Like most things related to women’s health, there isn’t enough nuance in the discussion with prenatals. Most doctors will say any prenatal is a good option and not much is discussed beyond that. We are going to get into all the nuance of important nutrients for pregnancy as well as what our favorite prenatals are. Next week we will get into how to build your own prenatal. Let’s first establish what prenatals are and are not before getting into essential nutrients and our favorites.

What prenatals are: prenatal supplements are designed to provide essential nutrients for mom and baby that can be difficult to get in adequate amounts from food.

What prenatals are not: they are not a solution to meet all of your nutrient needs during pregnancy. We will always need to get nutrients from food as well.

Essential Nutrients For Pregnancy

The first thing we want to start with is the fact that there are many misunderstood nutrients when it comes to pregnancy. Magnesium and copper are the big ones that stand out. Our nutrient needs actually shift and change throughout pregnancy. Our magnesium needs are higher in the first and second trimester than the third because of the amount of oxygen in utero. This shift from an anerobic (low oxygen) to aerobic (normal oxygen) state from the first to third trimesters, leads to a decrease in magnesium requirements and an increase in copper requirements. We use copper with oxygen to help the body make energy, so it makes sense that a higher oxygen state in the third trimester would mean we need more copper.
​First Trimester:

This is when oxygen is low–creating a hypoxic or anaerobic state. This increases our magnesium requirements. Most prenatals only contain 100mg of magnesium, which is not enough for most women to meet their needs. There is quite a bit of research on magnesium supplementation during pregnancy and how it can improve health outcomes. You can know look at your magnesium levels by testing Magnesium RBC. Optimal is 6.5 mg/dl.

Second Trimester:

Oxygen is starting to increase around weeks 16-18 since intervillous blood flow is initiated in the womb. Magnesium requirements start to decrease. Many women experience heartburn during this time–magnesium bicarbonate can be helpful for this and supportive of magnesium requirements.

Third Trimester:

Oxygen increases to an aerobic state, which lowers magnesium requirements, but increases copper requirements. Our blood volume is also growing so much during this time, which requires more copper and vitamin A. If you’ve been told you’re anemic during this time because of a low hemoglobin level, we cannot stress the importance of understanding that hemoglobin levels are supposed to drop during the third trimester. 9.5-10.5 is optimal because of the increasing blood volume.

The Controversy with Vitamin A During Pregnancy

In traditional cultures, vitamin A rich foods are prioritized for pregnant women to ensure that the mother and baby are healthy. This makes sense since vitamin A helps cells proliferate and ensure proper organ development during pregnancy.

We believe the Weston A. Price Foundation says it best when they emphasize the importance of vitamin A.

“After the formation of all the organ systems, vitamin A supports their growth. Chronic vitamin A deficiency during pregnancy compromises the liver, heart, and kidney and impairs lung growth and development during the last weeks of gestation.”

Unfortunately, pregnant women are advised to avoid vitamin A rich foods like beef liver and cod liver oil. This recommendation is given because of a study done that linked some birth defects to vitamin A supplementation. The key here is that they were correlated and that this was a recall study–they called the participants and had them do a survey. This typically has a very low accuracy rate. We also think it’s worth noting that the study was on vitamin A supplements and not foods that are high in vitamin A. Hopefully, you know by now that isolated nutrients don’t work the same as a whole food version of that nutrient. Beef liver, for example, has a lot of vitamin A, but it also has a significant serving of copper, which works with vitamin A in the body. While supplementing with an isolated version of vitamin A may be too much (even though many studies show this isn’t an issue), eating the real thing provides a lower dose of vitamin A with other essential nutrients.

Vitamin A Requirements & The Third Trimester

As usual, the nutrition information given to women has zero nuance. While we are not sold that we need a ton of vitamin A during the first trimester, we are very convinced that during the second and third trimester, as blood volume and copper requirements increase, we do need more vitamin A. Including vitamin A rich foods like beef liver more often during the third trimester would be my ideal way of boosting those nutrients. We also think it’s important to test and not guess. Check your retinol (vitamin A) levels via a blood test. Ideally, they are 2.5-3x higher than your vitamin D 25 OH levels.

How To Get More Vitamin A

Vitamin A is a fat-soluble vitamin, which means we need to get it from foods with saturated fat, and we need fat to absorb it properly. It’s best to get vitamin A in animal food form. The main reason for this is because it gives us retinol. Retinol is very different from beta carotene, which is the type of vitamin A found in plants. Our bodies have to convert beta carotene into retinol in the body, which varies from 5-65% in humans. It’s also been shown that too much beta carotene can limit the conversion into vitamin A in the body. Here are the best forms of vitamin D:

• Beef liver: eating it 1-2x per week and/or supplementing with a high-quality beef liver.
• Dairy: ideally grass-fed if possible–dairy contains vitamins A, D, E, and K–all of the fat-soluble vitamins.
• Fatty fish

It’s interesting because every pregnant client we have worked with, as well as loved ones, always crave some form of dairy when pregnant. Often if they didn’t tolerate dairy well before pregnancy, they feel fine eating it during pregnancy. It’s rich in vitamin A and calcium, which are both important for prenatal development. Our bodies are so smart!

B Vitamins: Folate & Choline

Is folate important for fetal development? Absolutely, but just like anything else, we can get too much. Especially with the emphasis on folate during pregnancy and the abundance of fortified foods, plus the large amount of folate found in prenatal vitamins. Research now shows, that taking in folate and vitamin B12 in excess is associated with an increased risk of autism. This doesn’t mean that one causes the other, but we do think there is cause for concern with the high levels of nutrients found in prenatals. For example, one popular prenatal contains 5,357% of the RDA for vitamin B12 and 227% of the RDA for folate. Our concern is that women are still eating food while taking a prenatal, so not only are those levels high, but the woman taking that prenatal is likely getting even more.

The other area of concern that comes up is that folate is a copper-dependent vitamin, this means we cannot get all of the benefits of folate without adequate copper in our diets. Many of the copper-rich foods we recommend (beef liver, bee pollen/royal jelly) are frowned upon during pregnancy, however, when we look at traditional cultures, these are the foods given to pregnant women to support a healthy mom and baby. Fun fact: beef liver also contains folate–3oz of beef liver has just over 200mcg of folate in the easily absorbable form. The more you look into the nutrients in beef liver, the more you will see a connection with a healthy pregnancy.

Choline is another important nutrient for pregnancy. It is responsible for liver and brain development along with many other tissues making it an essential nutrient for the development of the baby. Our bodies can actually substitute choline for folate if needed for certain reactions too, which is pretty cool. Choline is found in eggs, beef liver, dairy, and fish.

Other Important Nutrients

• Vitamin C: Whole food vitamin C contains tyrosinase. This is a specific compound in whole food vitamin C that helps make copper more bioavailable for use in the body. Vitamin C also a powerful antioxidant that works with copper and many other minerals in the body to reduce inflammation and support collagen and cell growth. Most prenatals only contain ascorbic acid, which can decrease copper rather than fuel it like whole food vitamin C.
• Vitamin E: Powerful antioxidant that acts similarly to progesterone in the body. The main reason we find it to be essential for a healthy pregnancy is because of how it protects the body from stress and oxidation. Pregnancy is a MAJOR stressor. So stressful that many women develop autoimmune conditions postpartum. Vitamin E can help counteract that.
• Iodine: Our iodine needs increase during pregnancy since thyroid hormone production increases during pregnancy. Iodine is required for the creation of thyroid hormone. Like many of the other nutrients we’ve discussed, the amount you need really depends on your health history and current diet. The RDA for iodine during pregnancy is 220mcg and 290mcg during lactation. Seafood is a great source of iodine as well as many other minerals as well as sea veggies like kelp. Most women are deficient in iodine. The majority of our fertility clients are taking a low dose iodine. Learn more about why here. ​

Problematic Ingredients In Prenatals

• Retinyl Palmitate: synthetic form of vitamin A, which can be toxic in high levels. This does not act the same way as retinol, which is the vitamin A we get from beef liver, dairy, eggs, and fatty fish.
• Beta Carotene: plant form of vitamin A that has to get converted to retinol in the body. We don’t convert all of it and beta carotene in high amounts can lead to thyroid dysfunction.
• Ascorbic Acid: this is the synthetic form of vitamin C and depletes copper, which is essential for a healthy pregnancy and Mom.
• Excess Vitamin D: vitamin D requires adequate magnesium, vitamin A, and vitamin K. Excess amounts can lead to high calcium, low potassium, low iron, and low magnesium. Ideally we get vitamin D from the sun and food (fatty fish, cod liver oil, mushrooms, liver, and eggs).
• Iron: our bodies recycle 24mg of iron daily. Getting adequate copper and vitamin A is what allows us to use this iron properly. Supplementing with iron does not improve how we use it in our bodies.
• Calcium: calcium is best when we get it from food since we want to get other nutrients with the calcium such as vitamin K2. When we eat dairy as a form of calcium, we also get this important vitamin.
• Excess Folic Acid: folic acid in excess can lead to slower brain development for the baby and unwanted symptoms for the Mom (cramps, diarrhea, dizziness, headaches, etc.). Folate is the form we get from food and is the best option. Most doctors recommend not exceeding 1,000mcg per day.

Our Top Picks

In our humble opinion, there is no perfect prenatal. None of our clients take just a prenatal. They always have other supplements added in based on their needs or we help them make their own prenatal with an assortment of supplements, so we know they are actually getting everything they need and nothing they don’t. While we are listing a few prenatals below, this does NOT mean we recommend to only consume them or that they meet all of the nutrient requirements we listed above. In fact, none of them have the type of vitamin A from whole food that we prefer. This is why we pair them with other supplements and a nutritious diet to help our clients meet their needs.

​FullWell Prenatal Multivitamin​

Pros:

• It doesn’t have a high amount of ascorbic acid that we are concerned would negatively impact copper levels.
• It has much more vitamin E than most other prenatals.
• It has more vitamin B6 than most prenatals, which can help some women with progesterone and nausea.
• Folate is 800mcg, so definitely the max we would want to see but not in excess.
• Doesn’t contain iron–we do not recommend any prenatals that contain iron.
• Contains manganese.
• Contains vitamin K2, which is important and often not found in prenatals.
• Meetings required amount for selenium.
• Meets the recommended intake for iodine for pregnancy but not breastfeeding.

Cons:

• Vitamin D is high–we’d rather see something 1-2,000IU.
• Zinc levels are a little high, which could negatively impact someone’s copper and iron status.
• Contains synthetic vitamin A.
• Choline doesn’t meed the needs for pregnancy. If someone couldn’t eat eggs and chose this as their prenatal, they would have to add a choline supplement on top.

Needed​

Pros:

• It doesn’t have a high amount of ascorbic acid that we are concerned would negatively impact copper levels.
• It has more vitamin B6 than most prenatals, which can help some women with progesterone and nausea.
• Folate is 551mcg, which is a very balanced amount and won’t provide too much of the vitamin.
• Meets the recommended intake for iodine for pregnancy and breastfeeding.
• Doesn’t contain iron–we do not recommend any prenatals that contain iron.
• Contains manganese.
• Meetings required amount for selenium.
• Contains vitamin K2, which is important and often not found in prenatals.
• Contains one full mg of copper.
• Has almost 100% of the requirement for choline, so if someone can’t eat eggs, they don’t have to take an additional supplement.

Cons:

• Low vitamin E levels.
• Vitamin D is high–we’d rather see something 1-2,000IU.
• Zinc levels are high, which could negatively impact someone’s copper and iron status.
• Contains synthetic vitamin A.
• Contains 200mg of magnesium, which most women will need more than and require another supplement.

Tend Bars

One other option that we do like for those that cannot take capsules and the powder form doesn’t work for is Tend bars. These are not perfect either but they have worked really well for our clients that cannot take any supplements due to nausea. Overall, many of the nutrients are much lower since this is 100% food based but it’s still more than most women are getting if they can’t take pills. The folate content still meets 100% of needs.

Why We Have To Look Beyond Prenatals

Ultimately, there is no perfect prenatal. We have to prioritize nourishing foods and ideally do testing to know exactly what our bodies needs. If you want to learn more about building your own prenatal, you can do that here!

reminder: i’m currently accepting people into my Nurture Your Fertility program. you can learn more here about the program and fill out an application!