What Prenatal Vitamins Should You Take and When?
Start a prenatal vitamin with at least 600-800 mcg folic acid ideally 1-3 months before conception. Key daily nutrients during pregnancy: iron (27 mg), DHA (200-300 mg), calcium (1,000 mg), vitamin D (600 IU), iodine (220 mcg), and choline (450 mg). Continue prenatal vitamins throughout pregnancy and breastfeeding.
The American College of Obstetricians and Gynecologists (ACOG) recommends comprehensive prenatal supplementation beginning before conception and continuing through lactation. Folic acid is the priority — the landmark MRC Vitamin Study established that 4 mg of folic acid reduced neural tube defect recurrence by 72%. For women without a prior NTD-affected pregnancy, 600-800 mcg daily is recommended. Methylfolate (5-MTHF) is an alternative for women with MTHFR gene variants who may have difficulty metabolizing folic acid.
Iron requirements double during pregnancy (from 18 mg to 27 mg daily) to support expanded maternal blood volume, placental development, and fetal growth. Iron deficiency anemia in pregnancy is associated with preterm birth, low birth weight, and postpartum depression. ACOG recommends screening all pregnant women for anemia at the first prenatal visit and again in the third trimester. Women with iron deficiency should take therapeutic doses of 60-120 mg elemental iron daily under medical supervision.
The MRC Vitamin Study established that folic acid reduced neural tube defect recurrence by 72%
How Do You Choose the Right Prenatal Vitamin?
Look for a prenatal vitamin verified by USP, NSF, or ConsumerLab for quality assurance. Ensure it contains at least 600 mcg folic acid, 27 mg iron, 200 mg DHA, 150 mcg iodine, and 200 mg calcium. If one supplement doesn't cover all needs, targeted add-ons for DHA and calcium are common and acceptable.
The FDA does not regulate supplements as strictly as medications, so third-party testing is important. USP (United States Pharmacopeia) verification confirms the product contains what's on the label, is free from harmful contaminants, and will dissolve properly. Prescription prenatals are not necessarily superior to over-the-counter options — many OTC prenatals meet or exceed ACOG recommendations. Your doctor can recommend specific brands based on your dietary patterns, risk factors, and tolerance.
Consider your individual needs when choosing. Vegetarians and vegans may need extra vitamin B12, iron, and algae-based DHA. Women with MTHFR variants may benefit from methylfolate rather than folic acid. Those with a history of bariatric surgery may need higher doses of fat-soluble vitamins and additional B12. Women carrying multiples may need adjusted dosing. If a prenatal causes intolerable side effects, switching formulations (tablet to capsule, standard to slow-release) often helps.
What Nutrients Should You Get From Food During Pregnancy?
Prenatal vitamins supplement but don't replace a healthy diet. Focus on folate-rich foods (leafy greens, legumes, fortified cereals), iron-rich foods (lean meat, beans, spinach), calcium sources (dairy, fortified plant milks), omega-3-rich fish (salmon, sardines — 2 servings weekly of low-mercury fish), and choline-rich foods (eggs, liver).
A balanced pregnancy diet emphasizes nutrient-dense whole foods. Folate from food sources (distinct from folic acid supplements) is found in dark leafy greens, asparagus, Brussels sprouts, beans, lentils, and fortified grains. Heme iron from animal sources (red meat, poultry, fish) is absorbed 2-3 times more efficiently than non-heme iron from plant sources. Pairing non-heme iron foods with vitamin C-rich foods improves absorption. Calcium needs are 1,000 mg daily — dairy products, fortified plant milks, canned fish with bones, and tofu are excellent sources.
Choline is an often-overlooked essential nutrient during pregnancy, critical for fetal brain development and neural tube closure. Only 8% of pregnant women meet the recommended 450 mg daily intake. Eggs are the best dietary source (147 mg per egg), followed by beef liver, chicken, fish, and soybeans. Most prenatal vitamins contain little to no choline, making dietary sources crucial. Recent research suggests choline supplementation may enhance infant cognitive development, though more studies are needed.
