I wrote this article because I treat pregnant women, I have been pregnant, and as a Naturopathic doctor I have a passion for preventative medicine beyond what is offered in today’s medical world. It is a common occurrence once you are pregnant to be told to start a prenatal vitamin (if you are not already on one), but there isn’t much else in the way of which one and why. There are literally hundreds on the market right now, and then what about fish oil, and probiotics…..you’re supposed to take those too right?? 

 

 

It’s just the start of the confusing world of pregnancy and questions you are going to start having, so I hope the following information will at least clear this up for you! One important thing before diving in is to say there is no substitute for exercise, a healthy diet and lifestyle choices, and to always speak with your OBGYN, midwife or Naturopathic Doctor before starting any supplement regimen. 

 

A Great Prenatal Vitamin

I say “great” because there are so many out there to choose from and not all are equal in content and quality.  You want the best for your growing baby. So, I want to highlight what is actually in a prenatal vitamin, why it’s in there, and what to look for when choosing yours. 

 

But first, why do we have to take a prenatal vitamin if we eat a balanced diet? Well, unless you are rockin’ your 3+ meals a day with 8-10 servings of colorful fruits and veggies, fermented foods, 50-80g protein, organic eggs, mercury-free salmon 2x/week (hint: not really such thing as completely mercury-free fish), and UV exposed mushrooms with enough sun exposure to keep vitamin D levels up (whew!)….it’s not a bad idea to consider a prenatal to fill in the gaps. So, let’s look at the ingredients:

 

 

 

Folate

The most important supplement for a pregnant woman to take is folate. Adequate folate levels in mom will reduce the risk of spina bifida and other neural tube defects in baby. Most of us know this, and the government has made sure we are getting this nutrient by fortifying foods like breads, cereals, and MANY others (start reading the label!). It is also in all prenatals you will find. As a result of these measures, there have been significantly less neural tube defects in the population.1

 

• Where to find it: Vegetables like dark leafy greens, especially cooked spinach are high in Folate. Other veggies to highlight are asparagus and brussels sprouts. Liver is quite high with 215mcg/3oz, as well as black eyed peas, romaine lettuce, and of course the fortified grains and cereals in the form of folic acid.3

 

• Optimal time to take it: In a perfect world, you should be getting adequate folate 2-3 months BEFORE you are pregnant since the neural tube forms very early on in pregnancy (4-6 weeks after your last period). Continuing to keep intake at optimal levels of 600mcg/day is important throughout pregnancy as well due to the reduction of anemia, preterm birth, cleft-palate and congenital heart defects.2

 

• Dosage: Most recommend between 400-600mcg/day in preconception and pregnancy, respectfully.

  

• Things to consider: Methylated vs not: You may see folate listed as 5-methyl-THF (also known as L-5- MTHF, 5-MTHF, L-methylfolate, and methylfolate) instead of folic acid. This means that it is being given in its “activated” form. The body needs to convert folic acid into 5-methyl-THF through a process that requires our methylation cycle. This cycle depends on the activity of the MTHFR enzyme. It has been found that up to 60% of the population have genetic variants, or “polymorphisms”, on the gene that controls this enzyme which slows it down. 25% are homozygous, which means it is slowed down even more.  Although this is a somewhat new field of research, many studies support the use of the methyl form instead of folic acid, especially in this subset of people. One study showed that when given 5-methyl-THF there was a more significant increase in folate levels in mom when compared to just giving folic acid. Another study showed higher hemoglobin levels (less anemia) in pregnant patients given a methylated medical food form vs a standard folic acid prenatal vitamin.  

 

 

B-vitamins

This is a large and diverse group of water soluble vitamins necessary to many functions in mom and baby.  Many are involved with energy and cell production, making them vital to the development of the baby. They also interact a lot, needing each other to work properly.  I will list them below with a brief summary of action and any interesting tid-bits. 

 

Vitamin B1

Also known as thiamine. Important for growth, development, and function of cells for baby. Sweet and simple, but very important! Deficiency has been linked to Alzeheimer’s and the function of our brain circuits.8 Food sources are largely fortified foods, pork, peas, oats, lentils, nuts, dried beans, acorn squash, and noodles.

 

Vitamin B2

Also known as riboflavin. The one that makes your pee neon yellow (yea you know what Im talking about if you have taken it!). In the form of FAD and FMN, it is largely involved in cell energy production and metabolism of fats, drugs, and steroids. It is also known as an antioxidant. In pregnancy, this relates directly to the development of all things baby as well as the skin and eye health of mom. It is also an important piece in blood cell production and will help prevent anemia.  

 

One study showed a reduced rate of preeclampsia in women who were getting adequate amounts. A common clinical use of B2 is for headache prophylaxis, and this can relate to in times of pregnancy as well. You’ll want to get about 1.4mg/day, optimally in both Riboflavin and Riboflavin 5-Phosphate forms. Food to include are eggs, lean meats, milk, and green vegetables. Grains and cereals are also fortified with riboflavin.

 

Vitamin B3

Also known as niacin. You know you’ve had too much if you get a nice warm flushing sensation. In fact, it’s important to note that studies have not shown safety in doses higher than 35mg.9  Flushing usually occurs around 30-50mg of nicotinic acid. In addition to being involved in the most reactions in the body (over 400) to help baby grow, niacin can be helpful to treat and prevent headaches in mom, reduce nausea, and improve digestion.9  Food to include are mainly meat-based like chicken breast, but also found in peanuts, tahini, sunflower and pumpkin seeds, as well as fortified foods. 

 

Vitamin B5 

Also known as pantothenic acid. There is little concern for deficiency of B5 as it is found in almost all foods, but interestingly, this is one that will degrade after processing. Making sure to include whole foods that have not been refined will be important here (and as a general nutrition rule anyways!). This B-vitamin helps with fat, protein, and carb metabolism, as well as hundreds of other vital reactions in you and your baby’s body. Aim for about 6mg/day. 10

 

Vitamin B6

Also known as pyridoxine. This is one to pay attention to! Not only is it a common deficiency in the US with 24% of non-supplement users getting less than the recommended 1.9mg, it is vital to the developing babies cognitive function.  The most common usage of this outside of the basic prenatal is for pregnancy associated nausea and vomiting. Studies have shown its safety and effectiveness over placebo at 40mg twice daily.11  This study also demonstrated it to be just as effective as ginger, and I believe in the power of therapeutic synergy, like in this product.  Caution not to exceed the intake of 100mg/day as studies do not support this, and always talk with your doctor or midwife before trying a new supplement.  Foods to include in your diet are chickpeas, chicken, garlic, beans, sweet potatoes, avocado, nuts and seeds, banana, and fortified foods. 

 

Vitamin B7

Also known as biotin. When we’re pregnant it usually is a bonus that our hair and nails seem to grow faster and our skin “glows”. Biotin is helpful in this process as it is directly related to DNA replication and how we make our fatty acids that benefit our skin. It is also involved in blood sugar regulation. For baby, it is helpful for the same reasons and is essential to growth.  30mcg per day is the recommended amount. Foods to include in your diet are eggs, meat, seeds, nuts, and certain vegetables such as sweet potatoes, avocado, spinach, cauliflower. It is important to note that whole foods and NOT processed foods will retain the most biotin content and a strong digestion will be required to break down food sources.  If you think you may be lacking in some of those pancreatic enzymes, please consider supplementing.12

 

Vitamin B9 

(folate- see above)

 

Vitamin B12 

Also known as cobalamin. This is an important one! It is a little like the black sheep of the B-vitamins and here is why: it is not found in many plant-based foods, it is stored for longer in our bodies, and it is a large molecule with a complex absorption process.  During pregnancy and the development of our baby it helps with nervous system function and development (along with folic acid), and plays a huge part in hemoglobin (where oxygen is carried on our red blood cells) production. Signs of deficiency to look out for are fatigue, tingling in hands or feet, brain fog, depression or anxiety, mouth sores, and sleep issues. Aim for at least 2.6mcg/day. Food to include are most animal products (free-range please!), nutritional yeast, and fortified foods. 13

 

Things to consider with B12:

• Look for forms of Methylcobalamin and 5-deoxyadenosylcobalamin
• If you have low stomach acid, are on PPIs, or have GI disorders affecting your small intestine, you may need higher doses in the form of injections. Don’t worry it’s not scary and very common!
• If you are a vegetarian or vegan, you NEED to be supplementing or eating enough nutritional yeast. 

 

 

Iron 

Iron’s main role in a pregnant mom is to help get oxygen to her muscles and lungs as well as to her babies. It is essential that her body’s levels of iron and ferritin (the storage of iron) are optimal going into pregnancy.  Iron deficiency anemia is SO common during pregnancy (41%!!) and postpartum and can lead to things like fatigue, muscle weakness, shortness of breath, and decreased mental clarity in mom. In baby, it can cause anemia right from birth, low birth weight,  preterm birth, and even an increase in birth mortality 14  In my practice I make it a point to include ferritin in my pregnant mom’s blood work so that we can PREVENT low iron in the future. I aim for a level of at least 50.

 

• Where to find it: Other than most prenatals, you can take it on its own in capsule or liquid form. Foods to include are red meats, beans, lentils, chocolate (win!), black strap molasses, and fortified foods.

 

• Optimal time to take it: I always recommend to take it with food and to pair it with things that aid in absorption like vitamin C rich foods.  Take it away from coffee or tea and calcium. Since it is most likely in your prenatal, you can’t avoid some of the interactions, but if you need additional iron these are good habits to get into. 

 

• Dosage: About 27mg is the recommended intake during pregnancy. That’s almost double a non-pregnant female, so you can see the importance! 15

 

• Things to consider:
  • Seek out the “ferrous” form for less constipation.
  • If you tend to get nausea and constipation from iron supplements, consider trying a whole food based one, or choose a multi or prenatal with a lower amount and get the rest from an iron rich diet.
  • If you are vegetarian, increase your intake about 1.8x to get what you need or make sure your supplement has the right amount. This is because plant based foods contain non-heme iron which is harder to absorb. 
  • B12 and folate are also players in red blood cell health, so make sure you are including them with iron. 

 

 

Vitamin D 

This is a VERY important vitamin and common deficiency in pregnancy and the general population. Vitamin D is involved in keeping your and your baby’s bones healthy and strong as well as moderating immune health, mood and cognition, and helping prevent fatigue and weakness.  To learn more about vitamin D’s benefits in pregnancy, check out my article here. 

 

• Where to find it: It is a bit difficult to get the amount you need from food, so this is a vitamin that you want to make sure is in your prenatal vitamin or to take additional as needed. Sun exposure is a great way as well, but you need to live below the 40th parallel and consider what season it is to really get what you need from the sun. Aim for 15-30min/day of direct sunlight 5 days/week. 

 

• Optimal way to take it: Since it is a fat soluble vitamin, your body needs it in some sort of lipid for optimal absorption.  When you get Vitamin D3 on its own, look for ingredients such as “phospholipids” or “medium chain triglycerides” or “olive oil”.

 

• Dosage: Most prenatals contain about 400-600IU/day.   See below though…..

 

• Things to consider: Please talk to your doctor about getting your 25 (OH) D blood levels tested to see if you need a higher dose.  Research suggests that many pregnant women need a dose closer to 1000-2000IU/day to stay in an optimal range and even more if they are already deficient. Again, read my article for the details on this. 

 

 

Vitamin K1/K2

This vitamin is essential in both blood clotting and bone health for both mom and baby.  Like all other nutrients, demand increases in pregnancy and you want to make sure to be getting adequate amounts of K as well.  You may be more familiar with the vitamin K shot for the newborn to prevent bleeding in case they have a rare vitamin K deficiency syndrome. Unfortunately, baby cannot get enough vitamin K through mom’s supplementation to not need this, so please don’t replace this important intervention. 

 

• Where to find it: High amounts in green leafy foods, soybean and canola oil (K1). K2 is actually made from your own gut bacteria and fermented foods. 

 

• Dosage: 90mcg/day

 

• Things to consider: This is another fat soluble vitamin so needs to be in a lipid like the ones mentioned with Vitamin D.  If you have malabsorption issues from a digestive disorder or bariatric surgery, you may need higher amounts of vitamin K. 17

 

Vitamins A and C

Although these are two very different nutrients, I lumped them together because you want to be careful not to get too much of these. 

 

Vitamin A

Vitamin A is essential to the health of our vision and eyes, immune system, reproductive system, and cell growth. Obviously we need all these things when growing a baby, but studies have found too much to be teratogenic to the baby in early pregnancy. 18  This means that it can cause malformation during growth in utero.  That being said, it is still a common deficiency in low income countries and should be included in a balanced diet and prenatal regimen. 

 

• Where to find it: Two forms of vitamin A are usually found: preformed vitamin A (retinol and its esterified form, retinyl ester) and provitamin A carotenoids. The first is found in animal products such as fish oil, dairy, and eggs. The second is found in veggies such as green leafy veggies, red and yellow veggies, and sweet potato.  Supplements can contain either type and commonly will have a combination. The preformed type is the one you want to limit.

 

• Dosage: 770 mcg RAE (Retinol activity equivalent). NOT TO EXCEED 3000mcg/day (10,000IU)

 

• Things to consider: Check your cod liver oil for vitamin A dosage if you are also taking a prenatal. This is a preformed vitamin A and one you want to consider keeping under the 3000mcg max.

 

Vitamin C

Also called ascorbic acid, it is a well known support for our immune system and a powerful antioxidant. Remember hearing about scurvy in pirates and sea folk?  Since vitamin C is vital to wound healing and the health of our connective tissue, they had bleeding gums and wounds that would not heal because of not having access to fresh vitamin C-packed fruits like oranges. It is an essential vitamin to get from food and supplementation because our body cannot make it on it’s own. 

 

Research has found that “vitamin C given alone reduced the risk of preterm and term prelabour rupture of membranes (PROM)”.20  This makes sense because of the connective tissue health mentioned above. That being said, taking large amounts (>25g) at a time in pregnancy should be avoided as it can cause stomach upset, diarrhea and possibly uterine activation. This is a similar recommendation as to why you avoid laxatives in pregnancy.

 

• Where to find it:  All prenatal vitamins contain it.  Some food sources are oranges, kiwis (actually more than oranges!), red peppers, and strawberries. 

 

• Dosage: RDA for pregnancy is 85mg. Tolerable upper intake is 1800mg, and the dose to not exceed is >25g (25,000mg). 

 

• Things to consider: Since keeping your iron in normal range is both difficult for some and important in pregnancy, try pairing your iron rich foods or iron supplement with a source of vitamin C. It will increase your body’s ability to absorb the iron!

 

 

 

Iodine 

This trace element is quite important in everyone, especially during pregnancy. It’s big role is in thyroid health since the body needs iodine to make thyroid hormones T4 and T3. Thyroid hormones work on almost every cell in the body by regulating their metabolism.23 Not many other hormones can say that!

 

Production of T4 increases by approximately 50% during pregnancy due to the high demand from baby.24 In the baby, it is required for the growth of the nervous system and skeleton. The big issue with iodine is that the soil is depleted in certain areas of the earth. The people living there were found to be sick and have large goiters, a sign of iodine deficiency. Because of this, Salt iodization programs were implemented and have dramatically reduced the prevalence of iodine deficiency worldwide. It’s a balance, though, because you don’t want too much either. Prenatals will have the proper amount for most individuals. 

 

• Where to find it: Prenatal vitamin (look to make sure though because not all may have it), iodized salt, seaweed, dairy, eggs, grains like bread. Vegetables too, but the amount depends on the soil they were grown in. 

 

• Dosage: Aim for 220mcg/day. Caution not to get more than 1,100mcg/day.

 

• Things to consider: If you have hypothyroid or it runs in your family, make sure to be on top of your thyroid testing by a knowledgeable practitioner and to be getting adequate but not too much iodine. I include a complete thyroid panel in women trying to conceive and at the 6 weeks postpartum check-up. 

 

Other Minerals (calcium, magnesium, zinc, copper, manganese, chromium, molybdenum, boron)

These minerals work in different ways but are all equally important to  keep bones, muscles, heart, and brain working properly in addition to helping them form in a fetus.  Minerals are also important for making enzymes and hormones.25 I will go into more detail on calcium and magnesium below as they require some more discussion.

 

• Where to find it: A varied and balanced diet rich in veggies, nuts/seeds, eggs is a great place to start. Prenatal vitamins of course too! 

 

• Dosage: Varied

 

• Things to consider: Minerals often times act on the same receptor in our bodies and may compete for absorption. For example, if you are taking high doses of zinc you want to make sure to also take copper so you don’t become deficient. 

 

Now to dive in to some specific nutrients that you may need in addition to a good prenatal:

 

Calcium/Magnesium 

Although about 99% of the body’s calcium is used for strong bones and teeth, the other 1% is essential for functions related to the vascular, muscular, and nervous system. Magnesium works right alongside calcium for bone health, but also is a cofactor for over 300 enzymes in the body! Needless to say, it does a lot. 

 

• Benefits for mom:
  • Most women in the US do not get enough calcium and magnesium, so keeping up with the RDI during pregnancy is a must and will benefit mom by keeping her stores high enough to support all the vital functions these nutrients do. Low blood levels of zinc, calcium and magnesium were found to be associated with PIH (pregnancy induced hypertension),28 a pretty common issue.  Also, magnesium can really be helpful for that oh-so-fun constipation during pregnancy. Taking an additional supplement of about 300mg before bed can be a life saver. I recommend starting magnesium citrate during the second trimester and keeping doses below anything that would cause loose stools (typically below 500mg). Due to its potential to cause loose stool, we want to be careful we don’t activate any uterine activity.  

 

• Benefits for baby: 
  • Baby gets between 50-330mg of daily calcium doses from mom and puts them to good use alongside magnesium for making strong bones.27 Babies born to women low in magnesium were found to have a higher risk of low birth weight.26 

 

• Dosage: 
  • Calcium: 1000mg in pregnant women >19 years of age.29
  • Magnesium: 350mg/day pregnant women >19, 360mg if your over 30yrs old.30 
  • Ratio: Cal/Mag is a great way to supplement these if you are taking additional from your prenatal. I aim for a 2:1 ratio of calcium:magnesium for most uses. 

 

• Where to find it: Most prenatals will have these both, but you may need additional amounts if your diet is lacking in sources such as dairy, green leafy veggies, nuts (almonds!) and seeds, whole grains, and certain fortified foods like cereals and juice. 

 

• Things to consider:
  • Calcium: don’t take in doses more than 500mg at a time as the body won’t absorb it as well. I call this expensive pee. Also, consider the form. Calcium citrate and glycinate seem to cause less side effects and is also better for people who have low stomach acid or digestive disorders. Calcium carbonate, on the other hand, is best taken with food because it requires stomach acid to be absorbed. Citrate-malate is a well absorbed form as well. 
  • Magnesium: Starting in the second trimester, the form and timing can be helpful here as well. I recommend taking it before bedtime because it can help with sleep as well as those muscle cramps, and then in the morning you’ll have a good AM poo! If you need relaxing-focused help such as sleep, tight muscles and anxiety, try magnesium glycinate. If you need help with constipation, then magnesium citrate is your way to go. Many kinds make a combination product which is good for all around help as well. 
  • Interference: Take your Cal/Mag away from other medications as it can decrease absorption. 

 

Omega 3s

Also known as EPA/DHA, or fish oil, these essential fatty acids can only be obtained through diet and supplementation. They are critical to fetal and newborn neurodevelopment and play an important role in a healthy inflammatory response. DHA is usually the focus during pregnancy because studies show how important it is for babies’ brains and cognition. The key issue with getting enough of these fatty acids is that we really want to limit seafood during pregnancy due to mercury contamination, and this is the main source from our diet. Read on for the solution!

 

• Benefits for mom: Skin, digestion, mood (pre and postnatal), lower inflammation

 

• Benefits for baby: Healthy neurodevelopment, lower risk of preterm delivery and low birth weight, higher cognition and visual acuity scores at 2-3 yr follow-up after birth. 32

 

• Dose and form: 
  • Supplement forms can be found as fish oil, krill oil, cod liver oil, and vegetarian products that contain algal oil. Whichever source you choose, the key is to look at the actual amount of EPA/DHA, not just “total omegas”. 
  • The goal is at least 1.5g Omega-3s/day at minimum.  EPA/DHA ratio goal is about 2g DHA to 1g EPA, based on research showing benefit for baby at this level.32
  • Vegetarians: You can still get your daily dose by choosing algae sourced supplements. You can also get some benefit from eating foods and supplements high in ALA like flaxseed, walnuts, chia, canola oil. The issue with this is that ALA needs to be converted into EPA/DHA, which is a very limited process in the body with reported rates of less than 15% conversion.33 That’s why the National Institute of Health says “…consuming EPA and DHA directly from foods and/or dietary supplements is the only practical way to increase levels of these fatty acids in the body.”

 

• Things to consider:
  •  I recommend not just taking a DHA product but one that balances it with some EPA. A higher DHA:EPA ratio is fine and may be beneficial. 
  • Cod liver oil supplements also provide vitamin A and vitamin D. So, read the labels to make sure you’re not going above your safe amounts across supplements. 
  • Make sure the brand you choose is testing for heavy metals and impurities!! Two brands I like are Metagenics and Pharmax. Vegetarian sources are here. 

 

 

Choline

This nutrient is what makes all of our cell walls strong and functional. It is found that about 90–95% of pregnant women are not getting the recommended amounts, and prenatal dietary supplements typically contain little if any choline.36  So pay attention to this one! It also is a key player in methylation (see folate above) and in the production of acetylcholine, a very important neurotransmitter.  This is another one that must be obtained from the diet and supplements since the body doesn’t make enough to meet our demand, especially not during pregnancy. Vegetarian/Vegan? MTHFR +? Read on. 

 

• Benefits for mom: Improves cognitive function, prevents age-related memory decline, supports a healthy liver, and protects the brain from diseases such as Alzheimers.35 Maybe we can expand this finding to new mom memory loss?? I sure hope so because ladies this is real.  

 

• Benefits for baby: Adequate choline in the mothers’ bodies ensures proper nutrient absorption through the placenta for the baby. Specifically, one study in a mouse model found that transporters for DHA, choline and acetylcholine were increased in response to choline supplementation.34  The most important job it has is creating strong cells with all that division that goes on and is it involved in early brain development. 

 

• Dosage: Commonly this amount is not met, as in only 18% of healthy pregnant women in one study!
  • 450mg/day
  • Food sources: Meat, poultry, fish, dairy products, eggs, soybeans, cruciferous vegetables, nuts and seeds. 
  • Some prenatals, but not many so check your labels! 

 

• Things to consider:
  • If you don’t eat eggs or animal products you need to add this to your list
  • If you know you are homo or heterozygous for MTHFR, I would add this along with your methylated B-vitamins
  • Intake amount during lactation goes up another 100mg35, so keep up with the supplementation after birth as well.

 

Probiotics

Something you have most likely taken at some point in your life, probiotics can play an important part in both your health during pregnancy and babies after birth. When your baby comes into this world, their gastrointestinal tracts will be colonized with the bacteria they first come in contact with. If born vaginally, this is mostly Bifidobacterium and Streptococcus species that comes from mom’s vaginal canal. If born by cesarean delivery, they will receive less Bifido and more Clostridium and Bacteroides as well as other potential bacteria present in the hospital environment.42  

 

Although there are many times where the choice of c-section is out of our hands, research does show a benefit of having more bifidobacterium in babies’ guts.  One study showed that babies with allergies in their first year of life had less Bifido in their GI tract compared to non-allergic babies. So if you find yourself needing a C-section, you know you have an unhealthy gut or history of allergies in you or your family, taking probiotics is something we CAN control and will most likely be beneficial. 

 

• Benefits to mom: Reduce likelihood of being GBS+ at birth, improve overall health of GI tract and possibly improve any constipation she is having.39,43

 

• Benefits to baby: The most studied benefit for babies is that it prevents Atopic dermatitis.41  It may also help reduce the incidence of colic and other GI complaints such as reflux and constipation.40

 

• Dosage and Type:
  • 10 billion-50 billion/day. Dosage varies by study, so it is a general range. 
  • Look for ones that have Bifidobacterium species, specifically longum, bifidum, and animalis, as well as the Lactobacillus species of rhamnosus, paracasei, and reuteri. 
  • Start taking them in your second trimester, or at least 2 months before delivery and continue through the first 2-3 months of babies life. 

 

• Things to consider:
  • Sourcing the right company is important with probiotics. My favorite is Klaire Labs as they make complete, female, and infant specific options that I trust. 
  • Careful with storage as most need to be kept in the refrigerator. 
  • If you have a negative reaction to probiotics such as bloating/gas, constipation or diarrhea, I recommend stopping them and getting further work-up done on your GI tract (possibly a stool or breath test) as this is a sign of an imbalance or overgrowth in the wrong bacteria. 

 

 

Carnitine

This non-essential nutrient (our body makes it on its own from from the amino acids lysine and methionine) is needed to bring energy from fatty acids into our cells and get toxins out. Most people make enough to meet their bodies’ demand for energy, and so widespread supplementation is not recommended 45. 

 

During certain states, though, such as having a genetic issue, in preterm infants, pregnant populations, and those with diabetes, supplementation has been found to be beneficial. Growing a baby is all about needing energy from the cells, so it’s easy to see why carnitine is such an important nutrient. 

 

• Benefits for mom: Possibly reduce the risk for gestational diabetes. Studies have found that low levels of carnitine in mom was a predictor for getting gestational diabetes.46 In addition, along with other key nutrients like zinc, vitamin D and magnesium (all discussed above!), supplementing with L-carnitine caused a reduction in pregnancy-induced hypertension (PIH) and gestational diabetes (GDM).47 

 

• Benefits for baby: Proper energy metabolism to grow and thrive properly, which may reduce the rate of small and large-for-gestational-age (SGA, LGA) neonates.47

 

• Dosage: 500mg L-carnitine or acetyl-l-carnitine/day. Levels of carnitine have been shown to decline as pregnancy progresses starting in the 12th week44, so starting in your second trimester is a reasonable approach.

 

• Things to Consider:
  • There also has been a link between low iron status and lower carnitine levels44. So, if you have anemia this also would be a time to consider upping your carnitine game.
  • Vegans get considerably less (about 10–12 milligrams) since they avoid animal-derived foods, so this is also an important population to consider supplementing. 

 

Inositol

This carbohydrate found in our body works on many cells involving hormones, neurotransmitters and growth factors.  It has been the source of research in many areas of the body including fertility and PCOS, mood, diabetes and blood sugar management. Most specifically to pregnancy, it is a very effective way to prevent gestational diabetes.

 

• Benefits for mom:
  • Decrease risk of gestational diabetes (GDM)51
  • Could prevent neural tube defects in women who are folate resistant or have the MTHFR polymorphism49
  • Mood support: Help reduce anxiety and give a sense of calm in this not-so-calm stage of life48. Improve symptoms of depression,50 which would be very helpful in the postpartum period especially. 

 

• Benefits for baby:
  • If reducing likelihood of GDM in mom, baby is less likely to be large for gestational age and less likely to have the increased risk factors associated with being born to a mother with GDM (preterm birth, low blood sugar at birth, and diabetes later in life)

 

• Dosage: It comes in two forms, and Myo-inositol seems to be the best choice. 
  • For GDM prevention, 2g of Myo-inositol twice daily was found to show benefit51
  • For anxiety and depression, a higher amount of between 6-12g/day may be needed.48

 

• Things to consider:
  • If you are taking a powder form, don’t take it along with coffee as this is shown to decrease absorption.49 Gel caps are a way around this too.

 

So in conclusion, there is A LOT more to consider when deciding what prenatal vitamin and other possible supplements you need may be. It is such an individualized decision and I hope this break down will help you support your body the way it needs for a beautiful pregnancy, birth, and baby. 

 

A break down of a beneficial supplement plan by diet and health considerations:

 

• General standard diet that includes all balanced food groups:
  • Good Prenatal 
  • Vitamin D3
  • Calcium/magnesium starting second trimester
  • Fish oil (EPA/DHA)
  • Probiotic, female strain specific starting second trimester 

 

• Vegetarian/vegan 
  • Prenatal that contains choline, or an additional choline supplement 
  • B12
  • Vitamin D3
  • EPA/DHA (from algae)
  • Probiotic, female strain specific starting second trimester 
  • Calcium/magnesium starting second trimester
  • Possibly additional iron

 

• GI disease/impaired absorption/on PPIs
  • Good Prenatal (consider a shake or chewable to increase absorption) https://www.premierformulas.com/klaire-labs/prenatal-and-nursing-formula-90-caps
  • Vitamin D3 (liquid, sublingual form)
  • Fish oil (EPA/DHA)
  • Probiotic, female strain specific starting second trimester
  • Cal/Mag- 600/300mg. (Liquid form, not calcium carbonate)
  • Digestive enzymes (look for one that contains a variety of pancreatic enzymes, like the one here. Talk with your provider to make sure HCL is OK for you, and if not, find a product that excludes that ingredient.)

 

• Increased risk for gestational diabetes
  • Good Prenatal 
  • Vitamin D3
  • Calcium/magnesium starting second trimester
  • Fish oil (EPA/DHA)
  • Probiotic, female strain specific starting second trimester
  • L-carnitine
  • Inositol

 

• MTHFR polymorphism
  • Good Prenatal with methylated forms of B12 and folate
  • Vitamin D3
  • Calcium/magnesium starting second trimester
  • Fish oil (EPA/DHA)
  • Probiotic, female strain specific starting second trimester
  • Inositol
  • Avoid foods and supplements with “Folic acid” in the ingredients

 

• Increased risk for anxiety or depression
  • Good Prenatal with a higher amount of B-vitamins
  • Vitamin D3
  • Calcium/magnesium starting second trimester
  • Fish oil (EPA/DHA)-Increase dose to about 2-3g/day
  • Probiotic, female strain specific starting second trimester
  • Inositol
  • It is important to continue these supplements during the postnatal period as this is when you are most susceptible to low mood and anxiety. 
  • Have a mental health professional who specializes in perinatal health on speed dial.  Talk to your loved ones about signs and symptoms of postnatal depression and psychosis. I know this sounds scary but it is very important to educate yourself and those around you as a good preventative measure. 

 

 

References

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