Shopping for supplements can be overwhelming and when it comes to prenatals specifically – when so much seems to be at stake – it can also be incredibly stressful. To help get the facts straight I turned to Dr. Amanda Frick, ND, LAc, the executive director of medical affairs at Thorne, and she shared her insight on exactly what we should be looking for and why shopping conscientiously is so important.
Momtastic: When should a woman planning to get pregnant take a prenatal?
Dr. Amanda Frick: Ideally, a woman should begin taking a prenatal supplement at least six months prior to becoming pregnant. By the third week after conception, the baby’s nervous system is already forming. By the end of the fourth week, the part of the embryo that will develop into the baby’s brain and spinal cord – the neural tube – is already beginning to close. Also, during the fourth week after conception, the baby’s other organs, like the heart, are beginning to form. These essential biological processes occur so early in embryological development that many women don’t yet realize they are pregnant. If mom is deficient in folate or other nutrients, starting a prenatal supplement when she becomes aware that she is pregnant might be too late to prevent deficiency-related developmental issues. Starting a prenatal supplement prior to pregnancy helps ensure mom has adequate nutrients for the development of her baby’s healthy brain, nervous system, heart, and essential organs. The iron in a prenatal supplement can also help prevent iron deficiency anemia. This might be particularly important for women struggling with certain types of infertility.
Momtastic: Does it need to be prenatal or can it be just folic acid?
Dr. Amanda Frick: Prenatal supplements have a lot more to offer than just folic acid. Although folic acid is important for the development of a baby’s brain and spinal cord, there are many other nutrients that are essential to a healthy baby and pregnancy. For example, other B vitamins like riboflavin (B2), niacin (B3), and methylcobalamin (B12), as well as certain minerals like iron, are important for fetal heart development. Iron is also important for a healthy placenta. Iron protects against anemia in pregnancy, ensuring adequate blood supply to a growing baby. Pregnant moms need about twice the amount of iron they needed prior to pregnancy. Calcium and vitamin D are important to help promote baby’s healthy bones and teeth. Pyridoxine (B6), vitamin C, and vitamin K are other well-studied additions that reduce morning sickness in pregnancy. Other vitamins and minerals are essential for healthy fetal growth of multiple organs and systems.
Momtastic: What are some things women should look for when shopping for a prenatal?
Dr. Amanda Frick: At a minimum, a prenatal supplement should contain iron and folate. Ideally, the formula would also contain calcium, vitamin D, other B vitamins, and minerals like magnesium, zinc, and iodine. The balance of nutrients in a prenatal supplement isn’t the only thing that counts! The form in which these nutrients are delivered is equally important. Iron has a tendency to worsen pregnancy nausea and can increase issues with constipation.
Choosing a prenatal supplement with the right forms of nutrients can help alleviate these concerns, as well as others. Thorne’s Basic Prenatal contains iron bisglycinate, a highly absorbable from of iron, which helps minimize nausea and constipation that are common with other forms of iron. In fact, every mineral in Basic Prenatal is provided in chelated form, which means they are in prime form for optimal absorption and lower side effects.
Another consideration is the form of the B vitamins contained in the formula, particularly folate. Although we commonly refer to “folic acid” as a need in pregnancy, this is not actually what you want to see listed in the Supplement Facts box of your prenatal supplement. Folic acid is the synthetic form of vitamin B9, while folate is the natural and active form of vitamin B9 found in food and utilized within your cells. Look for a prenatal supplement that uses folate – methylfolate or 5-MHTF may be listed in the Supplement Facts box. Not only does folate provide a bioavailable form of B9 in the body, it’s also important to provide folate in the methylfolate or 5-MTHF format for women who have common genetic mutations like MTHFR, and others. These genetic variables can make it very difficult to absorb and utilize folate that is not provided in methylated form.
This is also true for vitamin B12. Look for B12 in the Supplement Facts box listed as methylcobalamin. Although the cyanocobalamin form of B12 is commonly used in vitamin supplements because it is less expensive than methylcobalamin, unfortunately, the body must convert cyanocobalamin to methylcobalamin to be biologically useful. Women with the same MTHFR genetic mutations, as well as those who have low stomach acid have difficulty converting cyanocobalamin to the bioactive form of B12. Acid reflux is common in pregnancy, particularly in the third trimester. Use of PPIs or other antacid medications can further compromise this conversion. Play it safe and effective by choosing a prenatal supplement that contains methylfolate (5-MTHF) and methylcobalamin.
Momtastic: Many women get very nauseous and can’t take a large pill. In that case, do you recommend taking just folic acid?
Dr. Amanda Frick: For the necessary benefits of other nutrients we have discussed, I don’t recommend a folic acid- only supplement in pregnancy. Splitting up prenatal dosing through the day and taking your prenatal supplement with meals helps alleviate the nausea that is very common in pregnancy. In addition, certain nutrients like vitamins B6, C, and K are well-studied for their ability to help reduce nausea associated with pregnancy.
Momtastic: Do women need to keep taking prenatal after delivery if they are not breastfeeding?
Dr. Amanda Frick: Even for moms who are not nursing, it’s generally advised to continue a prenatal supplement for at least six weeks postpartum. Mom’s body has just gone through quite a process! Nutrients can continue to be lost through postpartum bleeding for several weeks; supplementation might need to be extended for longer than six weeks if there is an extended period of postpartum bleeding. Even with the healthiest diet, nutrients such as iron can be depleted, which can lead to fatigue, mood disruption, hair loss, and others in mom. Nutrients like zinc, vitamin D, and vitamin C are essential for maintaining healthy immune function, especially in depleted moms, while vitamins B6 and D are important for helping to ward off post-pregnancy blues. And if you’re already planning ahead for baby’s next sibling, continuing to supplement becomes even more important.