You may have heard that it is important to start supplementing with folic acid for at least 3 months prior to conception to reduce the risk of neural tube defect. That is a good start, but in order to optimize your nutritional status, I would recommend taking a good quality prenatal multivitamin, which will include folic acid, for at least 3 months preconception. A good prenatal vitamin can help to increase fertility rates, reduce the risk of birth defects, and prevent nausea during pregnancy. It is important to note that not all prenatal vitamins are of good quality. When choosing a prenatal, I recommend looking at 3 important criteria:
1. What is the dosage of each vitamin and mineral?
Almost every prenatal vitamin will contain 1 mg of folic acid, but there is a pretty big difference in the dosages of other nutrients, such as Vitamin A, D, B vitamins, zinc, magnesium, calcium, iron.
B Vitamins – Essential in the development of baby’s nervous system, and helps to support mom’s energy and stress levels during pregnancy. B6 can help ease morning sickness. I recommend the following as guidelines: 30 mg of B1, 20 mg of B2, 100 mg of B3, 100 mg of B6, and 500 mcg of B12.
Vitamin A – supports the immune system, skin health and vision. High levels (above 10,000 IU) have been shown to cause birth defects, thus, I recommend not more that 6,000 IU daily. Avoid synthetic vitamin A, as it is poorly absorbed, and look for vegetable (beta-carotene) or animal (retinol) sources. Please note: if you are or were a smoker, then supplementing with beta-carotene is not recommended, as it may increase risk of lung cancer.
Zinc – Needed for fetal growth and immune system support. Deficiency in zinc can result in miscarriage, premature delivery, fetal distress, neural tube defects, low birth weight and toxemia of pregnancy. Make sure that copper is included as well, since long-term zinc supplementation can deplete copper levels. Ideal daily dosage is around 30 mg.
Vitamin D – It helps with the absorption of calcium, strengthens the immune system, reduces baby’s risk of asthma, increases fertility rates, and has been shown to decrease pregnancy complications, such as infection and gestational diabetes. Ideal daily dosage for Canadian women is 1,000 IU.
Calcium & Magnesium – Important for bone and tooth formation, as well muscle and nervous system development. Deficiency can cause insomnia, leg cramps and increased pain during childbirth. Ideal daily dosages: 1000 mg of calcium 1000 mg and 500 mg of magnesium.
Iron – Helps to prevent anemia. Especially important for vegetarians, as it can increase the risk of postpartum hemorrhage. I recommend around 30 mg (ferrous fumarate or ferrous gluconate).
2. What is the bioavailability or absorbability of the nutrients?
Most vitamins and minerals can be found in different forms, but some are better absorbed and utilized by the body than others.
Active vs. Inactive:
Many of the vitamins, especially B vitamins, in the generic prenatal are in their inactive form and it can be difficult to absorb these vitamins, especially if your digestive system is already compromised. Naturopathic professional brands typically include already active forms of B2 (riboflavin-5’-phosphate vs. riboflavin) and B6 (pyridoxal-5’-phosphate vs. pyridoxine).
Folic acid vs. Methylfolate:
Folic acid is critical for proper DNA replication, cell division and prevention of neural tube birth defects. All prenatal vitamins contain folic acid, but not all brands carry it in its active methylated form. More than 50% of the population has a defect in the MTHFR gene, which is responsible for activating folic acid into its usable form – methylfolate. Methylfolate is essential for methylation, a process used to support detoxification, produce neurotransmitters and hormones, create energy, repair cells, etc. I highly recommend methylated folate to my patients, in the form of 5-MTHF (5- methyltetrahydrofolate).
Cyanocobalamin vs Methylcobalamin:
Cyanocobalamin is the synthetic form of B12 that doesn’t get absorbed well and increases cyanide levels in the body, which can be toxic. Cyano-B12 is the cheaper of the two and is commonly added to most multivitamins.
Oxide vs. Citrate (Zinc, Copper, Magnesium):
Most pharmacy brands of prenatal vitamins contain oxide, which unfortunately is not as well absorbed as the citrate form and can cause irritation to the digestive system.
Iron Fumarate vs. Iron Bisglycinate:
Fumarate bound to iron can cause digestive upset, such as constipation, and it is not absorbed as well as bisglycinate or citrate forms.
Calcium Carbonate vs. Calcium Citrate:
Calcium carbonate is alkaline, thus, it requires a lot more stomach acid to be digested, unlike calcium citrate, which is more easily absorbed. Calcium carbonate is found in most pharmacy prenatal vitamins (Materna, PregVit, Jamieson), and calcium citrate in most naturopathic brands (Thorn, NFH, Pure, Douglas, Cytomatrix).
3. Pay attention to the additives and fillers
When looking at the ‘non-medicinal ingredients’ in most of the pharmacy brands of prenatal vitamins, it can be quite shocking to see a long list of ingredients that have no added benefit to the body. For example, Materna and PregVit contain food dyes and colourings (FD&C Red #40, Blue #2, Yellow #6, etc.), allergens (corn, soy, lactose) or other unnecessary chemicals.
When looking for a prenatal vitamin, feel free to consult with your Naturopathic doctor, who is trained in vitamin and nutrient requirements, so that you can choose a good prenatal vitamin for a healthy pregnancy and baby.
If you missed Dr. Tatiana’s previous post on preparing for a healthy baby, you can read it here.
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