PRECONCPETION

How to Choose the Best Prenatal Multivitamin

by: Alejandra Carrasco, M.D. and Christine Maren, D.O.

by: Alejandra Carrasco, M.D. and Christine Maren, D.O.

Physician founders of Hey mami!

There is never a more important time in your life to optimize your nutrient reserves than before, during, and after pregnancy.

This includes eating a nutrient dense diet (like the Hey Mami Diet), drinking plenty of water, and taking a high-quality prenatal multivitamin.

But how do you pick the best prenatal when there are so many to choose from (with so many poor quality options on the shelves)?

As board-certified physicians we can tell you that high-quality pharmaceutical-grade supplements are not always easy to find, and you are not likely to find them at your drug store or natural foods store. Moreover, there are a lot of counterfeit products sold online.

As advocates for prenatal health, we’ve done the heavy lifting for you. Our favorite prenatal is this one – keep reading, and we’ll tell you why it meets our high standards…

First off, look for a pharmaceutical-grade prenatal supplement

What is a pharmaceutical-grade supplement? They are supplements which have been manufactured in FDA-registered facilities with the same strict standards as pharmaceutical drugs within a GMP-certified facility. Generally, these products exceed the standards of the United States Pharmacopeia (USP) for supplement manufacturing.

What does this mean and why does it matter?

  • Third-party tested:  These supplements have been third-party tested for purity and potency – which means you’re getting a safe and effective product that actually contains what the label says it does, and is free of impurities like heavy metals, pesticides, microbial contaminants, solvent residues, and allergens.
  • Good Manufacturing Practices: These supplement companies adhere to “Good Manufacturing Practices” (aka: GMP) established by the Food and Drug Administration (FDA). Which means, though supplements are not regulated by the FDA, they do audit certified manufacturing facilities and supplement company headquarters to ensure GMP compliance standards are being met.
  • Free of fillers, binders and synthetic ingredients: A high-quality supplement doesn’t contain unnecessary fillers, binders and “other ingredients.” Sadly, most ordinary supplements contain chemical additives, preservatives, food dyes, and fillers like wheat, dairy, and soy. These can negatively affect nutrient absorption and health overall.

Secondly, pay attention to the specific types of nutrients in your prenatal

     1. Choose methylfolate vs. folic acid

Folate, also known as Vitamin B9, should be in the form of bioactive, methylated folate (also called methylfolate, 5-methyltetradhyrofolate or 5-MTHF), NOT folic acid.

This is key because methylfolate has greater bioavailability than synthetic folic acid, and bypasses some of the challenging steps in folate metabolism 1,2.

This is especially important in women with digestive issues and/or genetic variations in folate metabolism like MTHFR (which is very common – think 50% of the population)3.

As you likely know, folate helps prevent neural tube defects in unborn babies and is also essential for proper DNA synthesis, implantation and development of the placenta, methylation, and red blood cell health4.

Bottom line, folic acid is a deal breaker for us –  make sure you choose bioactive, methylated folate in your prenatal.

Learn more in: The Definitive Guide to Preconception Health.

   2. Look for activated B vitamins and other methylation nutrients

Methylated forms of B vitamins are more effective because they bypass some of the challenging steps associated with genetic variants (SNPs) in methylation metabolism.

What is methylation?

Methylation is a process in the body that produces methyl groups (CH3). Methyl groups are central to a vast number of biochemical reactions which are especially important during pregnancy.

In addition to methylfolate, the following nutrients are critical to supporting methylation:

  • Vitamin B12 in the form of methylcobalamin, hydroxocobalamin and/or adenosylcobalamin (not cyanocobalamin)
  • Vitamin B6 as pyrodoxial-5-phosphate
  • Vitamin B2 as riboflavin-5-phosphate
  • As well as other nutrients like choline (more on this next), zinc, and magnesium.

These nutrients are especially critical for developing babies (and their mamis) because of their role in red blood cell health, DNA formation, brain health, and nervous system maintenance5.

 

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    3.  Choline is critical!

Choline is one of the most underrated and underappreciated nutrients in preconception health.

In 2017, the American Medical Association voted to increase choline levels in all prenatal vitamins6 stating:

“Adequate levels of choline—an important nutrient that helps a baby’s brain and spinal cord to develop properly—are necessary to maintain normal pregnancy including neural development of the fetus and reducing the incidence of birth defects. Inadequate choline levels during pregnancy are thought to negatively affect cognitive development. Neural tube and hippocampus development also are dependent on adequate choline intake.”

Yet, most prenatal vitamins neglect to include enough (or any) choline in their formulas7…even the most trusted pharmaceutical grade brands. So play close attention to dose!

Adequate intake of choline during pregnancy defined as 450mg a day,8 which increases during the third trimester and lactation. And certain women need more, especially those with mutations (SNP) of the PEMT gene (you can learn more about this by testing your nutrigenomics).

Our favorite prenatal uses a mix of Trimethylglycine (TMG) and choline to meet the need for methyl groups in pregnancy.

So, why does choline matter so much?

Choline is an essential nutrient which plays a key role in fertility and a healthy pregnancy by:

  • helping to maintain the health and integrity of cell membranes for mother and baby9
  • promoting healthy placental development10
  • protecting against neural tube defects11
  • reducing the risk of preeclampsia and other adverse pregnancy events12
  • protecting your liver and gallbladder before, during, and after pregnancy.13 (and pregnancy can put some major strain on those organs)

Despite choline’s incredible nutritional prowess, about 90-95% of pregnant women are deficient in this important nutrient.14

So, this really is an important nutrient for mamis to supplement before, during, and after pregnancy. Learn more in: Choline: The Critical Nutrient You’ve Never Heard Of.

     4. The right kind of iron makes all the difference

Some women are afraid to take a prenatal supplement with iron because it can cause stomach upset and constipation… which is true when you use the wrong kind.

Look for a prenatal supplement with a gentle source of iron such as iron bisglycinate or ferrochel iron. This form of iron binds minerals to amino acids, which allows the iron molecules to pass easily through the intestinal wall (avoiding stomach upset) while maximizing absorption.

And this is important because:

  • Blood volume doubles throughout pregnancy, which increases the need for iron to make more red blood cells.
  • Iron deficiency is common. The World Health Organization estimates up to 30% of non-pregnant women and up to 41% of pregnant women have iron deficiency anemia.
  • Iron deficiency, even a mild deficiency, can cause a cascade of health issues as iron participates in a slew of bodily functions—from oxygen transport to making DNA.15
  • Going into a pregnancy without sufficient iron reserves can set you up for a more challenging pregnancy.16

     5. Vitamin A for the win

Vitamin A comes in two forms: Retinyl Palmitate and Beta-Carotene.

Retinyl Palmitate (aka Vitamin A Palmitate) is preformed vitamin A – it is the fat-soluble, active form of vitamin A found in animal foods like organ meats, egg yolks, cod liver oil and pastured dairy products.

Beta-Carotene is pro-vitamin A – it is the precursor to vitamin A found in plant foods like orange peppers, sweet potatoes and cantaloupe.

Believe it or not, Vitamin A deficiency or insufficiency is common among Americans.

Part of the reason for this is because of a genetic mutation called BCMO1 that can decrease your capacity to convert beta-carotene into active vitamin A 17 (you can learn more about this by testing your nutrigenomics).

And secondly, most of us don’t eat a lot of foods rich in preformed vitamin A, such as organ meats.

Vitamin A plays a crucial role in:

  • vision 18
  • fetal growth 19
  • fetal bone metabolism 20
  • immune function21
  • gene transcription22
  • egg quality23
  • early formation of the embryo24
  • healthy lung development for babies in-utero.25

Although controversial, our vote is for a mix of natural beta-carotene and retinyl palmitate in your prenatal vitamin.

*Note: High doses of Vitamin A can be dangerous during pregnancy and should not exceed 10,000IU’s daily while pregnant, nursing or trying to conceive.

In addition to a great prenatal vitamin, we also recommend a high potency fish oil to provide essential fatty acids and DHA. DHA can help protect your cells, increase cardiovascular health, balance inflammation, improve fertility,26 and can boost baby’s brain, eye and motor development.27 We recommend this one to our patients.

Want to go beyond the basics?

If you’re craving more information on how to further optimize your health during preconception, pregnancy, postpartum, and beyond take a deep-dive with:

  • The Definitive Guide to Preconception Health
  • The Hey Mami Diet
  • Nutrients in Pregnancy

References:

  1. https://www.ncbi.nlm.nih.gov/pubmed/24944062
  2. https://www.ncbi.nlm.nih.gov/pubmed/19852872
  3. https://rarediseases.info.nih.gov/diseases/10953/mthfr-gene-mutation
  4. https://www.ncbi.nlm.nih.gov/pubmed/22296249
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257642/
  6. https://www.ama-assn.org/delivering-care/public-health/ama-backs-global-health-experts-calling-infertility-disease
  7. https://clinmedjournals.org/articles/jfmdp/journal-of-family-medicine-and-disease-prevention-jfmdp-2-048.pdf
  8. https://www.ncbi.nlm.nih.gov/books/NBK114308/#ch12.s53
  9. https://www.ncbi.nlm.nih.gov/pubmed/16636297
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639110/
  11. https://www.ncbi.nlm.nih.gov/pubmed/19593156?dopt=Abstract
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782876/#R22
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394590/
  14. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/
  15. https://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_data_status_t2/en/
  16. https://www.ncbi.nlm.nih.gov/books/NBK409099/#
  17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372909/
  18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470929/#sec4-nutrients-11-00681title
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470929/#sec4-nutrients-11-00681title
  20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470929/#sec4-nutrients-11-00681title
  21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470929/#sec4-nutrients-11-00681title
  22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470929/#sec4-nutrients-11-00681title
  23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257687/
  24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257687/
  25. https://www.ncbi.nlm.nih.gov/pubmed/17665093
  26. https://arm.coloradowomenshealth.com/press-releases/cu-research-into-omega-3s-and-fertility
  27. https://www.sciencedaily.com/releases/2008/04/080409110029.htm

Our Bio

We are doctors Alejandra Carrasco M.D. and Christine Maren D.O. We’re board-certified through the American Board of Family Medicine, and certified in functional medicine through the Institute for Functional Medicine. We’re on a mission to support women as they navigate mamihood—from preconception through pregnancy, postpartum, and beyond. As mamis of 3 (each!), we got you.

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