How Do I Pick A Prenatal? | Increasing Fertility and Reducing Birth Defects

By: Carolyn Gundell, M.S. on October 25th, 2019

How Do I Pick A Prenatal? | Increasing Fertility and Reducing Birth Defects

Women's Health | featured | Featured Story

Why is a Prenatal So Important?

Prior to conception, the more we nourish our bodies, including taking quality prenatals, the more we decrease risk for birth defects and increase our chance for a successful pregnancy and healthy baby. Some women prefer to wait until they are pregnant to focus on their nutritional intake, but RMA of CT supports the approach that women and their partners should optimize their health many months prior to pregnancy. Men and women have higher fertility success and healthier pregnancy outcomes when they invest in their own health. Practicing a healthy lifestyle, even 8-12 weeks prior to conception, can also make a significant difference in the health of mother and baby. So, go for it, assuming you’re trying to conceive or even thinking about it, choose that prenatal now!

Where Do We Even Begin?

Copy of CG QUOTE (1) When a woman is faced with the task of choosing a prenatal, this decision can feel like choosing a cereal in a grocery aisle of 100 boxes. The U.S FDA categorizes vitamins as “dietary supplements,” so the regulation of vitamins is not as strict as what prescription medications go through in the country. For example, the supplement industry has no standardized serving sizes or nutrient dosing to ensure safety.

Simply, the FDA does not have the resources for inspection and supervision of the supplement world. Consumers should be aware that manufacturers don’t even need approval from the FDA to sell their supplements before they are marketed unless it contains a new product ingredient that has not been marketed before 1994. All that might sound a little unnerving, but the industry can’t go completely rogue on us!

Manufacturers are expected to follow the 2007 Good Manufacturing Practices (cGMP) to ensure supplement identity, purity, quality, strength, and composition. It is also up to the manufacturer to notify the FDA if there have been any consumer complaints or side effects with any supplement.

All this makes it that much tougher to choose a prenatal.

I do believe that preconception & prenatal care should be a shared responsibility between healthcare providers and their patients. I strongly recommend that all supplements (vitamins, herbs, and other supplements) be approved by your reproductive endocrinologist and/or obstetrician/gynecologist, or nutritionist/dietitian prior to consumption. Do not rely on internet reviews.

RMA of CT has researched and chosen a quality prenatal for both women and men, vitamin D3, DHA, and other fertility supplements. These products are all sold at every RMACT office location at very competitive prices.

When Should I Take a Prenatal?

Prenatal vitamins are very beneficial taken daily prior to fertility treatment, pregnancy, and preferably 3 months (or more) before conception. If you’re actively trying to conceive, start the prenatal regimen now.

And guess what? This goes for men, too! Folic acid/folate, which you’ve probably heard of at this point, is found in a prenatal, but also is an important nutrient for healthy sperm. All men who are actively trying to conceive will benefit from a basic men’s multi-vitamin containing 100% of the RDA or a specific men’s conception-based formula.

Which Prenatal is Best?

I would like to share a few steps that I take when helping my patients choose prenatals based on quality, safety, cost, and personalized dosing.

How to Choose a Prenatal Vitamin:

1. Observe Daily Serving Size

The number of daily pills or capsules are prescribed on the bottle. Serving sizes can range from one to even up to six pills daily. This information is very important because taking less than the minimum recommendation may increase risk for birth defects or maternal nutrient deficiency such as anemia. Also, confirm that the daily number of pills listed is realistic for you.

Also, more supplementation than recommended on the bottle is not better or safe to you or your baby.

2. Avoid a Gummy Option

Gummy vitamins may be easier to swallow for some, but usually with a gummy multi-vitamin or prenatal, many essential nutrients are either missing or they are provided at a lower than recommended dose. Iron is not at all found in a gummy vitamin. In addition, key prenatal nutrients like DHA, iodine, zinc and others are also not adequate in a gummy.

3. Avoid prenatal vitamins with added herbs

Many herbs are contraindicated in pregnancy.

4. Consider your personal preferences and/or medical needs, ie. cultural, religious, or medical. Options are available.

Does the prenatal need to be vegan/vegetarian, kosher, allergen-free?
Do you require special dosing or additional supplements? For example: Gluten free/celiac, allergies, bariatric surgery, vegan/vegetarian, anemia, MTHFR, seizure disorder, eating disorder, nutrient deficiency, spina bifida

5. Compare Cost

Keep in mind that some bottles will only cover one month or many times 2-6 months. Sometimes what appears to be a higher cost is actually the best deal!

6. Look for the following key nutrients on the label:

In addition to folic acid, growing research is supporting the importance of many essential vitamins and minerals in pregnancy, especially folic acid, omega-3 DHA, choline, iron, Vitamin D, iodine, and vitamin A.

These six tips are all so important when hunting through the seemingly endless prenatal options. Now that you’ve read through the basic checkpoints, let’s take a deeper dive into the ingredients…

What Are the Key Nutrients I Should Look for in a Prenatal?

Let’s talk about folic acid/folate a little more…

Folic acid, folate or methylfolate--found in a prenatal--are all a different form of the same essential B vitamin, that plays a key role in preventing birth defects of the brain and spine, such as spina bifida. The neural tube develops into the baby’s brain and spinal cord within the first 28 days of conception.

A birth defect can occur if the neural tube does not close and this is called a neural tube defect. This critical time period of fetal development is so early in the pregnancy that most women and couples do not know that they are pregnant—another reason to be taking a quality prenatal many weeks or months prior to conception. Folic acid/folate is also necessary for DNA synthesis of red blood cells, nervous system, and proteins; and cellular growth and reproduction.

What is the difference between FOLIC ACID, FOLATE, and METHYLFOLATE?

Folic acid is the synthetic form of vitamin B-9. This synthetic version is found in multi-vitamins, prenatal vitamins, and used to fortify foods such as breakfast cereals, pasta, and breads. Once consumed, folic acid is converted by the body into folate. Since folic acid has been added to grain products in the US--together with a greater emphasis on taking prenatals with folic acid—there has been a 50-70% reduction of neural tube defects.

Folate is a naturally occurring form of vitamin B-9 found in whole foods. Excellent sources of folate include foods such as leafy, dark green vegetables, citrus fruits, lentils and beans, asparagus, peanuts and wheat germ.

Methylfolate is a more bioavailable or highly absorbable form of vitamin B-9. This option is very beneficial for anyone who has difficulty absorbing folic acid or needs a clinically high dose for a medical reason.

But wait – it’s not just folic acid/folate that you need! Here is a list of all the key nutrients you need to be mindful of when selecting the right prenatal for you…

Prenatal Key Nutrients

ESSENTIAL VITAMIN & MINERAL	IMPORTANT FUNCTIONS	FOOD SOURCES
FOLIC ACID / FOLATE Prenatal Vitamin 800-1000mcg 400-800mcg Pre-conception 3 months prior pregnancy RMA CT rec 800mcg 600mcg-1,000mcg Pregnancy 4 mg Previous neural tube child Multiples 600mcg per baby 500 mg Lactation	DNA Synthesis-red blood cells/nervous system/proteins. Prevents spina bifida and other neural tube defects - critical in first 30 days. The neural tube is the foundation for the brain and spinal cord. Helps support the placenta. Helps to prevent miscarriage, preterm delivery, and maternal anemia.	Enriched /fortified cold/hot cereal, pasta, rice, breads/grains, FOLATE Source: lentils, split peas, beans – pinto, lima, northern, black, navy, white, kidney, chick peas, Cooked fresh or frozen green leafy-spinach, turnip greens, collards, romaine, asparagus, oranges, nuts –peanuts, seeds, grits, wheat germ
IRON Prenatal Vitamin 28-30mg 15 mg Pre-conception 28-30 mg Pregnancy 48 mg Vegetarian Pregnancy 15 mg Lactation Vitamin C food helps iron absorption	To make hemoglobin protein to carry oxygen to tissues. Need for iron in pregnancy doubles to accommodate separate maternal and fetal blood supplies. Helps prevent anemia, fatigue, preterm delivery, and low birth weight.	Heme Sources: Red meat, poultry, fish, pork, clams, Non-Heme Sources: Iron fortified cereals, grains & pasta, oatmeal, cream of wheat, lentils, beans –chickpeas, lima, kidney, pinto, spinach, raisins, pumpkin & seeds, eggs, tofu, soybeans, prunes, avocado, figs, collards, green peas, swiss chard, broccoli, wheat germ, dried fruit, blackstrap molasses
IODINE Prenatal Vitamin 150-300mg 150 mg Pre-conception 220 mg Pregnancy 150 mg Lactation	Brain development and growth. Supports thyroid/hormone regulation.	.
VITAMIN D Prenatal Vitamin 400 iu 600iu Pre-conception 600iu Pregnancy 600 iu Lactation Blood levels >30ng/ml Ideal 40-60 Vegetarians may need supplement	Assists calcium and phosphorus in bone and teeth formation and density. Muscle, bone, heart health, and immune function. Reduces risk for pre-eclampsia and autoimmune diseases. Deficiency can cause rickets-skeletal & growth abnormalities.	Fortified milk, yogurt, soy milk, fat spreads, cereals and juices, fatty fish, egg yolks
ESSENTIAL FATS 200-300mg DHA-omega 3 Vegetarians Need Increase	Development of fetal brain, vision, and nervous system. May decrease miscarriage, preterm labor, post-partum depression.	Wild Salmon, sardines, herring, anchovies, shrimp, scallops,blue crab, DHA Omega 3 Eggs
VITAMIN A -BETA CAROTENE Prenatal Vitamin 4,000-5,000iu ( Not in retinol form ) 700 mcg(2,300 iu)Preconception 770 mcg (2,565 iu) Pregnancy 1300 mcg Lactation Stay Below 10,000 iu / day because crosses placenta barrier and can cause birth defects at toxic levels.	Essential role in vision, cellular growth, and builds and maintains health of bones, skin, and GI and urinary tracts.	Fortified milk, fat spreads, and cereals, eggs Deep orange, yellow,green –carrots, pumpkin, collards, sweet potatoes, kale, spinach, broccoli, peppers, papaya, cantaloupe, guava, apricots, mandarin oranges, nectarines, peaches, persimmons, loquats, **Avoid Retin A, retinol, alpha hydroxy acids
VITAMIN B12 Prenatal Vitamin 2.6-12mcg 2.4 mcg Pre-conception 2.6 mcg Pregnancy 2.8 mcg Lactation 25-30 mcg. Vegetarian	DNA Synthesis, normal red blood cell function, cardiovascular and nervous system health, and strict vegetarians-deficiency risk.	Meats, poultry, fish, seafood, eggs, dairy, nutritional yeast, fortified soy milk
CHOLINE Prenatal Vitamin 450 mg 425 mg Pre-conception 450 mg Pregnancy 550 mg Lactation	Supports brain development for learning, memory, and attention. Rapid cell division, growth, and myelination.	Beef, eggs, chicken, fish, pork, nuts, legumes, cruciferous veg. cow milk, soybeans, quinoa

More Supplement Advice From a Fertility Nutritionist:

Could taking too much folic acid be a problem?

Yes. Do not take more folic acid than recommended by your physician or nutritionist. A mega dose of folic acid, without a medical reason, can mask a B12 deficiency, causing pernicious anemia and irreversible nerve damage. Methylfolate, a bioactive form, will not mask B12 deficiency.

Should I try to eat foods naturally rich in folate?

Yes. Folate is found naturally in foods. Excellent sources of folate include foods such as leafy, dark green vegetables, citrus fruits, lentils and beans, asparagus, peanuts and wheat germ. Incorporating these foods into a daily meal plan, in addition to taking supplemental folic acid from a prenatal vitamin, is essential and beneficial for conception, healthy pregnancy, and healthy baby.

Why not just eat food sources rich in folate instead of taking supplement folic acid?

The naturally occurring folate in food sources is important too, but it is not wise to rely on food-based folate intake alone for the following reasons:

Food based “folate” has a forty percent lower absorption rate compared to folic acid or methylfolate. If folate, not folic acid or methylfolate, is listed on your supplement bottle, then it is advised to switch to a supplement that lists folic acid or methylfolate instead of folate.
Folate in foods is easily destroyed when foods are cooked or canned. Fifty percent of food folate is lost in the canning process and up to ninety percent can be destroyed in cooking. Lightly steaming instead of boiling in water is recommended.

Why should I still take a supplement with folic acid even if I think I’m getting a good amount of folate from food?

Grains are the main food group that receives folic acid fortification. The lower carbohydrate meal plans restrict grains, thus lowering folic acid intake.
Be advised that many gluten free grains are not enriched with folic acid and other B vitamins and iron.
Ethnic foods found in the US are often not fortified with folic acid. This is especially true for corn masa flour—which is more popular among Hispanics—and is not fortified. In fact, Hispanic women are twenty percent more likely to have a child with a neural tube birth defect than a non-Hispanic white woman.
Organic food companies are not required to fortify grain products with folic acid. Some do, but many do not. Check the labels of your favorite organic grain products.
Folic acid /folate is a water-soluble nutrient, which means that our bodies do not store this B vitamin. Availability is dependent upon an individual’s daily nutrient intake.
Some medications and regular intake of alcohol can interfere with folate metabolism and other medications can reduce the serum and tissue concentration of folate.
Some vitamins/supplements can interfere with medication absorption and interaction. On the flip side, some medications can also interfere with supplement absorption. Always disclose and discuss your vitamin, supplement and medication list and your risk for interactions with your prescribing physician and your pharmacist. Some specific examples are…
1. If you’re taking thyroid medicine in the morning, it is best to take all vitamins and supplements in the evening as not to interfere with the thyroid medicine.
2. Calcium supplements should be 4 or more hours away from thyroid medicine, prenatal and iron supplements.
3. Herbal supplements may interfere with medication and RMA of CT does not recommend herbal supplements during fertility treatment. RMA of CT also does not recommend taking any essential oils or herbal supplements during the 1^st trimester of pregnancy.
If a woman has already had a child with a neural tube defect, her risk for having another is very high. She should speak with her RMA of CT physician or ob/gyn to get a high dose prescription folic acid.

Choosing a prenatal can be a stressful decision on top of the whole #TTC pressure. With these tips, answers, and trusty list of nutrients, you will become a master of the vitamin aisle. More importantly, you’ll be giving your body and your baby the best chance for a healthy, happy, nutrient-filled journey.

Ready to get cooking with folic acid?

About Carolyn Gundell, M.S.

Carolyn Gundell, M.S. is a nutritionist, specializing in PCOS and fertility. With over 20 years of nutrition experience, Carolyn has a special interest in helping women with conditions that affect fertility, including insulin resistance, diabetes Type1/Type 2, Polycystic Ovarian Syndrome (PCOS), lipid disorders, celiac disease, irritable bowel syndrome, underweight and overweight concerns. Carolyn earned her M.S. in Nutrition from Columbia University and completed her undergraduate studies in Biology/Nutrition at Albertus Magnus College in New Haven. She is trained as a Research Associate in Clinical Skills Training, and is certified in HIPAA, CPR, First Aid and Food Safety & Sanitation. Previously, Carolyn worked at Pediatric Endocrine & Diabetes Specialists, The Center for Advanced Pediatrics, both in Norwalk and at Yale University Medical Center’s Obesity, Diabetes, PCOS Clinic and The Yale Fertility Center.