Choosing a Prenatal

Written By Ana Ravier

First of all, congratulations !! Whether you are already pregnant, actively trying to conceive, or starting to think about preconception care; this is a really exciting chapter.
Pregnancy brings a lot of changes, and a lot of decision making - which can be overwhelming.

To help you make the right decision for you when it comes to prenatal supplements, I have compiled a few tips and comparisons below :


DISCLAIMER  :
Always follow your health professional’s advice.
If you have specific nutrition requirements or a health condition (eg. endo, PCOS, obesity, repeated miscarriages, bariatric surgery, ED…), discuss with your GP or dietitian prior to taking supplements.
Remember this guide is general in nature, and data-entering errors may exist. 

Which supplement to choose ?

Most big prenatal brands on the market will have the key micronutrients - but all differ slightly in the amount and type of micronutrients they include, and trying to look into it is enough to give anyone a headache ! 

So… what should you be looking for?  

  • Make sure it contains folate*, B vitamins, Iodine, vitamin D** . 

  • Iron requirements go up considerably in pregnancy (RDI 27 mg/day), so you may want to consider a prenatal with iron, especially if you don’t tend to eat much red meat. 

  • Other micronutrients which support foetal development : 

    • Choline - especially if you don’t eat many eggs.

    • Omega 3 (DHA)  - especially if you don’t eat fish 2-3 times per week. 

    • Zinc and selenium***

    • Vitamin K and C -  may be beneficial, especially if you don’t eat many fruit & vegetables. 

    • Calcium -  while calcium requirements don’t actually increase during preconceptions and pregancy, making sure you are consuming adequate calcium is important. Supplements may be beneficial if you don’t eat much dairy or other calcium rich foods (under the guidance of a healthcare provider !). You may notice many of the prenatals below don’t include calcium. This is because calcium inhibits iron absorption ! Having them in the same supplement is therefore redundant.

*The recommended daily intake of folate is 600ug. The safe upper-limit for supplementation is 1000ug (ie. be mindful not to over supplement) 

** The adequate intake of vitamin D is 5ug/day, and the safe upper limit is 80 ug/d.
If you have dark skin, have PCOS, low iron, don’t eat eggs or don’t get much sun exposure, you may need more vitamin D (15 - 50ug) than others. 

***Too much selenium can be harmful, so if you have high levels of selenium in your diet (eg. you regularly eat brazil nuts), make sure you are not over-supplementing.

Why do some prenatals not include iron?

Iron supplementation can cause constipation, and aggravate bloating and nausea during pregnancy. Certain brands therefore choose not to include it as not to cause (or worsen) symptoms which many people are susceptible to in pregnancy. 

Iron and calcium inhibit each other, and most prenatal capsules contain both. Not including iron, and taking it separately at a separate time, can help increase absorption.

With this in mind, it’s important to choose a prenatal which suits your needs : if you have high levels of iron (ferritin), and frequently experience nausea / constipation, it may be worth choosing an iron-free prenatal. 

Making sure you are having enough iron in your diet is important, especially as your needs go up considerably during pregnancy (from 18 to 27mg /day).
You may find iron bisglycinate more gentle on your digestion compared to ferrous fumarate. 


Note : all iron supplements are non-haem, making them less bioavailable than haem iron (from animal sources). Consuming vitamin C or/& haem iron with non-haem helps boost absorption. 

Why do some prenatals not use 5-MTHF (ie. activated folate) despite it being more bioavailable?

Some prenatal vitamins do not use 5-MTHF (activated folate) despite its higher bioavailability for several reasons:

  • Cost: 5-MTHF is more expensive to produce compared to folic acid.

  • Stability: Folic acid is more stable and has a longer shelf life than 5-MTHF.

  • Manufacturing Preferences: Some manufacturers stick with folic acid due to its long history of use and established efficacy. 

    • Most studies which confirmed the relationship between insufficient folate intake and neural tube defects in babies in the 1980s and 1990s used folic acid. 

  • Regulatory and Consumer Familiarity: Folic acid is more commonly recognised by consumers and regulatory bodies, making it a preferred choice for many manufacturers.

However, 5-MTHF is increasingly used in prenatal supplements due to its advantages, especially for individuals with MTHFR gene mutations.

How do different prenatal supplements compare ?

*Naturobest prenatal trimester 2,3 has 400 mg choline (91% of adequate intake - AI) 

This is a guide only.
Find the link to a more detailed comparison here. 

What about inositol?

Inositol, particularly myo-inositol, has been studied for its potential benefits in improving blood glucose metabolism, particularly in pregnant women with gestational diabetes mellitus (GDM).

For instance, a meta-analysis and systematic review concluded that myo-inositol supplementation during pregnancy can reduce the incidence of GDM and improve insulin sensitivity - which could be particularly beneficial in women at higher risk of GDM, for example those with existing insulin resistance, PCOS, or a family history of diabetes.

Some studies have suggested that inositol supplementation may also reduce the risk of adverse pregnancy outcomes associated with GDM, such as macrosomia (large for gestational age infants) and preterm birth .

HOWEVER - While short-term studies have shown positive effects, there is limited data on the long-term safety of inositol supplementation during pregnancy. More research is needed to confirm its safety profile.

There is also a theoretical risk that inositol could cause hypoglycemia, especially if used in conjunction with other glucose-lowering medications. Pregnant women should be monitored for signs of low blood sugar if taking inositol, and checking with their health professional before starting any new supplements.

  • Note: The typical dosage used in studies ranges from 2 to 4 grams per day, often divided into two doses. However, prenatal which include inositol ( InNatal, Naturobest and Eagle Tresos Natal ) all do in much lower amounts, ranging between 30-50mg /day. Keep in mind dosage should be tailored to your individual needs and medical advice.

Bottom line

I hope you feel more empowered in your decision making with this information. Remember vitamins should never replace a balanced diet.
If you have any other questions or need further information, feel free to ask!

Much love,

A x

References

  • BioCeuticals. (2024). Innatal®. [online] Available at: https://www.bioceuticals.com.au/product/preview/Innatal[Accessed 4 July 2024].

  • Blackmores. (2024). Pregnancy & Breast-Feeding Gold. [online] Available at: https://www.blackmores.com.au/products/pregnancy-breastfeeding-gold [Accessed 4 July 2024].

  • Elevit. (2024). Elevit Pre-conception & Pregnancy Multivitamin. [online] Available at: https://www.elevit.com.au/products/elevit-prenatal-multivitamin/ [Accessed 4 July 2024].

  • Kin Fertility. (2024). The Prenatal by Kin. [online] Available at: https://www.kinfertility.com.au/products/prenatal[Accessed 4 July 2024].

  • NaturoBest. (2024). Pregnancy & Breastfeeding Multivitamin. [online] Available at: https://naturobest.com/product/pregnancy-breastfeeding-multivitamin [Accessed 4 July 2024].

  • Life Extension. (2024). Prenatal Advantage. [online] Available at: https://www.lifeextension.com/vitamins-supplements/item01971/prenatal-advantage [Accessed 4 July 2024].

  • Eagle Natural Health. (2024). Tresos Natal. [online] Available at: https://www.eaglenaturalhealth.com.au/products/tresos-natal [Accessed 4 July 2024].

  • Honest Company, 2024. Honest Natal Prenatal Supplement. [online] Available at: https://www.honest.com/collections/prenatal-supplements [Accessed 3 July 2024].

  • Moode, 2024. The Prenatal by Moode. [online] Available at: https://www.moodehealth.com/prenatal [Accessed 3 July 2024].

  • National Institutes of Health, 2021. Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, Vitamins. [online] Available at: https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx[Accessed 4 July 2024].

  • Milman, N., 2006. Iron and pregnancy—a delicate balance. Annals of Hematology, 85(9), pp.559-565. [online] Available at: https://link.springer.com/article/10.1007/s00277-006-0108-2

  • Koletzko, B., Cetin, I. and Brenna, J.T., 2007. Dietary fat intakes for pregnant and lactating women. British Journal of Nutrition, 98(5), pp.873-877. [online] Available at: https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/dietary-fat-intakes-for-pregnant-and-lactating-women/0BBAEDA5C05B61B9C74F1F9D82C1658A

  • https://docs.google.com/spreadsheets/d/1UzfAeBVd2eAjUWZtinbc0mEc3da9HJGLxPV2hhbgadY/edit?gid=127158809#gid=127158809

Ana Ravier
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