The information included in Dear Stephanie posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Always consult your healthcare provider to determine the appropriateness of the information for your own situation, or if you have any questions regarding conception, pregnancy, or your prenatal treatment plan. For more Dear Stephanie posts, click here. Have a question for Steph? Click here to e-mail her.

Dear Stephanie,

Help! There are so many prenatal vitamins to choose from! I’m overwhelmed with all the choices. What do you recommend? – Chelsea S. on Instagram (and many other mamas who DM us this question regularly!)

Three factors when choosing a prenatal

Even with a well-designed, whole foods-based diet, you can still be deficient in certain nutrients, such as magnesium, iron, vitamin D, and choline. I’m glad you’re being thoughtful about this decision. Now that you’re “eating for two”* we want to make sure your food plus supplements work together to encourage nutrient sufficiency for you and your baby’s growing demands. We want to keep you and baby well-nourished, healthy, and happy.

Since we don’t know how your first trimester will go, we want to make sure you’ve got plenty of nutrients on-board to see you through some of the potentially challenging days (or weeks). That way, if your diet starts resembling what you ate during your freshman year of college, you can feel confident that your needs are being met. This is why I recommend starting a prenatal vitamin while you’re trying to conceive.

I’ll discuss three factors to consider when choosing a quality prenatal multivitamin:

  1. Whether it’s food-based or synthetic
  2. The forms and amount of vitamins it contains
  3. What you can tolerate

*The phrase “eating for two” is sometimes misunderstood to mean that mamas need to double their intake. Calorie needs only increase by about 340 calories in the second trimester and 450 calories in the third trimester. We’re using it here to refer to the fact that your baby’s growth requires sufficient nutrient intake and stores to keep you and baby healthy and happy.

Looking for more nutrition support during pregnancy? Join Healthy Mama, Happy Baby to access resources and community support.

What’s the difference between food-based and synthetic prenatal vitamins?

The majority of prenatal multivitamins you’ll find on store shelves are synthetic. This means they contain processed, isolated nutrients. This includes many supplements that are marketed as “whole foods supplements.” While food-based supplements start out with a whole-foods base, they’re also processed and synthetic vitamins are often added. This doesn’t mean that food-based supplements are bad, in fact they often include phytonutrients and other components that are naturally part of the whole food version of that nutrient. These components can work synergistically, which can improve their safety and bioavailability. We just want to make sure you know that both forms are processed and include synthetic forms of nutrients in case that played a role in your decision. Labels can be deceiving!

So how do you decide between a food-based and synthetic prenatal multivitamin?

They both have their place depending on your budget, needs, and preferences. For example, synthetic prenatal vitamins tend to have higher levels of nutrients and may require you to take fewer capsules. If you have genetic variants that require higher doses of nutrients (such as MTHFR requiring more methylfolate/folinic acid or VDR requiring more vitamin D), whole foods-based supplements may not provide enough of what your body needs. If you have nutrient deficiencies or dietary restrictions, synthetic prenatal multivitamins can provide that extra boost of nutrients to cover your bases. Some nutrients are hard to isolate from whole foods, so you’ll also get a more comprehensive formula with a synthetic vitamin.

I’ve used both synthetic (Thorne Research Basic Prenatal and Seeking Health Optimal Prenatal) and food-based (Innate Response Baby & Me) prenatal multivitamins during my pregnancies with great results. Talk to your provider about what the best choice is for your unique situation.

How can I be sure I’m getting the most available form and the right amount of a nutrient?

If you choose a food-based prenatal multivitamin, your best bet is an organic option. Don’t sweat it if your budget doesn’t allow. The source of the vitamin should be listed so you can avoid anything you may be intolerant of or allergic to. Many of the popular brands are gluten/dairy-free, but check your labels.

For synthetic multivitamins, you’ll want to look for nutrients in their most active or absorbable forms. This includes the methylated type of folate (listed as L-5-MTHF, L-methylfolate, or L-5-methyltetrahydrofolate), B6 (in the form of pyridoxal 5’-phosphate) and B12 (in the form of methylcobalamin). I also encourage finding a vitamin that includes choline and iodine which are essential for brain health for you and baby.

If needed, choose an iron in a chelated form (such as ferrous bisglycinate chelate), which your body can more easily absorb. This is less likely to cause constipation and other complaints. You may also consider herbal and dietary approaches to increasing your iron levels, such as nettle tea and red meat. Of course, work with your provider to choose a solution that best meets your needs.

Some prenatal vitamins include herbs such as red raspberry, ginger, probiotics, and enzymes, so you’ll want to consider whether those would be a valuable addition to your regimen.

What if prenatal vitamins upset my stomach or cause other discomfort?

Food-based prenatal vitamins tend to be easier on the stomach than synthetic. If you have a hard time tolerating supplements, food-based may work best to help you avoid indigestion, stomach cramps, nausea, and heartburn.

To reduce the potential discomfort, make sure you’re taking your prenatal with food. This is less important for food-based supplements, but it can still help. You may also choose to break up the dosage, so you’re not taking all of the capsules/tablets at once. For example, if the recommended dose is four capsules a day, you could consider taking two with breakfast and two with lunch. Also, try to have a source of dietary fat with your meals when taking your vitamins. This ensures optimal absorption (for nutrients such as beta-carotene, EPA/DHA, and vitamin D).

If capsules just aren’t working for you, you could consider prenatal gummies, chewables, or a prenatal powder (Seeking Health Optimal Prenatal Chewables and Powder is a good choice). Some of these options will have sugar, flavorings, and other additives. I’d still argue that they’re better than not taking anything to support this time of increased nutrient demands.

These types of considerations will increase the cost. Again, don’t beat yourself up if you can’t afford everything I’m mentioning.

For more information

You’re doing the best you can! For more information on supplements to take during your pregnancy, you can check out our Whole Mamas Podcast episode #61, where I interviewed a leading expert on women’s health and supplements, Dr. Low Dog, MD.

Steph(hi)-6Stephanie Greunke is a registered dietitian with a master’s degree in nutrition who specializes in women’s health. She is a certified personal trainer and prenatal and postnatal corrective exercise specialist. Stephanie guides and supports women locally and globally through her web-based private practice,