you so much, I won’t be taking vitamin D then but I will definitely buy water with more calcium and magnesium 🙂
        Thank you for all your help!

  • Hi Alex, I’m switching prenatal vitamins and am trying to decide between Thorne Research Prenatal and Naturelo. Can you tell me why Thorne didn’t make your list? Naturelo is not a company I’m familiar with, but Thorne I am.

    • Hi Dianah,

      The Thorne Research Prenatal is a little high with the iron and methylfolate. It also has a reputation for digestive upset and nausea.

  • Me again Alex sorry for all the questions. Frontrunner Health does not contain any Choline, is that a problem?
    I did order a bottle of Naturelo based on your recommendation to try it out. Is it fine to switch prenatal now? I’m 7 weeks pregnant.
    Finally I know they have an incredible range of vitamins but do they have 3rd party testing? I’m a little worried about trying a prenatal from a brand new company with no feedbacks from pregnant women.

    • Hi Cannelle,

      I prefer you get choline from the diet if possible. If not, then supplementation becomes more important for choline. I see no issue switching Prenatals, but if the Frontrunner product is working for you, there may not be a need to switch. Naturelo currently does testing internally, but are moving to third party testing in the next few months. I reviewed their Certificate of Analysis and they reject any ingredients from suppliers that have detectable amounts of heavy metals.

  • Hi Alex, I’m switching prenatals and I think I’m gonna go for the Naturelo ones, but I’m trying to find supplements for the other things you mentioned as well
    (You may require more vitamin D (check your levels early), dietary calcium, DHA from fish oil and dietary choline).

    So I have some questions…
    1. I checked Nordic Naturals Prenatal DHA, they contain 15IU Vitamin E. Would that combined with what’s in Naturelo (30IU) be to much?
    2. Would you suggest taking more Iron as well and which one?
    3. Would you suggest taking cod liver oil for vit A?
    4. Or could I just take cod liver oil and cover vit A and DHA with that?

    I hope all this makes sense.
    Thank you very much.

    • Hi Tina,

      1. No, I wouldn’t be concerned about 15IU. Potential issues appear to be over 400IU. The 30IU is a general target.
      2. Iron supplementation is dependent on your dietary iron intake and blood levels. I would check your bloodwork before supplementing with more iron. You want to avoid iron levels that are too low and too high.
      3/4. Cod liver oil does cover vitamin A and DHA. I think it is an excellent choice if your dietary vitamin A is low.

      • Hey Alex, thank you for the reply, very much appreciated. Do you perhaps have a suggestion for vitamins for my partner maybe? We have been trying to get pregnant for over a year with a miscarriage last May. So something basic I guess. Thanks.

        • Hi Tina,

          You are welcome. Yes, I would recommend the Naturelo Men’s multivitamin explained here.

          I also have written a fertility article on Nutrition Genome found here.

  • Hi, Alex, thanks for your article and recommendations. I’m planning to take Naturelo Prenatal Whole Food Multivitamin for my wife, she’s pregnant. But after I’ve done some researches about Naturelo, I can only find it here and http://www.multivitaminguide.org, no results about it from FDA website. And it’s rated as Grade F on FakeSpot.
    After all this is for my wife and unborn baby, I don’t want them to take any risks by taking Naturelo. Can you please provide anything authoritative about Neturelo? Thanks.

    • Hi Charles,

      I had the same question when coming across FakeSpot and contacted the company. Apparently last year, Amazon got serious about fake reviews and now immediately delete any review that could possibly be fake. I can only comment on my own independent analysis of the Naturelo and the product. I have been in continuous contact with the company with a legion of questions – which they have given thoughtful and knowledgeable answers – found the forms of the vitamins and minerals to be highest based on quality and absorption, and verified their Certificate of Analysis. While I feel comfortable with the integrity of the product, there are other choices in this article that are also suitable. I would be much more concerned with the massive use of the often recommended One-A-Day and Centrum prenatal.

      • Thank you very much Alex! My wife is taking One-A-Day now, I wanted her to take better prenatal supplements. But if current one is good enough, I’ll let her keep using One-A-Day.

  • With regard to the Naturelo prenatal vitamin, is there a concern with lead levels since this is an algae based calcium? And, as far as the natural form of Niacin noted on their label; can you be more specific? Would that be considered Niacinamde, which is preferable over Niacin? If not, is this Niacin considered to be flush free? Thiamin is generally considered best if it is Benfotiamine. Is that what this is? Again, specifically naming what “natural” actually is would be helpful.

    • Hi L,

      Good question and I understand your concern. Let me explain why I do not see an issue. I reviewed the spec sheet of the algae based calcium and according to the formula details, 10% (or 35 mg) of the calcium comes from Aquamin and 90% comes from citrate-malate and ascorbate. 35 mg of Aquamin represents only 1.5% of the total volume of one serving of the Prenatal. For pregnant women, the U.S. FDA’s provisional total tolerable intake level for lead is 25 mcg (25.0ppm) daily. It is 75 mcg for regular adults. According to the spec sheet, there is 0.3 ppm of lead per milligram. Multiply 0.3 ppm by 35 mg and you get less than 1 mcg of lead per daily dose. Now factor in that calcium blocks lead uptake and vitamin C reduces blood lead levels. Another reason to get higher amounts of both during pregnancy since lead exposure is greater in our environment due to air and water pollution.

      Regarding the B-vitamins, I made the same suggestion to the company to use the forms instead of the word “natural.” If you look at their other multivitamins, they are listed there. The B-vitamins are made via fermentation. Niacin is niacinamide and thiamin is mononitrate.

      • Thank you, Alex! I also reached out to them and here is a bit more info (their prompt reply to my questions, copy and pasted below, for everyone’s benefit):

        “Aquamin is sourced from algae harvested off the coast of Iceland and is processed in a facility in Ireland before being brought into the US. Since Ireland is part of the EU, they follow very stringent safety standards which are tougher than the ones here in the US.

        I am not sure why Mononitrate was chosen as the source of Thiamin. My guess is that Benfotiamine was more difficult to obtain, but I will send a request to our R&D manager to look into it further and consider it for future inclusion into our formula.

        I am not aware of any of our ingredients causing constipation, nausea or headache. The ingredients we use in the Prenatal multivitamin are the same as the ones we use in our Whole Food Multivitamin for Women and we have never had any similar complaints about that product.

        All our products come with a 30 day satisfaction guarantee so if your daughter experiences any side effects we can give you a full refund.”

        Also, they are doing third-party testing now and the results should be available within 2 weeks.

        I must comment that they do have prompt and efficient customer service!

        • Hi L,

          Thank you for including this information. Yes, they by far have the best customer service that I have seen for a supplement company.

  • Do you have any thoughts/comments on USANA prenatals/multivitamins?

    • Hi Brittany,

      The USANA prenatal (Prenatal CellSentials Vita-Antioxidant) I reviewed uses folic acid and cyanocobalamin, so this isn’t one I recommend. The same is true of the multivitamin.

  • Hi Alex,
    I was wondering, I am lactose intolerant and therefore not eating any dairy. I am now 11 weeks pregnant, do you think I need to supplement for calcium?
    How much mineral water should I drink to make sure I am not calcium or magnesium efficient?
    Thank you so much,
    Cannelle

    • Hi Cannelle,

      Our bones were very healthy before the introduction of dairy, so I wouldn’t worry about that. Fish with bones, dark leafy greens like collard greens, almonds, along with mineral water that is higher in calcium are the best sources. How much you need to drink or if you need to supplement would depend on how much calcium you are getting from your diet. If you are concerned you aren’t getting enough, you can definitely supplement with calcium and magnesium.

  • Thanks Alex, I will try to eat a maximum of calcium and magnesium in my diet. If I don’t have enough which supplement would you recommend for calcium and magnesium?

    • Hi Cannelle,

      If you want one with calcium and magnesium, Thorne Research Calcium-Magnesium Citramate 1:1 is a good product. Leg cramps and acid reflux in the second and third trimester are a sign you aren’t getting enough.

  • I’ve used the recommendations from your site to seek out a prenatal vitamin (even ones not on your list). Curious to know if you’ve seen the ACTIF brand and what your opinion is?
    Also, I have low B12 confirmed by a blood test. I do the monthly injections of 1ml of cyanocobalamin. What is your opinion of continuing those injections while trying to become pregnant or even during pregnancy? Thanks

    • Hi Jericka,

      I have seen the ACTIF brand. The prenatal is an interesting formula and I’m curious about the absorption of some of their forms of vitamins and minerals. I wouldn’t rely on D2 for vitamin D. D3 should be used. The EPA and DHA amount is not enough to cover prenatal needs.

      I think that injections of cyanocobalamin during pregnancy could be problematic based on the research stated in this article under B12. It would be better to find out why you have low B12 in the first place (deficiencies in folate, iron, calcium, lithium, poor gut bacteria, etc.). Figuring these things out is actually what nutrigenomic testing is for and could help you prevent any issues during pregnancy.

  • Hello, I am originally from Brazil and have a 3 year old boy. Took prenatal vitamines while pregnant also a liquid vitamine for Iron supplementation. The brands were Bellybar Chewable Prenantals and Floradix, respectively. What is your opinion on those? My red blood count is low so I took Floradix on my own. Also, I rather liquid or chewable forms of vitamines. Thank you so much for all the info!

    • Hi Nathalia,

      The Bellybar Chewable Prenatal uses folic acid, cyanocobalamin, a poorly absorbed form of zinc called zinc oxide and is missing iodine(!), vitamin K, magnesium, and selenium.

      There is 27mg of iron pentacarbonyl in Bellybar, and it appears you are not absorbing it. Floradix is adding more cyanocobalamin along with the iron gluconate.

      You would be better off with a higher quality prenatal like Naturelo and an iron supplement without cyanocobalamin.

  • Hello. I am split between taking Frontrunner’s prenatal and Naturelo prenatal. I have been trying to research for reviews and feedback on the Naturelo brand, but I haven’t really found any with the exception of Amazon. Being such a great product according to their ingredients, shouldn’t this be of concern? How can i make sure that if i choose to purchase this prenatal, that i will be receiving the stated value in their supplement facts? Also, what does “Natural” mean? Is it made with yeast? Then, in regards to Frontrunner’s brand, is their lack of Vitamin D, B6 and Zinc be of concern to me?

    Also, if i at times suffer from leg cramps, is there a specific testing i should have done by my dr. to make sure that i need additional supplements? And if i am Vitamin D deficient, having a result of 17, should i be consuming additional Vitamin D?

    As you can probably tell, I am new to this and would appreciate your feedback if possible. I am trying to conceive and I want to make sure that i take the best informed decision to make sure that i am taking the best possible supplement. Thanks in advance for your feedback.

    • Hi AC,

      All good questions. I’ll try my best to answer all of them in detail. The Naturelo prenatal product was just launched in January, so the reviews are just beginning to be posted. You can see the reviews of their other multivitamin products online as well. To find out if you are receiving the stated value in the supplement facts, you want to review a Certificate of Analysis (COA). Naturelo sent me their COA and each amount was verified. They also sent me an analysis showing exceedingly low heavy metal count. Natural often means a fermentation process from yeast, which is how B-vitamins are synthesized into a formula along with foods like broccoli that are rich in methylfolate. If you still have concerns, they have excellent customer service and transparency with their products.

      For Frontrunners, low vitamin D, B6, and zinc may be an issue depending on your diet and needs. Legs cramps are often a sign of low magnesium levels. The best testing, in my opinion, is nutrigenomic testing. This is done through Nutrition Genome. The analysis tells you where your highest vitamin and mineral needs and allows you to customize your diet and supplementation based on your individual needs. I think this incredible information to have for fertility and pregnancy, especially when folate and choline needs are much higher due to certain genetic variants.

      Vitamin D needs to be supplemented separately for people like yourself that are in the deficiency range. You may require 4,000IU daily to get in the healthy range.

  • So the Naturelo prenatal does have yeast? Or not?

    I’m taking mega food baby and me 2 and it has s. Cerevisiae which is causing me some yeast issues, even though they say that isn’t possible. So I need something without yeast.

  • Do you have any suggestions for a choline supplement?

    I have a strong family history of schizophrenia and I’m trying to find a way to supplement my choline intake. I don’t like eggs and I’m a vegetarian. I’m hoping to force myself to eat eggs once I become pregnant but I’m nervous I won’t be able to eat enough of them. Thank you!

    • Hi Samantha,

      Thorne Research and Seeking Health make a phosphatidylcholine product. If schizophrenia runs in the family, it is also important to avoid gluten during pregnancy. I would recommend reading my mental health article that goes more in-depth.

      • Thank you so much for your help Alex! I will definitely look into both of the choline supplements you recommend. Have you heard anything about the product Nutrasal PhosChol? I was looking at that one because the dosage was higher & in the study referenced they used a high amount of choline. Cutting back on gluten will be a challenge but I’m definitely willing to try.

        • Hi Samantha,

          I haven’t heard of that one. It might be a little strong as one dose. If it affects your sleep then it is too strong for you.

  • Thank you for this article. I’ve been taking Vitamin Code Raw Prenatal, but will be switching to Naturelo after hearing so many good things. Nonetheless, I am curious to know your thoughts on Vitamin Code Raw Prenatal.

  • Hello there, I’ve read recommendations to take prenatal vitamins months before trying to conceive (some say 3 months). Base on your replies to other comments, I think I can safely assume that you believe that there’s value doing so too. Wanted to find out if you think there’s a need to start with DHA supplements early on as well or can that be left to after being pregnant? Also, I was reading up on Labdoor’s review of Nordic Natural Prenatals DHA (https://labdoor.com/review/nordic-naturals-prenatal-dha) and their review is that while the product met all purity standards, it saw EPA measure at 87.78% off its label claim. I then went to their rankings of other fish oils (https://labdoor.com/rankings/fish-oil), would you recommend using other brands that have a better measure of its label claim? Thank you!

    • Hi Colleen,

      Yes, I would start taking fish oil before getting pregnant. Regarding the Labdoor analysis, I contacted Nordic Naturals. They said that every batch has a COA and is tested by a third party. Labeling laws allow a deviation of 10% less or more, however, many companies aim for approximately 3%. For this analysis, Labdoor did not specify the lot number and give any references regarding the testing. Nordic Naturals said that they would be happy to show the COA and third party testing for verification of the amounts if you provide them the lot number of the product.

      Just a few years ago, the Nordic Natural Prenatal had 90mg of EPA and 450mg of DHA, and now has 205mg of EPA and 480mg of DHA. If you look at other DHA products on that Labdoor list, you will see the DHA often falls in the mid-200mg range of DHA. I prefer a product to be in the 400mg range of DHA for pregnancy, and I have always found Nordic Naturals to have extremely high standards and a good reputation.

      • Hi Colleen,

        I just received a call from Nordic Naturals. They obtained the lot number of the product tested by Labdoor and said that the COA actually shows an EPA count of 101mg and a DHA count of 494mg. So the amounts actually exceeded the amount on the label. It sounds like Nordic Naturals legal team is now getting involved with Labdoor over their claim that the EPA is 87.78% off its label claim.

        • Hello Alex, taking this into consideration, would you say that Nordic Naturals Prenatal DHA is safe for mom and baby to consume although the amounts exceed the amount on the label? I am unsure now and would appreciate your advice. Thanks.

          • Hi AC,

            That batch was from 2014 when the amounts were 90mg of EPA and 450mg of DHA on the label. Even so, I wouldn’t worry about that deviation. I had Nordic Naturals send me their March 2017 batch COA and the 205mg and 480mg on the label match with the final product. To give you a frame of reference of EPA and DHA levels in our diet, a 6 oz. portion of wild salmon contains 883 mg of EPA and 1,111 mg of DHA. So if you ate the recommended amount of fish a week (3x), you would get 3,333mg of DHA from wild salmon. If you took the prenatal of 480mg daily, you would get 3,360mg of DHA. Pretty comparable! Higher intake levels have been found in Japanese women during pregnancy without any signs of toxicity.

  • I am leaning towards the Naturelo after some extensive research, but I am hesitating because it’s so NEW. Do you think this is a valid concern? I just figure if it is JUST coming out there aren’t enough reviews or long term effects posted anywhere which makes me nervous..

    • Hi Mari,

      I understand your concern and I think track history is important. Then Women’s One a Day prenatal has been around for decades, but that doesn’t mean it’s a good formula. The Naturelo Whole Food Multivitamins contain the same ingredients as the Prenatal multi and they have over 400 positive reviews on Amazon since the release in 2013. I reached out regarding feedback on the prenatal so far because only about 1% of those who purchase a product leave a review. They said over 1500 woman have purchased the prenatal and have not reported any side effects to the best of their knowledge.

      The formulation, forms of vitamins and minerals, COA and heavy metal testing are important for any formula. They have sent me the COA and heavy metal testing, so I have verified it. However, your peace of mind is important and if you feel more comfortable with another formula on this list, that’s no problem. You have to choose what is best for you.

  • I’ve been taking nordic natural prenatal dha. I didn’t start it until right after my son was born. He was born a month premature. I’m trying to get pregnant now again. I switched to Naturelo prenatal based on your review.

    I’m wondering if o should continue with nordic natural dha or switch to a cod liver oil? I’ve read cod liver oil can help prevent preterm birth and can also help boost the birth weight of babies.

    I don’t thinking stomach a liquid cod liver so would need a capsule. What do you think?

    • Hi Kelsey,

      Yes, cod liver oil can definitely be used, especially if you aren’t getting enough vitamin A. The cod liver oil I have listed is very palatable, but you could also use capsules.

  • I am 42, compound heterozygous for MTHFR, and six weeks pregnant. I have been taking the MegaFood Baby & Me 2 for the past four months. I have a history of iron deficiency, and slight vitamin D deficiency. Would you recommend supplementing the Baby & Me 2 with additional folate, iron or D? I started taking 400 mg of Solgar Folate in addition to the Baby & Me 2 a few days ago, and was taking the MegaFood Vitamin D prior to finding out that I was pregnant. Thanks!

    • Hi Het,

      Baby & Me 2 only has 600IU of vitamin D and if you are potentially low, higher amounts are required. Iron is hard for me to determine without knowing your current level. I would look at your iron levels (and your vitamin D) with your doctor to determine appropriate supplementation. 600mcg of methylfolate in Baby & Me 2 is likely sufficient for the compound heterozygous MTHFR if you are eating your folate-rich greens, especially when combined with B2, B6, B12, and choline intake.

  • What are your thoughts on the Thorne prenatal? https://www.thorne.com/products/dp/basic-prenatal

    • Hi Susan,

      Thorne just updated their Basic Prental formula at a very competitive price. I have received some feedback that their old formula led to some digestive upset and nausea. The new formula includes a blend of both folinic acid and methylfolate, something I think every formula should do. It has 45mg of iron bisglycinate, so it would be best for those that are low in iron. They also changed all the minerals to bisglycinate chelates, which was a smart move. I will consider adding this one to the best list.

  • Hi Alex, Thank you for all your comprehensive research. My wife is now 9 weeks pregnant with twins and was taking the Harmons brands prenatals and then the doctor prescribed (which also had all the bad stuff, how do they not read up on this?). I always like to research what we put in our bodies and I wish I started my research on this earlier. I can’t believe how hard it is to find a prenatal that has everything and the good forms of it all. No wonder we have so many health complications in this country, we start out by giving our children the crappiest prenatals right from birth. Anyway I could go on all day about that so I’ll get to the question. I found your page here and I am very much liking the Naturelo after an exhausting search. My questions is about the K2 in it. Above you mention woman shouldn’t take more than 65mg of K2 while pregnant and I also read k2 my not be good for pregnacy, so why does it have K2 and not K or K1, which it doesn’t have any of? Is there a difference? Thanks so much for all the ifo!

    • I forgot to add her doctor told her to take extra folic acid. Do you recommend a certain brand for that? Thanks

      • Hi Jaime,

        Did your doctor specifically say folic acid? Methylfolate and folinic acid are the two forms of folate that should be used, not folic acid. See the section on folate in this article and why to avoid folic acid. If your doctor still thinks she should go over 800mcg of methylfolate, I would ask him or her about using folinic acid by Seeking Health. More prenatal formulas are beginning to combine folinic acid and methylfolate to address upstream and downstream folate metabolism for those with folate issues.

        • Yes I have already instructed the wife to stop taking the folic acid until the Naturelo prenatals get here. That and the b12 have been my biggest concerns in a prenatal. I believe he said folic acid but seems some people use the term interchangeably even though I think it shouldnt be because obviously they are different. She unfortunately did buy folic acid, and like I said before I wish I had started this research earlier. But she is only 9 weeks so lucky its still early to switch. We will see him tomorrow and I am going to print out the Seeking Health supplement fact sheet and clear it with him. Thanks for all the help!
          Any other big concerns you would advise not yet mentioned in your research? I recently started paying more attention to the water she drinks as well and have found it all to be highly acidic so I ‘m getting a filtration system.

    • Hi Jaime,

      I agree and your experience – like many – was a motivational factor for writing this article.

      The optimal amount of K2 for pregnancy is still being determined, so the dosage is currently a moving target. Health professionals are now saying 100-200mcg is an optimal amount for supplementation. I think that 65-100mcg is appropriate depending on your dietary intake of K2.

      If you look at the amount of K2 in certain foods found here in the figure 4 table, you can see what an average amount would look like per day. I have not seen any evidence that K2 is bad for pregnancy unless there is a blood clotting disorder (Factor 5 Leiden). On the other side, those with irritable bowel disorder, cystic fibrosis, fat malabsorption issues or have taken antibiotics or blood thinners for an extended period of time are more likely to be vitamin K deficient.

      There is a difference between K1 and K2. K1 is found in many vegetables and is easy to get from your diet. K1 plays a major role in healthy blood clotting. K2 is a little harder to get depending on your diet and appears to play a role in teeth, cranial and skeletal formation. Current research has also looked at vitamin K2’s role in treating osteoporosis, cancer and preventing calcification of the arteries in adults. K1 is also produced by intestinal bacteria and converted to K2, but how much we obtain this way is up for debate. Based on the foods that are highest in K2 and the poor state of many people’s digestive systems, I would say suboptimal levels are likely for many people.

  • I wasn’t there when he told her so I only know what she said and unfortunately i started all this research after she started taking all the bad pills. But she is only 9 weeks so happy at least we are on the right track now. I will print out the seeking health supplement facts to show him and see what he says. I recently started looking at the water she is drinking an found that it is very acidic so i am getting a filtration system. Any other major suggestions you may have aside from what you have already included in your research above? Thanks for all the help

  • Hi Alex,
    Hope you’re well. A little update, I am now 25 weeks pregnant and I’ve been taking Nordic Naturals DHA and Front Runner’ s Baby Best Start prenatal since conception and I’ve had a very easy pregnancy so far. 10 days ago I switched to Naturelo based on your recommendation. 4 days ago I was hospitalized for too many contractions and put on IV for 56 hours. They are releasing me today because my cervix is closed and I have to rest (not bedrest but take it easy). I have a pretty small figure and they think it might be causing contractions. All my blood and urine test came back fine. My iron level are low and they gave me iron with folic acid at the hospital and I stopped taking my prenatal since I’ve been there. I think I will go back to taking Frontrunner (just because my body seemed to react very well) but I would like to take iron supplement not sure which one, I don’t want to keep taking the one from the hospital. Do you have any suggestions. Sorry for the long explanation. Thank you so much.
    Cannelle

    • Hi Cannelle,

      I’m very sorry to hear that but I’m glad you are okay. There are numerous reasons why that could have occurred. The first thought that came to mind was a drop in progesterone, especially if you have a low percentage of body fat. But like I said, there are many possibilities that I’m sure your doctors have attempted to address. It sounds like you were doing great with Frontrunner and you have to do what’s best for your body.

      As for iron, I have Iron Bisglycinate by Thorne Research listed in this article as the best one. Let me know if you need anything else.

  • Thank you so much Alex. Yes I started my pregnancy at 104 and I am now 114 pounds so maybe that’s it. Actually they did not give me any iron they say my iron is right at the limit but to keep taking my prenatals. I had a small yeast infecfion that they treated but I am still having them. Do you think taking magnesium can help with the contractions?

    • Hi Cannelle,

      Magnesium may help with the contractions, but the hormones have to be functioning optimally as well.

      • Would you recommend I take the Thorne Magnesium and Calcium combo or Magnesium Citrate or Magnesium Citramate? Thank you Alex for all your help.

  • Hi Alex, I have researched Mykind Organic one a day prenatal supplements. I am concerned about them not being in capsule form for better absorption & having the correct amounts of each vitamin to be sure that I am not over dosing or under dosing…which could create any issues. I have been supplementing with pure natural forms of separate vitamins in the suggested amounts according to studies proving the harmful affects different dosages. What are your thoughts on this particular product? I am 29, planning to become pregnant, no proir children, & have rid my body of birth control for 10 months in preparation. I was married May 20th and am ready to get pregnant. Thanks!

    • Hi Jessica,

      First, I want to say great job of being aware of taking the time to build your reserves before pregnancy. The Garden of Life myKind Organics is one of the only true 100% whole food multivitamins. My main concern is the level and form of zinc, which is poorly absorbed directly from plants to begin with. The same is true of the form of iron.

      • Thank you for your advise Alex. I will further research how to make up for those in a different formula. Would you say The Garden of Life Mykind (one a day) is comparable to your listed Naturelo prenatal? Mykind prenatal is Certified Organic Whole Food; Certified USDA Organic; Non-GMO Project Verified; Whole Foods From Organic Farms & that is important. I like that Garden of Life Mykind has a one a day bottle, but I would consider switching to your suggested prenal Naturelo because I can see how a three a day supplement can be beneficial…if the reasoning behind it is that your body better absorbs at lower doses several times throughout the day. What is your opinion in comparison of products to reap the full benefits?

        • Hi Jessica,

          I would say there are some similarities. If you choose the Mykind, be aware that you will need extra calcium, magnesium and potentially zinc. Yes, it is advantageous to spread out the dosage to maximize the absorption potential.

  • Hi Alex, I am currently using seeking health optimal prenatal capsules and am 10 weeks pregnant. I am also taking Nordic dha. However I find it hard to take 8 capsules daily and usually don’t get the full 8. I was thinking of trying Thera natal complete prenatal vitamin. Is this a good choice?

    • Hi Justyna,

      The Theralogix prenatal uses folic acid and cyanocobalamin, so it isn’t one I recommend. Is that the correct one?

  • Hi Alex,
    I am considering the switch to Naturelo prenatal since they seem to have all of the right vitamins & nutrients needed for planning our pregnancy. However, my concern lies where the sources are labeled as natural whole food. I am concerned about insecticides & pesticides in the supplements since I haven’t seen any evidence of Naturelo being a USDA certified organic prenatal. I’ve have trouble finding an organic whole food prenatal with all of the needed vitamins, nutrients, or minerals with the amounts recommended or similar amounts. Do you have a certified organic recommendation similar to the amounts & vitamins listed in Naturelo?

    Thank you!

    • Hi Jess,

      I am not aware of a USDA certified organic prenatal with a similar formula to Naturelo, otherwise, I would definitely list it. Many companies use third party testing for heavy metals, pesticides, and herbicides and do not go through the certification process because it increases the price of the formula to the consumer. MegaFood is a good example of doing extensive testing for pesticides and herbicides (but not certified organic) while being non-GMO certified and kosher certified. I think the best approach for you may be to use the Mykind Prenatal and make sure you are getting extra calcium, magnesium, and zinc to better complete the formula.

  • Hi, I am 9 weeks pregnant, a vegetarian and taking MegaFood’s Baby and Me 2. You don’t mention supplementing with DHA with the MegaFood prenatal. Do you recommend doing so? My doctor thought that I should take DHA if my prenatal does not have it. Thanks!

    • Hi Het,

      In the beginning of paragraph under “Best Prenatal Vitamins,” I mention that each prenatal will need additional DHA. But you are right, I need to add a reminder to that product. So yes, definitely add DHA.

  • Hi Alex, I am wondering why Garden of Life Vitamin Code didn’t make your list? Thanks.

    • Hi Stephanie,

      Vitamin Code starts with USP vitamins – of which some are synthetically made – and given to yeast in a nutrient rich broth. The finished metabolized product qualifying as a “whole food vitamin” is debatable and there isn’t any research I am aware of that proves this to be advantageous for absorption. From my experience, Garden of Life isn’t as transparent as they should be with their formulations.

  • Since taking Naturelo prenatal, skin has cleared and I feel great (i am anemic) It does NOT make me constipated like all other vitamins. This is a capsule form vitamin. For some reason i’m so crazy about the smell of the capsule, lol– I love it. My (very very very picky) 6 year old takes the children chewable and my husband takes the men multivitamin. love love love!!!!!!!!

  • Hi Alex, i’m so glad to read your article. can you tell me what you think about ACTIF ORGANIC PRENATAL WITH 25+ VITAMINS AND ORGANIC HERBS, NON-GMO? my daughter in law ask me to research her prenatal vitamins. thank you!

    • Hi Alica,

      The prenatal is an interesting formula and I’m curious about the absorption of some of the forms of vitamins and minerals, including the zinc and iron. Stability is also an issue for this type of process and companies should provide testing after a few months on the shelf. I wouldn’t rely on D2 for vitamin D. D3 should be used. The EPA and DHA amount are not enough to cover prenatal needs.

  • Hi Alex,
    What do you recommend for postpartum vitamins while breastfeeding?
    Thank you 🙂

  • Sounds good thank you Alex!

  • Hi Alex! Im 5 weeks pregnant and just ordered Prenatal Vitamins by NutriVital Supplements before reading this. They say they have Blessed thistle and Fenugreek . Ive done some research and it says not to take while pregnant? Is that the case? Im not going to take them since I have chosen to now go by your reconmmendations of the Naturelo and Nordic Natural DHA.

    • Hi Abbie,

      From what I’ve read, it appears both blessed thistle and fenugreek should be avoided during pregnancy.

      • Thank you so much Alex! I’m so glad I found this site! It has helped me so much! I’m an over thinker and I just want to do the best for me and the baby. You have put me at ease! Cant thank you enough!

        • Just curious.. Are the Naturelo low in heavy metals? Do they have no harmful additives and are pesticide and herbicide free.?

          • Hi Abbie,

            You are very welcome! Yes, they have been tested to be very low in heavy metals, zero harmful additives, and the pesticide/herbicide free confirmation is a separate test that I recommended Naturelo complete.

  • What’s your review on Melaleuca’s prenatal multivitamin?

    • Hi Heidi,

      The Melaleuca prenatal uses synthetic folic acid and cyanocobalamin for folate and B12, so it isn’t one I recommend.

  • Hi! Very helpful article, thank you. What are your thoughts on Biotics Research Pre- Natal Packs? They seem to be a complete multivitamin and have EPA and DHA already. I live in Hawaii and I am not concerned about lower Vit D dosage and slightly lower fish Omega 3 than your recommendation. The only thing missing from the formula is Choline? Also, I found out that fish oil and other sources of Omega 3 have blood thinning properties, my platelets are already on the low side, which seems to be quite a common problem at different points of pregnancy. Do you think it is possible to intake too much fish oil (I eat fresh fish, seafood, fish roe and canned sardines or mackerels on regular bases). One can of sardines lists EPA at 1380mg and DHA 1720mg. I add salmon fish roe, because it seems to be an excellent source of Vit D it fat soluble form. Should I still supplement every day? Thinking to add Naturelo to alternate with Biotics on the days when I do consume a lot of fish oil. Would that make sense? And thank you for you encouragement to eat organ meats once a week!

    • Hi Edi,

      The Biotics Research Prenatal Pack looks pretty good. Based on your diet and location, I would agree that the lower vitamin D and DHA are not a problem for you. It is possible that you could have too much fish oil, especially with a higher seafood intake. I am so impressed you eat fish roe. That is also a source of choline. It is basically the perfect pregnancy food that not many people eat anymore. I’m not sure I could say with complete certainty what the best combination would be due to your platelets. I would check with your doctor, but my initial opinion would be that it may be best to alternate the fish oil supplement. And you are welcome regarding the organ meats! It sounds like you are spot on with the pregnancy diet.

      • Thank you Alex! Unfortunately, doctors I dealt with know very little about nutrition and supplements. I think women can benefit greatly from your article and other online resources. Good to know about choline in fish roe too!

  • Hi Alex, My question was out of all the prenatals you suggested what would be your top- most recommended? I think the first one you recommended I was going to order, so would I need to get the cod liver oil as well for sure?

    My other question would be if I have a 3 yr old who has been battling eczema for awhile, and I have done more research then I can comprehend on it, diets, creams, gut health, what would be your top probiotic, or kids vitamin for him? Since he is 3 can he have some of these that suggest 4 and up?

    I want to give him cod liver oil as I have heard it can help, is that ok, how much?

    When I ask questions about a more natural approach to my docs, they don’t really know or give a good suggestion😡. Their answer is just steroids and harmful meds we have not seen help. I love your blog and reviews on these as I can’t handle anymore research, and don’t know what half of it means. Thank you for your help!
    P.s I am 6 weeks pregnant and had hypermises gravidarium last pregnancy which was horrendous, so I’m hoping that won’t start soon if you have any recommendations for the help of nausea.

    • Hi Courtney,

      The Naturelo Prenatal would be my first choice. You would need to get cod liver oil or fish oil because it doesn’t contain any EPA or DHA.

      My top probiotics picks can be found here: http://paleoedge.com/best-and-worst-probiotics/

      The BioKult Infantis is the one for babies and children. Eczema can tricky. It can be food allergies (dairy and wheat are common), chemicals in laundry detergents and body products (choose chemical free ones), poor gut flora, zinc deficiency and an omega-3 deficiency.

      I haven’t personally seen cod liver oil resolve eczema, so I couldn’t comment on that question. I have seen putting coconut oil on the eczema help clear it.

      For the hypermises gravidarium, make sure you are getting enough B6 in the P-5-P form. Higher levels may be needed than is provided by the prenatal, which where your doctor would need to step in. But I’ve seen B6 consistently prevent nausea.

    • Hi Courtney,

      I added a new children’s probiotic to the probiotic article for age 3 and up. It is called Pro-Kids.

  • Thanks for adding vitamins for kids under 4. That is very helpful!
    Also, you mentioned B6 being good for nausea. What type of pill form or supplement without all the added stuff would you recommend? I hate when I get stuff at even health stores there is so much I don’t want in me with the supplements or vitamins!
    I’m not sure what foods sound good depending on the day, and if I could keep anything down I would just try to eat B6 on foods, but since I prob need a pill form or powder, I would love your recommendation.
    Just curious what foods are high in B6 as well.?

    Thanks so much,

    • Hi Courtney,

      Your prenatal can serve as a source of P-5-P if it contains it. There are also isolated P-5-P products but I don’t have any particular recommendation for that one. Since I don’t know much about your health history, I can only say it is a suggestion to run by your doctor.

      It would be really interesting for you to do a Nutrition Genome Report and see if there are issues with your B6 metabolism.

      B6 foods include wild salmon, wild cod, avocados, pistachios, potatoes and fermented drinks.

  • hello alex, does WELLNESS ESSENTIALS safe to take during pregnancy???…. i just wanna know. i want the best and the safest prenatal vitamins… plase help

    • i mean please help

    • Hi Rhojean,

      Wellness Essentials by Metagenics (if that is the one you are referring to) contains EGCG from two sources, which blocks the DHFR enzyme in the folate cycle. That could be a potential problem during pregnancy. Green coffee bean extract may also have caffeine. I can’t confirm this formula is safe or not during pregnancy, so I would ask Metagenics.

  • Hi Alex, I’ve just come across your site and find the information to be so helpful. I’ve been on a search for the best Prenatal vitamins. I plan to get pregnant and I’ve been taking Pure Synergy Purenatal for the last month or so. I was especially interested in finding something made from organic Whole Foods. I am also taking Rositas virgin cod liver oil and Bio Kult probiotics. I would really love to get your thoughts on these brands and if you think that I’m taking far too much Vitamin A. It is very high in this prenatal compared to Naturelo. I may consider switching to Naturelo. Many thanks!

    • Hi Jen,

      Synergy is not very transparent when it comes to their vitamin and mineral formulations. The impression is that the vitamins and minerals are coming from organically grown fruits and vegetables, but they actually use a process like Garden of Life that feeds USP vitamins and minerals to yeast in a broth, then dehydrated fruit and vegetable powders are added. I am not aware of any research that shows this process to be superior for absorption and effectiveness, and I think they are deceiving many customers. A major challenge of dehydrated whole food supplements is stability because just like real food, once processed and left to sit, the vitamins degrade. There are also issues with absorption from certain types of minerals like iron and zinc, which are poorly absorbed from the plant kingdom.

      Bio Kult and Rosita’s Virgin Cod Liver oil are both excellent choices and ones I recommend here on various articles.

      Probiotics: http://paleoedge.com/best-and-worst-probiotics/

      Cod Liver Oil: http://paleoedge.com/how-to-make-your-own-multivitamin-with-food/

  • Hi Alex, I am so happy I have found this article and Q and A section. There is mine field of information, often conflicting and often confusing! Your detailed replies and approach gives me great confidence. my gf is 6 weeks pregnant and is currently advised to take Vitrum prenatal with a supplementary folic/folate tablet. She has done a lot of independent research and wants a more natural vitamin/supplement course during her pregnancy and after. She has been recommended Natures Sunshine. My questions to you are these a) do you know anything about Vitrum Prenatal? b) and as to whether Natures Sushine are any good? After reading your detailed reviews and analysis I am heavily leaning towards Naturelo Prenatal Whole Food Multivitamin. I was just hoping you able to shed some light on the other two I have mentioned so I can talk to my gf as to why both are bad, and why not going in the direction of Natures Sunhine is also not recommended and for what reasons. If you have the time I would greatly appreciate a reply. Many thanks Nick

    • Hi Nick,

      Congrats! If the Vitrum label was correct that I found, it contains synthetic folic acid and cyanocobalamin. Same is true of Nature’s Sunshine. You want methylfolate or folinic acid and methylcobalamin. You want to aim for 800mcg of folate total, but not in the folic acid form. Also, Vitrum does not have iodine and Nature’s Sunshine only has 75mcg. You want to see at least 150mcg of iodine. Scroll to the iodine, folate, B12 section of this article and your girlfriend will see why these points are important.

  • ps: these seems to be the composition of Vitrum Prenatal: Vitrum Prenatal Forte forms, composition and dosages:

    Tablet, Film-Coated; Oral; Beta-Carotene 2500 IU; Calcium (Calcium Carbonate) 200 mg; Chromium (Chromium Chloride) 25 mcg; Copper (Copper Oxide) 2 mg; Folic Acid 0.8 mg; Iodine (Potassium Iodide) 0.15 mg; Iron (Ferrous Fumarate) 60 mg; Magnesium (Magnesium Oxide) 25 mg; Manganese (Manganese Sulfate) 5 mg; Molybdenum (Sodium Molybdate) 25 mcg; Selenium (Sodium Selenate) 20 mcg; Vitamin A (Retinol Acetate) 2500 IU; Vitamin B1 (Thiamine Mononitrate) 3 mg; Vitamin B12 (Cyanocobalamin) 12 mcg; Vitamin B2 (Riboflavin) 3.4 mg; Vitamin B3 (Nicotinamide) 20 mg; Vitamin B5 (Calcium Pantothenate) 10 mg; Vitamin B6 (Pyridoxine Hydrochloride) 10 mg; Vitamin C (Ascorbic Acid) 120 mg; Vitamin D3 (Cholecalciferol) 400 IU; Vitamin E (DL-Alpha Tocopherol Acetate) 30 IU; Vitamin H (Biotin) 30 mcg; Zinc (Zinc Oxide) 25 mg

  • Hi! Thank you so much for such valuable information. Have you heard of Metagenics Wellness Essentials Pregnancy? If so, what is your opinion on them? They are extremely pricy and Im looking for comparable vitamins at a lower cost point.

    • Hi Faiza,

      I think the Metagenics Wellness Essentials pregnancy formula would rank as “okay.” There are a lot of things they do right, including the choline addition and the right amount of DHA. They use a form of magnesium (oxide) where only 4% is absorbed. I’m not crazy about the aspartate forms of selenium and molybdenum because they are excitatory. The folate and B12 are on the high side, but the right form. This packet requires 7 supplements, which can be a lot to stomach while you are pregnant. However, if you are okay with this amount, I would be more inclined to make my own custom pack of all the best ones with the right forms and amounts of everything.

  • Hi Alex!

    What’s your opinion on Seeking Health Optimal Prenatal Vitamin?

  • Hello Alex,
    I had Mthfr A1298C single mutation, also borderline Protein S deficiency. My mfm recommend to take baby aspirin while trying and lovenox during pregnancy. I also have Hyperthyroidism ( Graves disease). I am looking for a good prenatal that is suitable for me.
    I am worried about Vitamin K, iodine and selenium.
    Would you recommend me to take vitamin k while on blood thinner? Do you think Vitamin K2 is better for me than vitamin K1.
    In your opinion, which is best prenatal for me.
    Also do you recommend me to take DHA before pregnancy. Does it affect my thyroid. Any vegetarian or vegan dha supplement you recommend.
    Thank you so much.

    • Hi Ruchi,

      Sorry for the delay! It is my understanding that Lovenox does not have the same issue with vitamin K as the blood thinner Warfarin. I would double check with your doctor, but I don’t believe you have to be concerned with vitamin K1 or K2.

      Avoiding iodine and selenium is an issue during pregnancy due to the importance of both of them, especially iodine. The typical prenatal is going to have iodine and selenium. DHA shouldn’t negatively affect your thyroid. Yes, Nordic Naturals makes an algae-based DHA.

      This is a tough recommendation because it requires someone with access to your health history like your doctor. You will likely need to take separate products like a B-complex, vitamin D, fish oil, calcium/magnesium with trace minerals and potentially choline based on your diet if you want to avoid iodine and selenium in a supplement. I’m not aware of a prenatal that omits iodine and selenium that also is well formulated with the right forms of the B-vitamins.

  • Hi Alex do you know anything about Carlsons superior DHA ? It was recommended to me over Nordic naturals prenatal DHA …

    • Hi Justyna,

      I don’t see anything that would make Carlson’s better than Nordic Naturals. The Nordic Naturals product has a better EPA and DHA ratio, along with being a full spectrum oil containing the other omega’s.

  • Hi Alex, I am new to the whole prenatal thing as my husband and I would like to start trying to get pregnant in the near future. A friend of mine recently recommended My Kind Organics Prenatal Whole Food Multivitamin. Are you familiar with this? Is so, what are your thoughts? I was considering the Megafood Baby and Me 2 but for some reason decided to try out her recommendation. It was only been a few days since I have been taking it and I can’t complain of any unwanted side effects however if there is a better one out there than I am willing to make the switch. Thank you for your help and feedback!

  • Aloha Alex,
    I just received an order of the Seeking Health Optimal Prenatala capsules bc I read so many great reviews. However, upon receipt it noticed that there is a Cal Prop 65 warning. While they emailed me the Certificate of Analysis with heavy metal levels. I don’t understand if these levels are the norm or if they’re exceptionally high. Do you know anything about this or have any guidelines. I obviously want the safest thing for our potential future baby. Mahalo and thanks!

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