Prenatals 101
"What prenatal do you recommend?"
It is probably one of the most frequently asked questions I get & the answer is complex.
In short, there is not one prenatal that I recommend to everybody & I don’t believe every woman needs to take a formal prenatal. For my clients, I usually recommend 1 out of 3 options. This really depends on if we are working with lab/hair test results and how much health history I have on the person.
Option #1: Take a high quality prenatal alone.
This is obviously the simplest option. Here are my concerns with most (if not all prenatals) on the market:
It is basically impossible to try to fit the RDA of all the vitamins & minerals into 2-4 pills.
Many prenatals use synthetic versions of vitamins which can actually be harmful to mom & baby.
Women are all so vastly different and may need more, less, or none of certain vitamins & minerals.
Vitamins & minerals are synergistic (they work together) and antagonistic (they work against each other). Putting them together can mess with absorption.
I strongly prefer whole-food sources of vitamins & minerals. This is because they are in the natural, God-designed ratios and your body is better able to utilize them.
That being said, these brands are better options:
Birthright Prenatal (6 capsules)
Pros:
Completely whole-food & animal based.
Contains beef liver, fish eggs, oyster, colostrum, bone marrow, black haw, dandelion, & magnesium
Cons:
They do not publish a nutrient analysis, so we don’t know for sure how much of each vitamin & mineral the prenatal contains. They call it a “complete” prenatal, but I am skeptical of different nutrients (vitamin A, folate, magnesium, etc).
It is a “one-size fits all” approach & some women may need more or less of certain vitamins/minerals.
Needed (8 capsules)
Pros:
Methylated B vitamins (especially folate)
No iron
Good amounts of vitamin E, B6, K2, copper, selenium, & iodine.
Good amount of choline (easily able to get remaining RDA of choline from foods)
Cons:
Synthetic Vitamin A & Vitamin C
High Vitamin D
High Zinc
Low Vitamin E
Low Magnesium (would most likely need additional supplement)
FullWell (8 capsules)
Pros:
Methylated B vitamins (especially folate)
No iron
Good amounts of vitamin E, B6, K2, selenium, & iodine.
Cons:
Synthetic Vitamin A & Vitamin C
High Vitamin D
High Zinc
Not enough choline (would be OK if able to tolerate eggs daily)
Option #2: Take a high quality prenatal with specific, tailored supplements and/or dietary changes to fill in any gaps.
Depending on the prenatal, you could fill in the gaps or balance out certain ratios with other supplements & diet changes. This would be hard without comprehensive lab testing (blood work, hair testing, etc).
For example, if a woman wanted to take the Birthright prenatal, but had markers of fat soluble vitamin deficiency, high copper, and thyroid issues, I would recommend taking cod liver oil, whole-food vitamin C, methylated folate, kelp, and extra magnesium as well.
Option #3: DIY Prenatal.
This is my personal favorite approach, but can be the messiest & most expensive (sometimes, depending on diet). Again, highly recommend lab testing with this option to ensure the most beneficial mix of vitamins & minerals, but it wouldn’t be absolutely necessary. This does, however, very much depend on diet (& what you are able to tolerate when pregnant)
Let’s breakdown the essential nutrients you need during pregnancy (note, this changes slightly postpartum when breastfeeding). Beside each I have put the recommended RDA during pregnancy (remember, this is the bare minimum). I go more in depth on these vitamins & minerals in their respective pages.
Fat soluble vitamins: Stored in the body’s fat tissues.
Vitamin A: 770 mcg RAE (2,566 IU)*
This is probably the most controversial nutrient during pregnancy. I would like to see the RDA much, much higher.
Upper Limit is 3000 mcg (10,000 IU)/day (again, research done on this is synthetic retinol)
Food-based only (no synthetic, esp synthetic retinol!)
Examples (animal based preferred): cod liver oil, liver, grass-fed butter
Vitamin D: 15 mcg (600 IU)
Again, pretty controversial. I do not like supplementing vitamin D. It is much more complex.
Best sources are sunshine (so many other benefits here as well!), fatty fish, eggs, grass-fed whole milk, & cod liver oil
Vitamin E: 15 mg
RDA much too low in my opinion. I like to see around 200-300 mg daily
More if diet high in PUFAs
One of the few vitamins I like to supplement with. Prefer a supplement that has mixed tocopherols & no seed oils
Food sources: fatty fish, eggs, chicken thighs, avocado
Vitamin K: 90 mcg
A complex vitamin. We need both plant (K1) & animal (K2) sources. Only about 10% of K1 is absorbed though, so focus on animal sources
Supplement if necessary (often not)
Food sources: Liver, eggs, cheese
Water soluble vitamins: Not well stored; excreted through urine if excess (or not bioavailable)
Vitamin B1 (Thiamine): 1.4 mg
Needed for energy & nervous system development
Supplement if necessary (often not)
Food sources: Pork, fish, beans
Vitamin B2 (Riboflavin): 1.4 mg
Needed for energy, baby’s growth, and blood cell formation (def can lead to anemia)
Supplement if necessary (often not)
Food sources: Liver, dairy, beef
Vitamin B3 (Niacin): 18 mg
Needed for hormone production (like progesterone!), DNA repair, energy, and baby’s skin & brain health.
Supplement if necessary (often not).
Food sources: Liver, poultry/meat, fish
Vitamin B5 (Pantothenic acid): 6 mg
Needed for fatty acid production, progesterone production & can prevent muscle cramps
Supplement if necessary (often not)
Food sources: Liver, sunflower seeds, fish
Vitamin B6 (Pyridoxine): 1.9 mg
Best known for improving nausea in pregnancy. Also crucial for progesterone & baby’s brain development.
Supplement if necessary (most often in cases of morning sickness)
Food sources: Chickpeas, liver, fish
Vitamin B7 (Biotin): 30 mcg
Best known for hair & skin health. Crucial for fetal development.
Supplement if necessary (often not) **Supplemental biotin interferes with lab results (esp thyroid and maybe progesterone).**
Food sources: Liver, eggs, salmon
Vitamin B9 (Folate): 600 mcg
Perhaps the most “famous” of the prenatal vitamins. Absolutely cruical for preventing neural tube defects (spina bifida). Many other important functions as well.
Supplement if necessary (depends on diet, often recommended in 1st trimester)
I recommend ALWAYS avoiding Folic Acid (synthetic version) in vitamins and enriched food products. Especially for those that have MTHFR mutations or symptoms of such (recurrent miscarriage is one example).
L-methylfolate, L-5-methyltetrahydrofolate, & folinic acid (NOT folic acid) are the best forms when supplementing. Food-based also good.
Food sources: Liver, eggs, cooked spinach
Vitamin B12 (Cobalamin): 2.6 mcg
Needed for red blood cell production (preventing anemia), energy, and preventing neural tube defects and developmental delays. Deficiency is very common among vegans & vegetarians, but can also occur in those eating animal foods if insufficient intake or poor absorption (low stomach acid, parasites, etc).
Supplement if necessary (often not unless vegan/vegetarian)
Food sources: Liver, oysters, eggs, meat
Choline: 450 mg
Becoming a more well-known prenatal vitamin for it’s importance in preventing neural tube defects and brain health in baby.
RDA could be higher - This study showed 900 mg daily in the 3rd trimester led to improved cognition in infants.
Supplement if necessary (if unable to consume eggs or maybe in 3rd trimester)
Food sources: Eggs (1 egg has approximately 150 mg of choline), liver, meat
Vitamin C: 85 mg
Crucial for immune health, progesterone production, iron absorption, and collagen formation.
RDA is low, I recommend closer to 500 mg daily from food or whole-food supplements.
Supplement if necessary (often not). I do not recommend synthetic vitamin C (ascorbic acid or sodium ascrobate). There are several food-based supplements (camu camu, acerola, etc) that can provide you with sufficient vitamin C if your diet is lacking.
Food sources: Peppers, citrus, cooked veggies
Macrominerals:
Calcium: 1,000 mg
Fun fact: During pregnancy, calcium needs don’t increase by much because your gut actually naturally increases the absorption of calcium (this stops postpartum though, & calcium needs when nursing are super high!)
Food sources always, I do not like synthetic calcium supplements. Easy if dairy is tolerated, but still doable if not.
Needs to be balanced with Magnesium.
Food sources: dairy, greens, sardines
Magnesium: 350 mg
Need more in 1st trimester usually
Supplement usually necessary. Form matters a lot!
Mg Oxide - basically a laxative, doesn’t do much
Mg Citrate - helpful for constipation, but not well absorbed otherwise
Mg Glycinate - well absorbed, good for nervous system, anxiety, and sleep (take in PM)
Mg Malate - well absorbed, can be energizing, good for pain and nervous system (take in AM)
Sodium: 1,500-2,300 mg
Pregnant women are often told to limit salt intake (esp if history of preeclampsia or high blood pressure), but I really disagree with this. Sodium & potassium work together very, very closely.
Sodium intake is very individualized (I really like to see HTMA results for this). It also depends a LOT of potassium intake. The more potassium you consume, the more sodium you can (& should) consume. Most people do best with a 3-4:1 potassium to sodium ratio.
I like to recommend adding a dash or more of high quality sea salt to water throughout the day for sodium needs.
Salt brands, believe it or not, are a controversial topic in the health & wellness world. Something like 90% of salts have tested high in heavy metals and positive for microplastics. These are the brands I like & trust:
Redmond Real Salt
Baja Gold Salt Co
Celtic Sea Salt
Potassium: 2,900 mg
Again, this RDA is very low in my opinion. Potassium is probably the most common deficiency I see. I recommend aiming for 4,000-5,000 mg a day.
I don’t recommend supplementing (with a few exceptions), because often when supplementing we end up just losing more through urine/stool. Also it is very possible to get enough through food.
Note: if you are currently only consuming 1000-2000 mg of potassium daily, you will want to increase slowly because it can cause other minerals to become imbalanced and cause unwanted symptoms.
Food sources: potatoes, coconut water, kiwi
Microminerals
Copper: 1000 mcg (1 mg)
Essential for red blood cell production (preventing anemia) and regulating iron. Aids in baby’s heart and nervous system development.
Supplement if necessary. Whole food source preferred.
Food sources: Liver, shellfish, nuts & seeds
Zinc: 11 mg
Needed for immune function, digestion, & cellular health/DNA synthesis. Deficiency linked to preterm birth & low birth weight.
Supplementation often not necessary. Whole food based if needed.
Food Sources: Oysters, red meat, pumpkin seeds
Iron: 27 mg*
A very controversial mineral in pregnancy. I am of the belief that iron needs in pregnancy are extremely individualized. In my experience, very few women need supplemental iron in pregnancy.
Note: if you have been told you are iron deficient, I highly recommend Morley Robbin’s book Cure Your Fatigue to learn more about the iron recycling system and the roles of copper, vitamin A, and magnesium.
Of course please talk to your health care provider before starting or stopping any recommended supplements or medications.
Supplementation often not necessary in my experience. Food based if necessary.
Animal sources of iron are going to be much, much more bioavailable than plant sources (which is another reason why the RDA is probably too high in my opinion).
Vitamin C increases absorption. Calcium, coffee, and tea decrease absorption.
Food Sources: Oysters, Liver, Red meat
Iodine: 220 mcg
Essential for mom & baby thyroid health. Prevents developmental delays.
Supplementation may be necessary depending on diet. I like kelp capsules or kelp flakes sprinkled on food.
I don’t recommend exceeding RDA too much without professional guidance. Especially for those with thyroid concerns.
Food Sources: Seaweed, seafood, dairy, eggs
Selenium: 60 mcg
Essential for mom & baby thyroid health. Powerful antioxidant.
Supplementation usually not necessary.
Food Sources: Brazil nuts, seafood, eggs, meat
Manganese: 2 mg
Important for bone development.
Supplementation not often necessary.
Food Sources: shellfish, nuts, chickpeas
Chromium: 30 mcg
Helpful for healthy blood sugar balance.
Supplementation not often necessary in a balanced diet.
Food Sources*: cooked broccoli, grape juice, whole grains
Molybdenum: 50 mcg
Essential for detoxification and metabolism.
Supplementation not often necessary.
Food Sources: Liver, dairy, legumes
Boron*: N/A
Not currently considered essential because of lack of knowledge, but I consider it important. Gaining a lot of popularity for fertility benefits (specifically in men), hormone health, and bone health.
Supplementation not often necessary and safety hasn’t been established. I wouldn’t go over about 10 mg a day if supplementing.
Food Sources: Avocado, fruits, root vegetables
Lithium*: N/A
Not currently considered essential because of lack of knowledge, but I add it because it is one that I often see deficiencies in on hair testing. This mineral is almost exclusively used for severe mental health disorders at high doses. However, research is showing that low-dose supplementation shows promise in many, many other areas.
Supplementation not recommended unless under very close supervision by a knowledgable health care practitioner.
Food Sources: grains, potatoes, tomatoes
Trace mineral drops usually contain lithium as well.
Again, I strongly recommend working with a practitioner if you are going to “DIY” your prenatal. There is a lot of nuance and everyone if different. This is a generalized approach that may not be right for everyone.
Nutrition Foundations: Eating a healthy, well-balanced diet will get you very far.
Eat at least 3 meals a day.
100 grams of protein daily (animal sources preferred).
3 cups of vegetables daily (preferably cooked)
Animal based fats at each meal.
Nutrient dense carbs at each meal (root vegetables, fruit)
Filtered water with high-quality salt and/or trace minerals added in.
Fill in the gaps: Take an inventory of your typical diet (a food tracker app or ChatGPT can be helpful here) and see what areas you are lacking in. Here are the most common areas that need support & how to increase/supplement:
Vitamin A:
Cod Liver Oil (Jigsaw or Rosita are my preferred brands)
Desiccated Beef Liver or Organ Capsules
Vitamin D:
Cod Liver Oil (Jigsaw or Rosita are my preferred brands)
Get outside.
Vitamin E:
400 IU vitamin E (Integrative Therapeutics is my preferred brand)
Folate:
Depending on where you are landing with food intake, 200-600 mcg from supplement (L-methylfolate, L-5-methyltetrahydrofolate, & folinic acid recommended - NOT folic acid).
Choline:
3+ eggs daily
Choline bitartrate supplement if necessary.
Potassium:
Adrenal cocktails
Jigsaw Pickleball cocktail
Mt Capra Mineral Whey (>1000 mg of potassium in 2 tbsp)
Magnesium:
Magnesium glycinate supplement
Calcium:
Increase dairy if tolerated
Egg shell powder may be helpful if dairy not tolerated
Iodine:
Kelp flakes or kelp capsules
Eggs are also a good source
Selenium:
1-2 brazil nuts daily
100-200 mcg seleniomethionine in supplement form may be needed