Your Prenatal Vitamin Primer Why, when, and how to choose the right supplement

Good prenatal care means visiting the obstetrician even before you conceive, as well as maintaining a healthy diet and avoiding smoking and drinking alcohol. It also means taking a prenatal vitamin supplement.

Prenatal vitamins contain important nutrients in stronger dosages than regular multivitamin supplements (even those formulated for women). Just picking up some more ordinary vitamins at the drugstore is not enough for a healthy pregnancy.

Before You Conceive

It may be called a prenatal vitamin, but think of it as a preconception vitamin too. Start taking prenatal vitamins at least two months before you plan to conceive. Why? Because you want to get your body into the best condition possible to be fertile ground for a baby to grow. Make taking vitamins a part of your preparations, along with dropping bad health habits, getting other medical issues under control, and improving or maintaining your physical fitness.

Taking prenatal vitamins ahead of conception is smart for one other particular reason. A good prenatal vitamin should include folic acid and calcium, among other nutrients that are important to a healthy pregnancy and baby. The March of Dimes reports that birth defects of the spine, skull, and brain, such as spina bifida and anencephaly, are more likely to occur if the mother does not get sufficient folic acid during the first few weeks of her pregnancy—even before she knows she’s pregnant. Research has shown that folic acid can prevent these neural tube defects in developing fetuses by as much as 50 to 70 percent.

The suggested dosage for folic acid for a non-pregnant woman is 400 mcg (or 0.4 mg) and for a pregnant woman it is 800 to 1000 mcg (0.8 to 1.0 mg). Most over-the-counter prenatal vitamins pack at least 400 mcg of this critical B-vitamin punch—many contain as much as 800 mcg. To get more you may need a prescription. Talk with your doctor if you have not considered (or already started) taking a prenatal vitamin. Meanwhile, load up on green leafy vegetables, citrus fruits, and nuts, legumes, and grains, all of which contain folate. Incidentally, folic acid is good for you, too, not just your fetus, so try to get that 400 mcg daily even when you are not trying to conceive.

Choosing a Prenatal Vitamin

Multi-nutrient supplementation is recommended for women who are even considering pregnancy to cover the increased nutrient needs. When shopping for a vitamin, be sure to look for folic acid, calcium, copper, iron, zinc, and vitamins B-6, C, and D.

When looking for good vitamin, discuss with your doctor the right mix of nutrients for you. And remember that more isn’t always better. In a study of over 22,000 pregnant women, those who took supplements with more than 10,000 international units (IU) a day of pre-formed vitamin A (retinol) were almost five times more likely to give birth to a baby with a birth defect than women who consumed 5,000 IU or less. A good vitamin A alternative is beta-carotene, which the body will convert into vitamin only if needed. (These days, many supplements have beta-carotene added to their formulae; look for it listed under vitamin A activity.)

A question that perplexes many moms-to-be is what is the difference between over-the-counter prenatal vitamins and prescription prenatal vitamins, or even between different brands?

Prescription vs. Over-the-Counter

The studies that have revealed the benefit of folic acid in decreasing the chance of miscarriage and organ abnormalities have shown that the minimum dosage to acquire this added protection is 400 mcg a day. Over-the-counter vitamins usually have this 400 mcg dose, and increasingly, over-the-counter prenatals have up to 800 mcg, but prescription vitamins have a full 1000 mcg (1 mg). So the advantage of the prescription vitamins is more than enough folic acid. These also have more iron, as well as formula mixes of other vitamins that have been tested extensively by large corporations that have spent a lot of money to ensure a safe product. Because the dosages are larger, and therefore prescription, they also have to deal with extra FDA scrutiny.

They may have a higher price tag because of that, too, but bear in mind that if you have a good health insurance plan with prescription coverage, it may actually cost you less to pay the co-pay on a prescription than the retail price of the over-the-counter prenatal at the store.

The problem with the prescription brands is that because they’re big-gun vitamins, some women have trouble tolerating them (due to nausea, constipation, etc.). So sometimes it’s better for a woman’s nutrition to use the non-prescription vitamins until the side effects subside to the point where she can try a different brand of prescription vitamin, says Dr. Gerald DiLeo, MD, a board-certified OB-GYN who has served as chief of the medical staff at Lakeview Regional Medical Center in greater New Orleans. Not all brand-name prescription vitamins will be tolerated the same, but there should be one that works for everyone. Don’t give up on them all because you can’t tolerate a particular one.

If you find you really cannot tolerate the high-dose vitamins, or your doctor recommends it, then choose an over-the-counter prenatal multivitamin with 600 to 800 mcg of folic acid and some iron. Dr. DiLeo prefers big-company brands over “health food concoctions” for the assurance you get that the balance of nutrients will be appropriate. (For example, he says, “Too much vitamin A can affect the growth of the baby. Too much iron can deposit iron in other organs of a woman’s body. These are the things that the big companies have worked out with billions of dollars’ worth of research.”)

Registered Nurse Marie O’Sullivan compared five brands of prenatal vitamins, and reports that, indeed, the dose of each vitamin varies from brand to brand, with all doctor-prescribed brands having 1000 mcg (1 mg) of folic acid, the vitamin to be most concerned about. Over-the-counter brands have between 400 and 800 mcg, she confirms. The other big difference she found is the form in which the vitamin is offered. Some prenatal vitamins come in a chewable or liquid form. The liquid is especially helpful if you are nauseated. You can add the dose into your orange juice and drink it (slowly), O’Sullivan suggests.

Prenatal Vitamin FAQs

Is there a male version of the prenatal vitamin for when we’re trying to conceive?
They don’t make prenatal vitamins for men (at least not yet!), but the diet and lifestyle choices the would-be father makes may affect your chances for conception. Check out The Fertility Diet for Him.

Do overweight women need a higher-dose vitamin?
Research led by Dr. Martha M. Werler, DSc, an epidemiologist at Boston University, suggests that typical prenatal vitamins don’t contain enough folic acid to provide protection against neural tube defects in the babies of overweight women. Dr. Werler found that while at least 400 mcg of folic acid a day reduced the risk of neural-tube defects by 40 percent for children of women weighing less than 154 pounds, this dose did not reduce the risk in heavier women. As a result, some physicians believe plus-size women should take additional folic acid supplements along with their prenatal vitamins to obtain full protection. Ask your physician whether a higher dose of folic acid is right for you.

If I eat a healthy diet, do I really need to supplement?
The discovery of folic acid’s role in the reduction of neural tube defects led to the fortification of many commercially-produced foods (breads, pasta, and cereals) with the vitamin. According to the Centers for Disease Control (CDC), this fortification led to a 25 percent decrease in neural tube defects in the overall population. So, indeed, many women who eat healthy diets rich in folic acid (including dark green leafy vegetables, nuts, or fortified cereals) ask why they need the supplement. The answer is that the synthetic form of folic acid seems to be more effective for this type of protection, and pregnant women require twice the amount of folic acid that non-pregnant women require.

According to the March of Dimes, during the last six months of pregnancy and breastfeeding, your body will absorb more calcium from food than when you are not pregnant. In turn, your baby is absorbing this extra calcium from you to build strong teeth and bones. Many women do not get sufficient calcium in their diet. If you don’t get enough calcium during pregnancy, your baby’s calcium needs will be supplied from the calcium stored in your bones, thus weakening your bones. So calcium supplementation can help while you pursue a calcium-rich diet.

Both you and your fetus also need additional amounts of iron during pregnancy. Iron is important for building your blood supply, and your baby needs it to stockpile for future use. Since human milk and cow’s milk are both low in iron, your baby will be able to draw upon a banked supply for the first three to six months of his life. For this reason, 30 to 60 mg of supplemental iron (typical quantities for prenatal supplements) are recommended during pregnancy. Excellent dietary sources of iron are dried fruits, spinach, liver, dark green leafy vegetables, and sardines.

I didn’t start taking prenatal vitamins until after I found out I was pregnant. Will my baby be OK?
Since nearly half of all pregnancies are unplanned, there are no doubt many women in the same boat. The March of Dimes and healthcare providers for women of childbearing age have long been trying to spread the word of how important it is to take prenatal vitamins with folic acid prior to conceiving (or even in general in case of unintended pregnancy). According to the Duke University Center for Human Genetics, neural tube defect occurs in about one in 1000 live births in the United States. Even as NTD is one of the most common birth defects, not taking prenatal vitamins before conception doesn’t mean it will automatically strike you. So what do you do now? Start by taking a good look at your diet and talk with your healthcare provider about the best nutritional plan and necessary follow-up for your pregnancy.

I have morning sickness and it’s hard to keep the prenatal vitamins down. What should I do?
Those prenatal vitamins can really do a number on the stomach. If you’ve got this problem you should mention it to your doctor or midwife; perhaps she wouldn’t mind your taking the vitamins just before bed so that you can sleep through its side-effects. It may also help to take your vitamin with food—try in general to get your nutrition from food rather than only from vitamins, Dr. DiLeo cautions. Some physicians will prescribe an extra dose of vitamin B-6 to help combat nausea. Be sure to talk to your health care provider before taking extra vitamins, however.

How long do I have to take prenatal vitamins?
According to Dr. Diane Bales, an associate professor and human development specialist with the Cooperative Extension Service at the University of Georgia in Athens, women should not only take folic acid when trying to conceive, but also during pregnancy and into breastfeeding. As noted, the folic acid helps develop the neural tube, which later becomes the baby’s brain and spinal cord and which begins developing during the first eight weeks of pregnancy. But to boost Baby’s brain, she recommends continuing after birth. Folic acid helps with the manufacture of red blood cells and with the development of fast-growing cells, like those in the brain in an infant.

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