For years, OBs have routinely given pregnant women prescriptions for specialized prenatal vitamins at their first prenatal visit. Now, more and more doctors are advising women to “pump up” their supplements even before they conceive. And with some prenatal vitamin formulas now available without a prescription, that’s easier than ever to do. But what to take?
“Women of childbearing age should be sure to get enough folic acid, iron, and calcium—three essential nutrients for keeping a woman and her developing baby healthy,” advises Siobhan Dolan, MD, MPH, Associate Professor of Clinical Obstetrics & Gynecology and Women's Health at Albert Einstein College of Medicine. “Don’t wait for your doctor to give you a prescription [for prenatal vitamins] at your first prenatal visit; start taking them at least one month before you get pregnant.”
The catch: Who knows when it’s one month before you’ll get pregnant?
The nutrients you need
Turns out you may be able to get what’s most crucial for the development of a healthy baby from a regular one-a-day multivitamin. According to the March of Dimes, a non-profit group that works to prevent birth defects, taking 400 micrograms of folic acid every day in addition to what you get in a balanced diet, before and just after conception, can prevent up to 70 percent of neural tube defects (problems with the developing baby’s brain or spine that can be devastating). That amount is found in many one-a-day multivitamin/mineral formulas, especially in those designed for women.
During pregnancy, you also may need more iron and calcium; and since you probably won’t know you’re pregnant for the earliest weeks, it’s a good idea to start boosting your intake of both these minerals as soon as you start “trying.” For iron, the recommended intake for adult women is 18 milligrams per day, and that’s what you’ll find in most multivitamins. Pregnant women need more—27 milligrams daily—and that’s typically the threshold for prenatal formulas.
When it comes to calcium, even prescription supplements often don’t match up to the levels of calcium that nutrition experts recommend for women approaching childbearing age, which is 1000 milligrams each day. That level of calcium makes a multivitamin pill too large. Taking a separate calcium supplement is one option, as is taking an over-the-counter prenatal formula, which sometimes has more calcium than the prescription versions. And women should be sure to get plenty of calcium in their diets, from dairy products and leafy greens.
Experiment with formulas
You may have to try several formulas before you find one you like. Some may upset your stomach (particularly formulas high in iron). Others may be too large to swallow easily.
There’s no standardization in prenatal formulas. Manufacturers can choose whether to make their product available with or without a prescription. They can include longer or shorter lists of vitamins and minerals, and even herbs. There’s no consistency in the list or amount of ingredients from brand to brand. Because the preparations can vary so much, it’s up to you to be informed: read the labels, talk to your doctor and pharmacist, and choose the best pill for you. The right one will depend on your diet, your tolerance for different pills, and whether or not your insurance covers prescription pills (if it does, they may be the least expensive option).
If you choose an over-the-counter brand, the March of Dimes recommends looking for “USP” on the label—that indicates that the vitamins have been given a stamp of approval from the U.S. Pharmacopeia, an organization that checks safety and quality. Read labels carefully. You may find that the once-a-day multivitamin you’re already taking contains the vitamins and minerals you need right now.