Best Prenatal Vitamins
Based on In-Depth Reviews

Whether you’re pregnant, thinking about getting pregnant, or have just completed a pregnancy, there are certain nutrients and minerals your body needs to compensate for having to produce doubly for you and your baby. This is where prenatal vitamins come in. They work not only for your baby’s development, but to ensure you get all the required nutrients necessary to carry out a pregnancy, and to replenish your depleted stocks postpartum.

Ideally, mommies-to-be would be getting all the necessary nutrients from a balanced diet. However, it’s not exactly a secret that women are at their queasiest during pregnancy, and hormonal fluctuations may make eating that extra plate of spinach particularly off-putting. 

Xaimar Sánchez, a registered nutritionist working for Head Start and who tends to a large population of young expectant mothers echoed this, “the truth is that many women find it difficult to ingest all the essential nutrients they need during pregnancy. Whether it’s because they can’t physically stomach ingesting the required foods, or because they simply don’t make the best nutritional choices when it comes to their diet, many women don’t receive all the minerals and vitamins necessary to cover their nutritional requirements. That’s where prenatal vitamins come in.” Prenatal vitamins try to even out the dietary playing field, so you can have as many of the essential nutrients you need for a healthy, uncomplicated pregnancy. 

Regardless of this, the importance of a balanced diet during pregnancy is crucial. “In theory, if a pregnant woman has a proper and balanced diet, she should be able to cover all her nutritional needs since she’ll be ingesting all the vitamins, minerals, and macronutrients she needs. But the reality is that most of the time this doesn’t happen,” added Sánchez. 

Despite the important role prenatal supplements play during pregnancy, it’s a well-known fact that the vitamin world is a vast and sometimes messy place. The lack of regulation and oversight in the vitamin industry, coupled with the multitude of companies claiming to have the best, most natural products, can make the process of picking the right prenatal especially daunting.

Because vitamins in general aren’t FDA-regulated, it’s important to know what to look for when choosing the best prenatal vitamins. 

Here are some points to consider:

1. Know the Recommended Dietary Allowance (RDA) for each essential mineral or vitamin. The American College of Obstetric Gynecologists (ACOG) has established specific RDAs for each essential pre- and post-natal nutrient. This is the dosage that should be met unless you have special dietary needs, or your doctor recommends otherwise.  
2. Source material, and how much bioavailability these sources have. Bioavailability refers to how much of a particular mineral or nutrient your body can absorb and effectively use. Not all vitamins are created equal—while some supplements can include whole-food-based ingredients, others may be entirely synthetic. The type of ingredient used can influence how easily a specific nutrient will be absorbed by your body, as well as to what degree. This is especially important because some fat-soluble nutrients, such as vitamins A, E, K, and D can be harmful at higher dosages (because they accumulate in your body), but how much of that dosage your body will actually absorb varies if the vitamin is made synthetically, or derived from organic sources. 
3. The amount of nutrients you regularly intake from your current diet. The first place you should always look to get your essential nutrients is your diet. If you know you’re a big salmon eater, for example, the amount of DHA (an important omega-3 which aids in the development of the baby’s nervous system) you’ll need in your prenatal supplements may not be as copious as for a vegan mom-to-be who may be much more lacking in this nutrient. How much necessary foods you regularly include in your diet will directly affect how much of a particular nutrient you need in a prenatal supplement.
4. Supplement third-party verification. Third-party verification is an important factor to keep in mind when choosing prenatal supplements, since vitamins as a whole aren’t regulated by the FDA. When vitamins get third-party tested, companies are assuring customers they’ve verified that the contents of their product matches that of the supplement labels.

WHAT YOU REALLY NEED WHEN YOU’RE EXPECTING

Prenatal vitamins were created so that women could have the proper intake of minerals and vitamins necessary during pre-, peri- (during), and post-conception. Many vitamins today include these nutrients, while also adding on other minerals that help throughout the many phases of childbearing. 

Dr. David Aguirre, an ob-gyn with more than 20 years of experience, told us that: “The most important thing is to have a balanced diet because prenatal vitamins can’t replace healthy food. There are many other nutritional factors to consider during pregnancy, it’s not all just about minerals and vitamins.You also need proper amounts of calories, proteins, and fats for a healthy pregnancy. Gestational diabetes, constipation, and overall malnutrition are all at risk of occurring during pregnancy and all depend on how balanced your diet is.”

In other words, the best way to obtain the essential nutrients you need is through a complete and balanced diet. But acquiring the necessary nutrients—and in the adequate amounts—is so essential for childbearing, that prenatal vitamins could be indispensable for many women.

No matter how many sophisticated or “all-natural” additives some companies like to include, there’s only a handful of nutrients that should absolutely be part of any prenatal supplement you choose, in part because of how difficult it is to meet their necessary dosages. These are folate, or folic acid, iron, calcium, and vitamin D.

Folate or Folic Acid (RDA by ACOG: 400-600 mcg)

Folic acid is perhaps the one absolutely indispensable nutrient a prenatal vitamin must have. 

While often used interchangeably, it’s important to note that folate and folic acid are not the same thing. Folic acid  is the synthetic form of Folate (or Folacin), a B vitamin essential to the development of healthy red blood cells, as well as for the division of cells and the development of genetic material in your body.

Although naturally occurring folate is commonly found in leafy green foods, such as spinach or kale, women need elevated amounts of folate during pregnancy or they can run the risk of becoming anemic through what’s known as folate-deficiency anemia. Folate is a necessary component for the formation of hemoglobin, which carries oxygen to the essential parts of the body, such as the heart and brain. Without the proper amounts of it, women run the risk of becoming anemic. 

Moreover, research has demonstrated that at least 85% of folic acid is estimated to be bioavailable when taken with food, whereas only about 50% of folate naturally present in food is bioavailable. While you should always prioritize getting folate from your diet, prenatal vitamins are a vital aid in supplying the proper quantity of folate needed for a healthy pregnancy.

Aside from what we've mentioned, the main reason it’s so important to consume this nutrient before and during pregnancy is that folic acid is essential for the development of the baby’s neurological system, as it helps the baby’s neural tube properly develop into its brain and spinal cord. Pregnant women or those who want to get  pregnant must be sure to get the recommended dosages of folate or folic acid because it protects growing fetuses from developing Neural Tube Defects (NTDs). In fact, several studies have shown that pre-pregnancy use of prenatal vitamins containing folic acid can prevent 50 to 70 percent of NTDs. 

These defects, which can result in life altering consequences, or even death, usually occur within the first 28 days after conception—before most women are even aware of their pregnancy. For this reason, it’s widely recommended that all women of childbearing age consume folic acid even if they are not planning on becoming pregnant.

“Depending on how severe the condition is, spina bifida can cause partial or full body paralysis, lack of bladder control (meaning the baby will most likely have to be catheterized the rest of its life), or even death.” says Ingrid Ancalle, a neonatologist who often sees newborn complications related to NTD’s. She added that: “This is why, ideally, all women of reproductive age should take folic acid, to minimize this risk.” 

Unfortunately, many women still lack access to essential health information such as this. One study published in 2018 found that fewer than 5 percent of poor, urban women use prenatal vitamins. 

Because of how essential folate is, many prenatal vitamins will often include higher doses of folic acid or folate in their products, which may be beneficial for women with folate deficiencies. Although this nutrient is water-soluble, meaning your body will get rid of excess amounts, it’s important to bear in mind its tolerated upper intake level (UI), which is 1000 mcg daily. According to the CDC, higher doses than these should not be taken unless recommended by a doctor, not because it can cause harm, but because it provides no added benefit. Excess amounts of folic acid have also been shown to hide symptoms of B12 deficiencies.

Folic acid vs Folate: What's in a name?

Whereas folic acid is the man-made form of folacin, folate is the naturally occurring form that can be found in whole foods such as dark green leafy foods, certain vegetables, and nuts. 

The difference between the two types matters largely because of a genetic mutation in a gene called the MTFHR gene. This mutation is estimated to affect about 25% of Hispanic women and 10-15% of Caucasian women. The MTFHR gene, which is supposed to properly break down the folic acid found in many fortified foods and vitamins, is unable to do so in women that have this mutation, meaning these women are also at a higher risk for having children with NTD’s. 

Moreover, individuals with this mutation often aren’t aware they have it unless they undergo genetic testing or begin to show symptoms of the conditions often associated with it. 

For this reason, women that carry this mutation need the metabolically active form of folate that their bodies can properly process. Many prenatal vitamins today contain the natural active form of folate, often appearing as 5-MTHF, methylfolate, or 5-methyl tetrahydrafolate. 

The most common brands of this metabolically active form of folate are Quatrofolic, Extrafolate, and Metafolin. Prenatal vitamins will usually name which brand of folate they’re using. 

Folate-Rich Foods:

-       Beef liver

-       Cooked broccoli

-       Beets

-       Leafy greens (such as spinach and kale)

-       Asparagus

-       Cooked lentils

-       Avocados

Iron (RDA by the ACOG: 27 mg for women 19-50 years old)

Iron is another essential nutrient that becomes even more relevant during pregnancy. Without sufficient iron your body can’t make enough red blood cells or hemoglobin to carry oxygen to the rest of your body’s tissues, which can result in anemia. “One of the most common problems during pregnancy is anemia because women often don't get enough iron.” says Dr. Aguirre. “In severe cases, anemia could also prevent enough oxygen from reaching the fetus, causing Small for Gestational Age babies or intrauterine growth restrictions.” 

Sánchez also commented on the frequency of iron deficiency in pregnant women, signaling improper nutrition as a big culprit. “The most common thing I see in pregnant women is iron deficiency, and it’s often because women don’t follow a balanced diet (they don’t snack properly or have their three meals), they’re missing certain foods from their diets, or they simply forget to take folic acid. This is all reflected in their decreased iron levels.”

Pregnant women are at a higher risk of becoming anemic because their bodies are producing 30-50% more blood, but there isn’t enough iron stocked up to produce hemoglobin. Vegetarian and vegan women are oftentimes at an even higher risk because plant-sourced iron is usually not as properly absorbed by the body as the kind that comes from meat.

Because mild anemia is fairly common during pregnancy, it’s important to make sure you get the recommended amounts of iron either through your diet, or through prenatal vitamins that include the necessary and adequate doses. It’s also important to regularly consult with your doctor if you feel any of the symptoms associated with anemia. 

Iron-Rich Foods:

-       Red meat

-       Organ meats (such as beef liver)

-       Legumes

-       Dark chocolate

-       Tofu

How you take iron matters 

There are two caveats you should keep in mind when it comes to the proper consumption of iron and choosing a prenatal supplement. One is iron’s interaction with calcium, the other is its interaction with vitamin C.

Calcium and Iron 

When scouting for prenatal supplements you’ll often notice that calcium and iron dosages are much lower than their RDAs. This is because, as a general rule, calcium inhibits the absorption of iron in the body. Many prenatal vitamins will often eliminate calcium altogether in order to supply higher levels of iron, since calcium is much more readily available to eat in foods. 

In the event that you choose to ingest the nutrient separately, it’s recommended that you take each one several hours apart, so as to increase the absorption of each one in the body. 

If choosing a prenatal supplement with both calcium and iron, eating foods high in calcium in the morning, while having iron-rich nutrients at night, for example, could help in the absorption of each.

Vitamin C and Iron

If calcium inhibits the absorption of iron, vitamin C has been shown to do the exact opposite. Vitamin C increases the absorption of non-heme iron (iron found in plant-based foods which is harder for our bodies to absorb), allowing for greater overall absorption of iron in the body. Studies have shown that eating foods high in vitamin C—such as oranges, strawberries, and kiwis—along with your daily intake of iron can help to greatly increase the latter's absorption. Taking a vitamin C supplement when consuming your favorite iron-rich foods could also speed up the absorption process.

Calcium (RDA by the ACOG: 1000 mg for women 19-50 years old)

Calcium is another essential nutrient for both you and your baby. Calcium aids in the development of your baby’s musculoskeletal system, as well in the development of her heart and nerves.

A proper intake of calcium during pregnancy can also reduce the risk of pre-eclampsia, which affects approximately 4 percent of pregnancies in the U.S. and can cause serious health complications for both the baby and the mother. 

Because calcium is not produced by the body, it’s essential to get the necessary amounts in your diet or supplements so that you don’t run out of your own supply. If you don’t consume enough calcium to sustain both you and your baby, your body could start depleting its own stocks, putting you at risk of osteoporosis.

One thing to keep in mind when selecting a prenatal supplement is that they’ll often include a much lower percentage of calcium than the established RDA, due to their interaction with iron. For this reason, it's highly recommended to take a calcium supplement along with your prenatal vitamins and include calcium-rich foods in your diet. 

Calcium-rich Foods

• Parmesan cheese

• Yogurt

• Canned sardines/salmon

• Cooked winged beans 

• Calcium-fortified tofu 

• Cooked collard greens

Vitamin D (RDA by the ACOG: 600 IU for women 19-50 years old)

It’s estimated that almost 42 percent of Americans are vitamin D-deficient. This number is important when talking about pregnant women, since vitamin D is vital for a healthy pregnancy.

First, vitamin D is crucial for the absorption of calcium, which is necessary for the development of bones in fetuses and for the overall health of the mother’s musculoskeletal system. As so, vitamin D deficiency can not only affect bone growth, but could even result in preterm birth.  

An important aspect to keep in mind about vitamin D is that recent studies point to the benefits of increased dosages of the vitamin in pregnant women. Amongst other things, this research shows vitamin D supplementation reducing the risks of preeclampsia, preterm birth, and infections during labor when taking at least  2000-4000 UI. Fortunately, many prenatal supplements include higher dosages than the established RDA. 

Vitamin D3 vs D2

Vitamin D—which is not strictly speaking a vitamin but a fat-soluble steroid—is available for ingestion in two different forms: vitamin D2 and vitamin D3.

D3 is derived from animal products and is the most bioavailable form of the vitamin, while D2 is derived from plants and is not considered as effective at being metabolized by the body.

This difference is important to women who are vegan or vegetarian since not all prenatal vitamins include the D2 form (ergocalciferol) of the nutrient. However, there are ways to obtain D3 or cholecalciferol through lichen, a cross between fungi and algae which is considered vegan. Regardless of the source, prenatal vitamins will always specify whether it’s cholecalciferol (animal-based), ergocalciferol (plant-based), or lichen derived (algae-based)—next to vitamin D in the product label.   

Foods Rich in Vitamin D

• Wild salmon 

• Shrimp 

• Oysters

• Canned tuna 

• Soy and cow milk

• Orange juice

• Fortified cereals 

Although this list only comprises a few of the many recommended nutrients the ACOG recommends, these are the most essential to have in your daily prenatal supplements, primarily because the rest of nutrients can be more easily ingested through your diet. As so, we recommend checking the labels of each product to verify that they include the necessary amount of nutrients recommended by the ACOG, and that simultaneously best fit your needs.

The most important takeaway, though, is that you eat healthy and be consistent in taking your prenatal vitamins. We know this is often easier said than done, what with unruly hormones and a hypersensitive belly taking over your life. But the truth is, just by consuming the adequate nutrients, you can minimize the dangers or risks of complications for you and your baby. As Dr. Aguirre told us: “The best prenatal pill is going to be the one with the proper amounts of iron and folic acid, but also one the mother tolerates. If you can tolerate a particular [prenatal] pill, you should take that one.”