The Best Prenatal Vitamin (According To A Dietitian)

There are a number of key nutrients to consider when choosing the best prenatal vitamin for you, but first, I want to discuss why it’s important to take a prenatal vitamin in the first place!

Updated September 7, 2023

Disclaimer: This article is for information purposes only and should not be used as medical advice or individual recommendations. This post contains affiliate links. Any purchases made using these links will result in a small commission for me, but at no extra cost to you. All opinions are my own. You can read about my affiliate disclaimer here. 

Why take a prenatal vitamin

Even before we become pregnant, health practitioners recommend taking a prenatal vitamin. In fact, it’s recommended for all women of childbearing age to be taking a vitamin with at least 400 mcg folic acid or folate, and those who are planning to become pregnant to begin taking a prenatal vitamin for at least 3-6 months prior to conceiving. Why?

This recommendation is largely due to the fact that inadequate folate intake can lead to neural tube defects very early on when an embryo is just forming – before we even know we’re pregnant. Taking in sufficient folate prevents this from happening and helps an embryo to develop healthily and normally.

This is actually why many foods like cereal and flour are fortified with folic acid, which means this nutrient is added to these foods. The practice began as an effort to decrease neural tube defects.

Additionally, if we are eating a nutritious diet, we can get plenty of folate from foods. Good sources of folate include:

• Beef liver
• Spinach
• Black eyed peas
• Asparagus
• Brussels sprouts
• Romaine lettuce
• Avocado
• Broccoli
• Mustard greens
• Green peas
• Kidney beans
• Wheat germ
• And much more (1)!

That being said, however, humans have been bearing children for generations before prenatal vitamins ever existed. The body is pretty brilliant at getting the nutrients needed to grow a healthy baby. So, do not panic if things haven’t been perfect (i.e. you’re pregnant and haven’t been taking a vitamin, or you’ve been taking one without ideal nutrients).

In fact, this happened to me with my second pregnancy. I had not been taking a prenatal for 3-6 months prior to getting pregnant as I was still researching to find one that I liked that fit my needs and qualifications. However, I did noticed an uptick in cravings for foods high in folate and choline before I even knew I was pregnant. This is actually something I’ve noticed my body has done for years. About a week or two before getting my period I would crave lots of plant foods – the body’s way of getting those important nutrients before potentially conceiving. Like I said, pretty brilliant!

The reason a prenatal vitamin is helpful is more of an insurance policy in case the foods we are consuming are not as nutrient-rich as we would hope, or we’re struggling to eat healthy foods early on due to numerous pregnancy symptoms. Keep reading to learn more.

What a prenatal vitamin is and is not

A prenatal vitamin is a supplement to a healthy diet in order to ensure adequate intake of all necessary nutrients. Unfortunately, nowadays, even if we are eating nutritious foods, we don’t always know exactly how many vitamins and minerals those foods contain given various factors such as soil quality, shelf life, light exposure, and time, which can all decrease nutrient content. An ideal scenario is consuming fresh, locally grown food, but that is not always possible. Additionally, we don’t know exactly how much of the vitamins and minerals we are absorbing from our food either, especially if we struggle with any digestive issues. So, a prenatal vitamin covers our bases and fills in the gaps.

It is not, however, an excuse to eat whatever we want during pregnancy (especially as it relates to junk food). On the contrary, pregnancy is when we actually want to eat the healthiest we can. But, this is the ideal. I, too, fall subject to nausea, fatigue, and food aversions only to end up eating nutrient-poor food more often during pregnancy, especially in the first trimester. When possible, focus on nutritious foods: fruits, vegetables (starchy and non-starchy), protein-rich foods (fish, beans, lentils, meat, dairy, eggs – whatever your preference/tolerance), and whole grains. But, do not beat yourself up if you’re unable to eat these foods at times!

What nutrients to look for in the best prenatal vitamin and/or additional supplements

Folate

As mentioned previously, folate is necessary for normal fetal development and the prevention of neural tube defects, especially early on in pregnancy, like, before you even know you’re pregnant. Low folate levels during pregnancy are also linked to low birth weight, preterm birth, congenital heart defects, and other birth defects (1).

I’ve seen folic acid and folate. What’s the difference?

Folic acid is the synthetic form often added to supplements and foods, while folate is the natural form found in foods and used to describe many different forms of folate.

Which is better?

Two common forms are usually used in prenatal vitamins: methylfolate and folic acid.

Methylfolate/5-Methyltetrahydrofolate vs Folic Acid

Folic acid is a synthetic form of vitamin B9 that must be converted to the active form, methylfolate (also known as 5-methyltetrahydrofolate).

The last step of the conversion process requires an enzyme called 5,10-methylenetetrahydrofolate reductase (MTHFR). When MTHFR activity is impaired, such as with those who have genetic variations of this enzyme (like me! Wondering if you do, too? Check out Mind Body Genes), folic acid is not activated as quickly and unmetabolized folic acid can build up in the body (2).

Unmetabolized folic acid may negatively affect the immune system as it is associated with a reduction in natural killer cells. High levels of folic acid may begin growth of precancerous cells or cancer cells that already exist, and increase levels of homocysteine, a risk factor for miscarriage (2).

So, generally speaking, the best prenatal vitamins will contain methylfolate as it is the active, more bioavailable form, especially for someone with a MTHFR variation.

Most prenatal vitamins will contain at least 600 mcg of folate, or folic acid, which is the recommended amount during pregnancy. More is not always better, however, and the upper limit is 800-1000 mcg folate from supplements or fortified foods, depending on age (1).

Vitamin B12

Similarly to folate, there are two forms of Vitamin B12 often used in supplements: cyanocobalamin and methylcobalamin. Some supplement companies are also using adenosylcobalamin (this helps prevent over methylation). I prefer to see methylated B12 or a combination of methylocobalamin and adenosylcobalmin for the same reasons as above: it will generally be better absorbed because it doesn’t require an enzyme to convert to the active form. Read more here.

Choline

Choline is vital for fetal growth, brain development, neuro-development, placental function, and aids in the prevention of neural tube defects. The minimum recommendations are 450 mg/day, with some research showing more may beneficial (3, 4). It is a very important nutrient that is not always added to prenatal vitamins, and if it is, I’ve often seen it in low quantities. The amount needed from a supplement, though, may really depend on diet. For example, if you eat 2 eggs daily, you’ve already met over half the daily recommendation.

Food sources highest in choline:

• Beef liver, 3 ounces: 356 mg
• Egg, 1 large: 147 mg
• Beef, 3 ounces: 117 mg
• Soybeans, 1/2 c roasted: 107 mg
• Plus a number of of other foods, including fruits and vegetables (3)

Prenatal vitamins with choline:

• MegaFood contains 300 mg
• FullWell contains 300 mg (use code GATHER10 to save 10%)
• needed. contains 400 mg in the Capsules and Powder, and 100 mg in the Essentials
• Seeking Health Optimal Prenatal capsules contains 250 mg
• Natalist contains 150 mg
• Ritual prenatal vitamin contains 55 mg, Ritual Essential Protein contains 250 mg
• Perelel contains 120 mg (all trimesters)
• SmartyPants gummies contain 55 mg, capsules contain 25 mg

Vitamin K2

Vitamin K2 works with vitamin D and calcium in the body, which are needed for the development of a baby’s skeleton.

Vitamin K2 is necessary for bone mineralization and building baby’s skeleton, whereas vitamin K is important for blood clotting (5). Additionally vitamin k2 helps improve insulin sensitivity and glucose metabolism (6). It is important to keep blood sugars balanced during pregnancy as mildly elevated blood sugars have been linked to baby’s with a higher birth weight, higher insulin levels, and a higher risk of congenital heart defects. The body does plan for this, though, and increases insulin production to account for the hormones and weight gain that make your body more insulin resistant in order to provide more nutrients to your baby (7). Along with getting adequate vitamins and minerals (including vitamin K2), eating balanced meals, and moderate activity can help keep blood sugars stable.

This is a nutrient I look for in multivitamins in general as vitamin K2 is only found in a handful of foods – foods which are not part of my normal diet, like natto and hard cheeses. It is not necessarily a requirement, but definitely a beneficial nutrient to have in a vitamin.

Omega-3 fats (EPA & DHA)

Omega-3 fats are not only essential to human health, but play an important role in baby’s brain and vision development. DHA specifically aids this development, while EPA helps DHA cross the placenta (8). The recommendation is at least 200 mg DHA per day (9), although the American Pregnancy Association recommends a minimum of 300 mg DHA based on established levels from International Society for the Study of Fatty Acids and Lipids (10).

It is possible to get adequate amounts from food, however. For example, according to Real Food For Pregnancy by Lily Nichols, RDN, CDE; 3 oz of salmon or sardines contain 1400 mg or more of DHA (8). So, if you’re eating 1-3 servings of fatty fish each week, you could meet these needs from diet.

I personally oscillate between craving salmon and being totally turned off by fish during pregnancy, so I take a DHA/EPA supplement and adjust it as needed based on my fish intake each week.

Iron

Certain supplements are not necessary for everyone at the same level, such as iron. The recommended daily intake for iron during pregnancy increases to 27 mg/day (11). Some or all may be obtained from diet, depending on the types of foods you consume. If you already eat plenty of iron-rich or iron- fortified foods, you may not need as much from a supplement, and it is possible to get too much iron. The upper limit for iron is 45 mg/day (11).

Vitamin A

Vitamin A is vital for the growth and development of organs, body systems (such as immune system), and healthy eyes and vision, however, it is possible to get too much. The tolerable upper limit is 10,000 IU or 3,000 mcg (12), so if a supplement has too much vitamin A, it’s best not to choose that one.

Vitamin B3 (Niacin)

Similarly, niacin is important for brain and nervous system development, but has a tolerable upper limit of 35 mg for all adults over the age of 19. It is also a relatively easy nutrient to obtain from food, especially if you eat poultry and/or fish, so a high dose in a prenatal is not necessary.

Other considerations when choosing the best prenatal vitamin

• Supplement quality – Not all prenatal vitamins are created equal
• Ingredient sourcing – For example, Ritual displays where their ingredients are sourced from
• Third party testing for heavy metals, allergens, other contaminants – FullWell and Ritual both use third party labs and test each batch
• Evidence-based – Are the supplements formulated using good science-backed recommendations?
• Transparency – Do the companies discuss their testing, ingredient sourcings, etc. and display this openly?
• Passion, care, and pride towards the creation and provision of their product and mission – Do the companies care about mother and baby’s health, take pride in their products? Did they create a supplement in order to provide higher quality ingredients for themselves and others? – FullWell, needed., Ritual, and MyKind are some companies that were developed this way.

The best options for prenatal vitamins

Truthfully, the best prenatal vitamin is going to be the one you feel comfortable taking, doesn’t cause or increase nausea, and meets your specific needs (example: someone who is vegan may need more iron and vitamin B12 than someone who is an omnivore).

During my first pregnancy, I took MegaFood Baby and Me 2 prenatal plus Nordic Natural’s prenatal DHA, which was fine! It didn’t cause nausea, and this combination met my personal needs perfectly. However, I have always wondered if I am somewhat sensitive to yeast, which was confirmed when I did genetic testing with MindBodyGenes, so I was looking for an alternative to MegaFood, which contains yeast.

I found FullWell and began taking it before I knew I was pregnant for the second time and loved it! I loved the quality and the types and amounts of nutrients the prenatal contained. And, as a busy mom to an active toddler, I felt more energized. Once nausea set in, however, I would feel worse after taking this vitamin, which stunk, so I switched back to MegaFood, despite the yeast. I have since been able to take Fullwell again now that I’m in the second trimester, and will sometimes go back and forth between supplements depending on ease. This is just one example of how it really just depends on YOU.

If you’re unsure what to take, however, these are some ideas:

FullWell (code GATHER10 for 10% off)

• Contains methylated folate & vitamin B12, and vitamin K2
• Contains 300 mg choline
• Contains higher amounts of B vitamins and Vitamin D than other prenatals to aid energy levels without exceeding tolerable upper limits
• Well researched and formulated by a dietitian
• Will still need: DHA and iron (as needed)

Klaire Labs Prenatal & Nursing Formula

• Contains methylated folate & vitamin B12, and vitamin K2
• Contains 150 mg choline
• Contains higher amounts of B vitamins and Vitamin D than other prenatals to aid energy levels without exceeding tolerable upper limits
• Contains 27 mg iron (can be a pro or con depending on needs)
• Will still need: DHA

MegaFood Baby & Me 2

• Contains methylated folate & vitamin B12, and vitamin K2
• Contains 18 mg iron (not too much, not too little)
• Contains 300 mg choline
• Will still need: DHA

needed.

• Contains methylated folate & vitamin B12, and vitamin K2
• Contains 100-400 mg choline depending on formula
• Contains higher amounts of B vitamins and Vitamin D than other prenatals to aid energy levels without exceeding tolerable upper limits
• Well researched and formulated by practitioners
• Will still need: DHA and iron (as needed)

Ritual Prenatal

• Contains methylated folate & vitamin B12, vitamin K2, and DHA
• Contains 18 mg iron (not too much, not too little)
• Contains only 55 mg choline
• Well researched and formulated by practitioners
• Will still need: Choline – can pair with Ritual Daily Shake Pregnancy & Postpartum (contains 250 mg choline), a different Choline supplement, or be conscious of choline intake from food sources

NatureMade Prenatal

• Contains DHA
• Contains 27 mg iron (a pro or con depending on needs)
• Does not contain methylated folate, choline, or vitamin K2
• An affordable option
• Will still need: choline

MyKind Organics Prenatal

• Contains folate from food, methylated vitamin B12
• Contains 27 mg iron (a pro or con depending on needs)
• Does not contain choline or vitamin K2
• Will still need: choline and DHA

Seeking Health Optimal Prenatal

• Contains methylated folate & vitamin B12, and vitamin K2
• Contains 250 mg choline
• Contains higher amounts of B vitamins and Vitamin D than other prenatals to aid energy levels without exceeding tolerable upper limits
• Will still need: DHA and iron (as needed)

If you want more guidance and individualized recommendations based on your specific needs and dietary preferences, consider working with a dietitian.

Sources

1. Folate. National Institutes of Health. November 1, 2022. Accessed May 24, 2023. https://ods.od.nih.gov/factsheets/Folate-Consumer/#:~:text=Folate%20is%20a%20B%2Dvitamin,foods%20and%20most%20dietary%20supplements.
2. The FullWell Science Brief: Methylfolate vs folic acid. Full Circle Prenatal. 2021. Accessed May 24, 2023.
3. Choline. National Institutes of Health. June 2, 2022. Accessed May 24, 2023. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/.
4. Nichols, Lily. Chapter 3: Foods That Build A Healthy Baby. In: Real Food For Pregnancy. 1st ed. 2018: 45.
5. Nichols, Lily. Chapter 3: Foods That Build A Healthy Baby. In: Real Food For Pregnancy. 1st ed. 2018: 47.
6. Su, Xiangni, et. al. Vitamin K2 Alleviates Insulin Resistance in Skeletal Muscle by Improving Mitochondrial Function Via SIRT1 Signaling. 2021 Jan 10;34(2):99-117. doi: 10.1089/ars.2019.7908. Epub 2020 Aug 19. Accessed May 24, 2023.
7. Nichols, Lily. Chapter 7: Pregnancy Expectations and Common Complaints. In: Real Food For Pregnancy. 1st ed. 2018: 142.
8. Nichols, Lily. Chapter 6: Supplements. In: Real Food For Pregnancy. 1st ed. 2018: 101.
9. Coletta, Jaclyn; Bell, Stacey; Roman, Ashley. Omega-3 Fatty Acids and Pregnancy. Rev. Obestet Gynecol. 2010 Fall; 3(4): 163–171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046737/#:~:text=To%20optimize%20pregnancy%20outcomes%20and,mg%20of%20DHA%20per%20day.
10. Omega-3 Fish Oil and Pregnancy. American Pregnancy Association. 2023. https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/omega-3-fish-oil-and-pregnancy/#:~:text=Omega%2D3%20fatty%20acids%20have,the%20mother’s%20risk%20of%20depression.
11. Iron. National Institutes of Health. Updated April 5, 2022. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/.
12. Vitamin A and Carotenoids. National Institutes of Health. Updated June 15, 2022. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/.
13. Niacin. National Institutes of Health. Updated November 18, 2022. https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/