Excel at: prenatal vitamins & supplements; extensive guide

When you first get pregnant or start trying to conceive, you are told to get prenatal vitamins. If you ask your doctor which one he recommends, he most likely will say, “Any with folic acid.” There is an agreement in the medical community that this is the most important supplement pregnant women need to be taking. Getting enough folic acid before and during pregnancy is crucial and can prevent major birth defects in her baby’s brain or spine. What about other vitamins and minerals? Are all prenatal vitamins created equal?

Disclosure: This post is not sponsored and does not contain any affiliate links. As of this moment, I am not part of any affiliate marketing programs. All opinions and recommendations are based on my own research and personal experience.

OFFICIAL GUIDELINES VS. LACK OF PRODUCT CLARITY

National Institute of Health and American College of Obstetricians and Gynecologists provide guidelines¹ that set numbers for Recommended Daily Allowances (RDA) and Upper Tolerable Limit (UL) of all necessary nutrients. It seems like any prenatal available on the market should have the same or similar nutrients and values, right? Not really. In reality, regulations allow for wide variation in formulations. Here’s why.

Are supplements food or drugs?

One issue is that in the United States, supplements and vitamins fall under the 1994 Dietary Supplement Health and Education Act. Manufacturers do not have to prove their efficacy or safety before market introduction, as these products are treated as “food” rather than “drugs.” It means they receive substantially less scrutiny, oversight, and testing. Each company designs its own “recipe” based on its marketing goals, philosophy, cost, and interpretations of official guidelines. They aren’t required to prove that they’re safe, work as advertised, or even that their packages contain what the labels say they do. If things were different, your OBGYN could prescribe everyone the same generic prenatal. But in a market-driven industry, there’s little financial incentive for that.

There seems to be a lack of consensus among those manufacturers about the Recommended Daily Allowance (RDA) they include for each nutrient (and even the choice of supplements or its source) in supplements they make for pregnant women.

Most of our minerals, vitamins, etc. should come from our food, which unfortunately is almost impossible to track for a regular person. Even if we knew exactly what we were getting, it would still be almost impossible to customize a prenatal to suit each person’s exact needs (that vary over time). This adds to the overall confusion.

My first pregnancy experience

During my first pregnancy, I was taking Ritual prenatal multivitamin. And I loved it. I felt great almost the entire pregnancy (show me a woman who enjoyed that last month, when you always feel you’re about to burst in seems. But I digress).
I had no morning sickness, little to no nausea, and only a few food cravings (I’m looking at you, stone fruit!). The only health issue was my gestational diabetes, which I was able to manage with diet only (gestational diabetes is thought to be caused by hormones from developing placenta).

My baby is perfectly healthy and developing milestones in/ahead of time. Maybe that was pure luck, and maybe that was my prenatal. I guess I will never know. Later I switched to Ritual Postnatal for my 2-year breastfeeding journey.

ORGANIZING THE DATA

This time, I wanted to give this more thought as we plan for another baby. I’m soon to be 35, so I began reading about improving egg quality and additional supplements that might help to conceive. The supplement market is growing, and it’s easy to fall for its clever marketing. I felt like I needed to see things laid out a bit more clearly.

To do this, I deployed the best tool out there: an Excel spreadsheet. If you think it’s only useful for accounting and the corporate world– think again. My husband has Excel for almost everything, from our finances to the nutritional value and taste ratings of our delivery meals. The man likes his things in order.

disclaimer

I am not a medical professional; I’m merely a mom, sharing the results of my research and trying to make sense of available products and health information. Please consult your doctor before taking any supplements. I will not tell you which prenatal to buy. I’m sharing this information so you can make an informed decision for yourself. This is a vast subject. If this amount of information makes you feel overwhelmed, skip it. The most important thing is to take prenatal vitamins. Your doctor is your best guide on this journey.

The basis of this comparison is the official recommendation of the ACOG (American College of Obstetricians and Gynecologists) titled “Nutrition During Pregnancy.”² All values in the table are from supplement facts listed on the manufacturers’ websites. I also included the recommended intake by EFSA (European Food Safety Authority) for reference. Medical authorities in Europe don’t always advise taking prenatal supplements at all, except for folic acid. That would indicate the emphasis on a food-first approach.

Click here for a high-resolution image.

SUMMARY

I find it bewildering how much prenatal vitamins on the market vary. Many have lower dosages or none of the recommended nutrients. On the other hand, some nutrients exceed the recommended values significantly. But can there be too much of a good thing when it comes to specific vitamins or minerals? Perhaps.

Many nutrients don’t have established upper tolerance limits. Some were found not to cause any harm in large dosages; some say there is insufficient data to determine that number. That’s not reassuring, as pregnant women are hard to study due to ethical concerns, like potential risks to the baby.

According to a few published papers, too low and too high levels can result in adverse health outcomes for developing babies (e.g., for nutrients like folate and vitamin B12³). Finding the right prenatal can be a daunting and confusing task. In the end, all we can do is make an informed decision with the best knowledge and information we have at the time. This decision is yours to make, and it’s important to feel empowered and responsible in making it.
You and your doctor should know best if you get enough nutrients from your diet alone. Keep in mind that proper nutrition could be challenging due to pregnancy’s nausea and sickness.

KEY POINTS:

– what to take separately

Prenatal vitamins often omit some key nutrients or include them in small doses. And there is a reason for that:

– Calcium is best taken separately and at different times of day, a minimum 1-2 hours after a supplement containing iron. It’s because they interact with each other negatively and reduce the absorption.

– Magnesium is a large molecule size nutrient, meaning in order to meet 100% RDA, manufacturers would have to increase the size/amount of pills in one serving. It can also cause some nutrient absorption interference.

– Choline is rarely included in prenatal vitamins, and when it is, it’s included in much smaller doses than recommended due to its large size and relatively high cost.

– food first approach

Food should be the primary source of nutrition. Some nutrients we likely get enough from diet alone are calcium, zinc, vitamin A, niacin, riboflavin, thiamin, vitamin B6, vitamin C, vitamin K, and selenium.

– Not all sources of nutrients are equal

Some absorb better or less (synthetic folic acid vs. food-sourced natural folates), are vegan or non-vegan, organic or not, gluten-free, etc. Decide what’s important to you and if it fits your beliefs/lifestyle.

– Folic acid vs. Folate

It was always said pregnant women should supplement folic acid, which is a synthetic form of folate.

Nowadays, you’ll commonly find these complicated names on supplement labels: L-methylfolate/L-5-MTHF/6S-5-methyltetrahydrofolate/ L-5-methylfolate/ L-5-methyl-THF/ L-5-methyl-tetrahydrofolate/ L-5-MTHF-Ca/ Quatrefolic/Levomefolic acid. They all mean a type of methylated folate. They are water-soluble vitamin Bs that are biologically active forms of folate.

Methylfolate has many advantages over synthetic folic acid as it’s a natural form of folate⁴. For example, methylfolate is well absorbed, and its bioavailability is not affected by metabolic defects in up to one-third of people. Methylfolate is said to have no tolerable upper intake level (which I’m very cautious about⁵) and will not mask vitamin B12 deficiency.

– Folates work together with vitamin B12

The upper tolerable limit for folate (1000 mcg/day) is set to prevent masking a vitamin B12 deficiency, rather than to account for folic acid bioavailability and metabolism.

There is no upper limit established for vitamin B12⁶. It is a water-soluble vitamin, meaning the excess should leave the body through urine. A small percentage of women may have low intrinsic factor, and without that, the absorption of vitamin B12 is only 1%, so higher doses are needed. It would make sense for some manufacturers to include up to 7000% of B12 RDA. But.

Although not officially recognized in the guidelines, there have been some studies indicating that both deficiencies and too high levels of those nutrients can be associated with a higher chance of complications for the baby (like neural tube defects, and autism spectrum disorder)⁷.

Vitamin B12 is present in foods of animal origin, including fish, meat, poultry, eggs, and dairy products. Plant foods do not naturally contain vitamin B12. However, fortified breakfast cereals and fortified nutritional yeasts are readily available sources of vitamin B12 that have high bioavailability⁸. If your diet is vegan, it’s worth paying extra attention to your vitamin B12 intake.

Cobalamin is no doubt needed for a healthy pregnancy. But there seems to be a sweet spot for a dosage of vitamin B12 for pregnant women. I’m comfortable taking the amount close to RDV established by health authorities (or even up to 10 times the RDA), but not 80 or 400 times more.

– iron supplementation

Adequate iron intake is crucial during pregnancy. Iron sufficiency during pregnancy results in better pregnancy outcomes for the mother and the child. Undoubtedly, the benefits of iron supplementation outweigh the risks in women about to become pregnant and in pregnant women with evidence of iron deficiency⁹. However, not all pregnant women might need additional iron supplements on top of their diet, and it’s best to speak with the doctor about it. Additionally, many women report iron supplementation aggravating common pregnancy conditions like nausea and constipation.

Some iron forms might be more tolerable and absorb better than others. It might be a good idea to look for names such as iron bisglycinate, ferrous bisglycinate¹⁰ chelate, ferrous glycinate, iron glycinate in the prenatal supplement facts list.

– VITAMIN B6

Vitamin B6 is crucial for the healthy development of the baby’s brain and nervous system. While experts recommend a daily intake of only 1.9 mg, the upper tolerance limit is 100 mg. To me, that’s a big difference. Doctors often prescribe extra vitamin B6 during pregnancy to help reduce nausea. But API warns about the excessive intake:

“Expectant mothers should be alert to the risks of excessive intake of Vitamin B6, as it’s frequently found in variously suggested multivitamins and prenatal vitamins as well as in various fortified foods.
While a slight excess is harmless, extreme intake of Vitamin B6 can lead to nerve damage, numbness, and other conditions. Individuals should avoid taking over 100 mg of Vitamin B6 in a day. 
Research from the National Library of Medicine reports that there appears to be no association between excessive Vitamin B6 and birth defects or malformations.
Most people can and should quickly reach their daily requirements with a balanced diet. Supplementing is unnecessary with a balanced diet and may even push you to unsafe intake values. “¹¹

– How much biotin?

There is no established upper limit for biotin, and it’s also water soluble, so it’s hard for the general population to take “too much” of it. But the FDA warns that taking biotin supplements can affect the results of some blood tests, including those for ferritin, cortisol, estrogen, progesterone, and testosterone, and might lead to a lack of or inaccurate medical treatments, including pregnancy conditions¹².

On the other hand, NIH published a study that suggests that biotin intakes exceeding current recommendations are needed to meet the demands of pregnancy¹³.

– Purity and 3rd party testing

Some prenatal supplements were found to contain heavy metals that can be dangerous to mom and developing baby. Find multivitamins with confirmed third-party testing for purity. Look for labels like NSF, USP, BSCG, GMP, and Consumer Lab.

my picks

You’re more than welcome to come to different conclusions than I did. The table provided is just a tool that I hope will help make that decision. The best prenatal vitamins for pregnancy are not only the ones that check all the right boxes but also the ones we can keep down and afford. Finding the right prenatal is a personal choice, but having clear information makes it easier. Check out my comparison table and share your experience—what prenatal worked best for you?

prenatal supplements

Not in any particular order.

Ritual Prenatal Vitamin

– Dosage: 2 capsules/day
– Folate source: methylated folate
– Iron: yes, ferrous bisglycinate
– DHA: yes
– Choline: low
– Biotin: yes
– Calcium: no

High-quality, 3rd party-tested, vegan, gluten-free, traceable ingredients. The manufacturer has a ‘food-first approach’ to multivitamins, which means they don’t add nutrients they claim you’re probably already getting enough of in your diet. As a result, they excluded vitamins A, B1, B2, B3, B6, C, K1, calcium, and a few other nutrients.

You might want to add: choline, calcium, and magnesium.

PinkStork Premium Prenatal

– Dosage: 2 capsules/day
– Folate source: methylated folate
– Iron: yes, ferrous bisglycinate chelate
– DHA: yes
– Choline: low
– Biotin: optimal
– Calcium: low

Pinkstork Prenatal is clean, Vegan-friendly, cruelty-free, third-party tested, and made without gluten, wheat, dairy, soy, or GMOs. This formula is as close to the recommended daily values for pregnant women as possible, which I found very refreshing. The choline, calcium, and magnesium values are very low, which is understandable, but they included a good amount of DHA.

You might want to add: choline, magnesium, and calcium.

Beli Women Prenatal

– Dosage: 3 capsules/day
– Folate source: methylated folate
– Iron: yes, ferrous bisglycinate chelate
– DHA: no
– Choline: yes
– Biotin: high
– Calcium: no

Clean, non-GMO, gluten-free, vegan-friendly, comprehensive formula prenatal
supplement. They included an optimal amount (400 mg) of choline and some
magnesium, which is rare for prenatal vitamins.

You might want to add: DHA and calcium.

Perelel 1st trimester pack

– Dosage: pack of 5 pills/day
– Folate source: methylated folate
– Iron: yes, ferrous bisglycinate chelate
– DHA: yes
– Choline: low
– Biotin: no
– Calcium: no*
High-quality, clean, 3^rd party tested, gluten-free, dairy-free, soy-free, non-GMO. This designer supplement comes in packs that contain base prenatal and additional supplement capsules. It is a lot of pills. The 1st-trimester pack includes two separate folate pills (700 mcg DFE + 825 mcg DFE). Together, they exceed 1000 mcg RDA, but if you don’t take the second folate one, you can choose to stay within the RDA limit. It’s formulated by OB/GYNs, and they offer packs for each semester of pregnancy, with ingredients that are supposed to match each stage’s exact needs.

You might want to add: choline, calcium, and magnesium*.
*It is pretty pricey, and since it comes with separate pills, I would like to see those included. However, the second-trimester pack includes magnesium and a bit of calcium, so I assume the company decided this is when those are needed most.

BabyRx Complete Prenatal+

– Dosage: 2 pills/day
– Folate source: methylated folate
– Iron: yes, but ferrous fumarate
– DHA: yes
– Choline: no
– Biotin: high
– Calcium: no
This prenatal vitamin covers almost all the recommended nutrients in optimal amounts. Non-vegan. 100% Natural, non-GMO, no artificial ingredients. BabyRx’s website states that their supplements are made in a facility that is cGMP Certified, FDA registered, and that they are NSF compliant. But I haven’t found any certification for 3rd-party testing for the purity of the product itself.

You might want to add: choline, calcium, and magnesium.

MegaFood Baby & Me 2 Prenatal Multi

– Dosage: 2 tablets/day
– Folate source: methylated folate
– Iron: yes, fermented iron bisglycinate
– DHA: no
– Choline: yes
– Biotin: high
– Calcium: no
This extensive formula is vegetarian (non-vegan), gluten-free, non-GMO, kosher, and 3^rd party certified.

You might want to add: calcium, DHA, and magnesium.

Mary Ruth’s Prenatal & Postnatal Multivitamin Liposomal

– Dosage: 1 tablespoon (liquid)
– Folate source: methylated folate
– Iron: no
– DHA: high
– Choline: low
– Biotin: no
– Calcium: no

You might want to add: iron, calcium, choline, vitamin C, and magnesium.

Garden of Life Organics Prenatal Multi Tablets

– Dosage: 3 pills/at three different times of the day
– Folate source: “organic food blend”
– Iron: yes, source: “organic food blend”
– DHA: no
– Choline: no
– Biotin: high
– Calcium: no

Garden of Life Prenatal is organic, non-GMO, gluten-free. The brand has a bunch of certifications, but I couldn’t find one related to its purity. This is a great, well-rounded formula. Despite that, some women report it’s hard to keep on track with the complex pill intake schedule.

Additionally, I couldn’t find the exact name of the iron or folate source. The supplement facts label only states “organic food blend.” Someone provided this info on their Amazon list page: “Our products contain Folate, not Folic Acid. The Folate found in our Vitamin Code formulas is in a whole food form, grown as a RAW Food-Created Nutrient. The Folate that is in our products is not labeled as methyl-Folate, and therefore, we are unable to make this claim.”

You might want to add: DHA, calcium, choline, and magnesium.

Smarty Pants Prenatal Multi & Omegas

– Dosage: 4 gummies/day
– Folate source: methylated folate
– Iron: no
– DHA: yes
– Choline: low
– Biotin: low
– Calcium: no

Clean, third-party certified (every batch!), non-GMO, gluten-free gummy supplement. Additionally, the formula includes methylated folate for easier absorption. But it lacks some essential nutrients. However, if you need a gummy, this is the one.

You might want to add: iron, calcium, choline, biotin, and magnesium. It is a lot on top of 4 gummies.

Olly The Essential Prenatal Multi

– Dosage: 2 gummies/day
– Folate source: folic acid
– Iron: no
– DHA: low
– Choline: low
– Biotin: no
– Calcium: no

Gummy vitamins are easier to keep for pregnant women struggling with nausea. However, they tend to lack essential nutrients. This formula has optimal folic acid + vitamin B12+ vitamin D levels, but includes synthetic folic acid rather than natural methylated folate.
It’s third-party certified (NSF) and gluten-free.

You might want to add: iron, DHA, calcium, choline, biotin, and magnesium (which is a lot if you struggle with prenatal pills in the first place).

OTHER SUPPLEMENTS ON THE MARKET

When researching this subject, there were supplements that I liked for the quality they offered. Still, I did not like the high folate and vitamin B12 levels that exceeded the RDA : Needed, Natalist, Bird&be, Fullwell, Thorne, Theranatal, Seeking Health, Nordic Naturals. And I am just not comfortable taking that much of those nutrients.

A few others I found seemed great with optimal supplement values, but I couldn’t confirm the third-party testing certificate information specifically for purity (lack of heavy metals, etc.). Those were Modern Fertility, Premama, and Movita Organics. I’d happily update my post if you’re the brand and can provide this information.

One prenatal that checked many boxes was New Chapter, but it was lacking in key nutrients, so I feel like there are just better options.

references

1. Evidence-based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. https://pmc.ncbi.nlm.nih.gov/articles/PMC9275129/ ↩︎
2. Nutrition during pregnancy. https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy ↩︎
3. Evidence-based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. https://pmc.ncbi.nlm.nih.gov/articles/PMC9275129/ ↩︎
4. Folate, folic acid, and 5-methyltetrahydrofolate are not the same thing. https://pubmed.ncbi.nlm.nih.gov/24494987/ ↩︎
5. https://publichealth.jhu.edu/2016/too-much-folate-in-pregnant-women-increases-risk-for-autism-study-suggests
   https://pubmed.ncbi.nlm.nih.gov/28984369/
   https://joe.bioscientifica.com/view/journals/joe/224/3/245.xml
   ↩︎
6. Vitamin B12. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ ↩︎
7. Maternal Multivitamin Intake, Plasma Folate, and Vitamin B12 Levels and Autism Spectrum Disorder Risk in Offspring  https://pubmed.ncbi.nlm.nih.gov/28984369/ ↩︎
8. Vitamin B12. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ ↩︎
9. Iron supplementation during pregnancy. https://pmc.ncbi.nlm.nih.gov/articles/PMC7173188/ ↩︎
10. The effects of oral ferrous bisglycinate supplementation on hemoglobin and ferritin concentrations in adults and children: a systematic review and meta-analysis of randomized controlled trials. https://pmc.ncbi.nlm.nih.gov/articles/PMC10331582/ ↩︎
11. https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/natural-sources-of-vitamin-b-during-pregnancy/ ↩︎
12. FDA biotin interference advisory. https://www.fda.gov/news-events/fda-brief/fda-brief-fda-reminds-patients-health-care-professionals-and-laboratory-personnel-about-potential ↩︎
13. Pregnancy and Lactation Alter Biomarkers of Biotin Metabolism in Women Consuming a Controlled Diet https://pmc.ncbi.nlm.nih.gov/articles/PMC4230210/ ↩︎