“Should I opt for folate or methylfolate? Why do I need choline? What about omegas?”

If you’re TTC or expecting and looking for the best prenatal multivitamin, these are things you may be pondering, as prenatal nutrition is critically important! There seem to be new prenatal options popping up left and right these days, not to mention the fact that you probably already have a million other things on your mind. How’s a hopeful or expecting mama supposed to choose what’s best? Especially when most don’t even know what methylated folate even means?!

We sat down with our Medical Director and Registered Dietitian, Lisa Dispensa, to wade through some of these questions and get her guidance on what to look for. Lisa helps break it all down simply in this 14-minute video. You can also skip ahead to our written recap below.

Watch or read to the end for a limited time offer to save 20% on our own Prenatal Complete Multivitamin and Dual Prenatal Immunity Probiotic!

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When should one start taking a prenatal vitamin?

Ideally, you should start taking one as soon as you start planning for pregnancy. This means while you’re trying to conceive (or even thinking about it). That said, about 50% of pregnancies are unplanned, so it’s important to take a multivitamin with folate as early as possible. If you’re actually planning a pregnancy, it’s preferable that you choose a prenatal. 

Folate is particularly important to get at the right levels, along with other B vitamins, at this time for pregnancy. These nutrients play a key role in the first 21 days of pregnancy, which is a crucial time. Of course, it’s recommended that you continue taking that prenatal throughout the entire course of your pregnancy.

What is most important to look for in a prenatal vitamin?

You should look to supplement with essential nutrients that are otherwise difficult to get in your diet. It’s important to go to the Supplement Facts box on the packaging to check for these. Iron (a bioavailable form of iron, at that, which just means the body can easily use it), iodine, DHA omega-3 fatty acid (not just fish oil, DHA), and choline are all great examples of key nutrients that are difficult to get in the diet. 

Not only should you look at which nutrients are included in the multivitamin, you need to look at the levels of each. Take Vitamin C, for example. A multivitamin may say that it contains 100% of your recommended daily amount (or DV, daily value) of Vitamin C. But the “recommended daily amount” cited may mean for adults; it may not mean pregnant adults specifically. The recommended level of Vitamin C for adults is 90mg, but for pregnant adults it’s 120mg; yet both may state 100% DV, so be careful of that distinction. 

Finally, be sure there aren’t a bunch of additional ingredients listed below the Supplement Facts box. The Supplement Facts box lists essential nutrients. Anything else listed below may not be necessary to supplement with. Ask your doctor or dietitian if you’re unsure about any listed ingredients. 

One thing that seems to confuse many people is DHA versus EPA. You mentioned the importance of DHA, but can you explain that some more?

Sure. You see “fish oil” a lot now at high levels… 500mg or 1,000mg, which in and of itself does not really offer any benefits. It can deliver DHA and EPA, but what you’re looking for is DHA at a particular level. DHA has a known, established role and benefits for an expecting mom and her growing baby. The recommended amount of DHA is between 200-300mg per day. 

There is no known role for EPA during pregnancy. It’s found in fatty fish and is perfectly fine to consume, but again, it has no known role. If EPA is included in your prenatal multivitamin, it’s important that it’s at a lower level, specifically a lower level than the DHA. So DHA should be higher, EPA should be lower, and avoid high levels of fish oils because there’s no known benefit and thus no need to supplement with them. It’s possible that another important essential nutrient may have been sacrificed to fit in all that fish oil! 

Another area of confusion for moms is folic acid versus methylated folate. Moms usually know folic acid is something they should look for, but it comes in two very different forms. What’s the difference between the two?

Folate is one of those things that needs to be consumed along with a healthy diet. Both folic acid and methylated folate play an important role for expecting mothers, and both can help prevent neural tube defects. The difference is that folate from folic acid needs to be converted to an active form before the body can use it. So why does that matter? There are individuals who cannot convert or inefficiently convert folic acid into its active form. This means that the body cannot fully utilize the folic acid, and people with this usually don’t even know it!

The methylated form of folate is already converted, so it’s already in its active form and available for the body to use or put into action. If you’re unsure, look for a prenatal multivitamin containing folate in the methylated (active) form.

You mentioned choline earlier. Choline and iodine have relatively newer recommended levels for pregnancy. Why are those important to look for in a prenatal multivitamin?

Choline is a bulky nutrient; we need it at a high level, about 550mg per day. The bulkiness means it’s difficult to “fit” into a multivitamin, but like iodine it’s very essential for fetal brain development. Definitely look for a prenatal containing choline at about 55mg. That's 10% of your DV, but because choline is so bulky, that's actually the most that can really fit in a multivitamin or prenatal (many don't even contain it). The rest should come from your diet, so be sure what you're eating is rich in choline. Eggs, milk, and meat are great sources.

As for iodine, definitely get 100% of the recommended level for pregnancy in your prenatal because it’s very, very difficult to get it through your diet. Iodine is particularly important for hormone imbalance. You should be getting 220 micrograms (mcg) of iodine per day. You may see that 150mcg is 100% of your daily value. That’s for adults and not for this very specialized time of pregnancy. Look for 220mcg.

We’ve talked a lot about what SHOULD be in your prenatal vitamin. What should NOT be in a prenatal vitamin?

Be mindful of both excess levels and low levels of nutrients. Avoid low levels of iron, low levels of iodine… those should be red flags. High levels of fish oil should also be a red flag. EPA that’s higher than DHA should be a red flag.

Vitamin K is an essential nutrient for blood clotting, and you meet this need through VItamin K1. Vitamin K2 does not meet your essential needs and would be found below the Supplement Facts box. Vitamin K2 is not an essential nutrient and not necessary to have in your prenatal.

Avoid random, multiple blends of probiotics. Probiotics can certainly be beneficial, but they need to be of the right genus, species, strain and dose that has been clinically studied during pregnancy. Otherwise, they have no known benefit. You’re probably not buying a prenatal multivitamin for its digestive enzymes. Those would be taken separately, if at all, and would be something recommended by your doctor.

Again, look below that Supplement Facts box. Keep in mind that you may be paying for extra ingredients listed in that space that you don’t need or ones that may not have a known prenatal benefit.

You mentioned digestion and probiotics. We have lots of moms that have had trouble taking prenatals because of morning sickness. What should moms do if they find they’re queasy after taking their multivitamin?

Lisa: It can be helpful to take them with food. Food also helps optimize nutrient absorption and supports digestion. You can also take your prenatal in a divided dose. If it is more than one capsule or tablet per day, you can take one in the morning and one at night.

Kimberly: I remember when I was pregnant, I kept crackers by my bed. I’d pop one in the morning to start my day, and it helped with some of that early nausea. It’s important for moms to try different things to determine what’s best for them.

These are great insights about prenatal multivitamins. We also often have moms ask if there are other supplements they should be taking in addition to a good prenatal.

Depending on how much calcium or dairy products are in your diet, you can consider a calcium supplement. You should take it separately from your prenatal because calcium competes with other minerals for absorption. Taking them separately can also help alleviate any ensuing queasiness that could occur.

The big picture is that you want to supplement with less during pregnancy. You may want to choose a calcium supplement and a probiotic but not much else (this is, of course, also depending on what your doctor may specifically recommend). If you’re going to add in a probiotic, be very intentional about which one you choose. For example, Lactobacillus Rhamnosus HN001™ is the exact genus, species, and strain that has been studied and is clinically proven to be beneficial during pregnancy. There’s long-term data on it, and that’s the kind of thing you want to look for. HN001 can help mom and baby with gut and immune health.

Upspring does make a prenatal multivitamin, Prenatal Complete Multivitamin Softgel, that contains the things that Lisa recommends and avoids the things she says to avoid (after all, she helped formulate the product)!

Lisa also mentioned a probiotic with the strain HN001. That’s what our probiotic, Dual Prenatal Immunity, contains. It’s a great complement to your prenatal.

Save 20% on either product for a limited time with code HEALTHYPREGNANCY at checkout.

Thanks so much for relaying all this important information, Lisa. The biggest takeaway is that moms should take their time in choosing a prenatal. Read labels. Compare. Ask questions. In fact, if you have questions for us about prenatals, simply reach out to CustomerService@UpspringBaby.com!