Prenatal supplements

Mamas on Bedrest: Are Your Prenatal Vitamins Meeting Your Needs?

November 21st, 2011

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How does a mama go about choosing a prenatal vitamin? For me it was easy. When I became pregnant, my OB prescribed prenatal vitamins and I took them. I assumed that this was how it is for all pregnant mamas.  Boy was I ever mistaken! Recently I was on a social network page and there were all manner of “suggestions” flying about from taking only organic supplements to taking a Flintstone’s Chewable if that is all mama can hold down. Last spring I was even shocked to learn from one of my clients that she wasn’t even taking a prenatal vitamin because her OB believed that all it did was create “expensive pee.” So what types of vitamins does a pregnant mama need?

In a recent blog post, I posted excellent information from my friend and colleague, Rosalind Haney, a nutritionist and natural fertility consultant.  Rosalind and I have often discussed the nutritional needs of pregnant women and quite frankly we disagree on the supplement issue. Rosalind believes that women can get all the nutrients that they need from their diet-provided they follow a very specific diet. I on the other hand, knowing how nutrient depleted many of our foods are once they reach market, am a firm believer in nutritional supplementation-especially for pregnant mamas. In addition to the decreased nutrient content of many of our foods and the mechanically altered practices used to process most of our foods,  my experience is that most women don’t get the recommended amount of nutrients to sustain their own health-let alone the health of a developing baby. Add to that morning (or as it was in my case all day for all 9 months) sickness or hyperemesis gravidarum (excessive nausea and vomiting during pregnancy) and a mama can easily become malnourished and nutritionally depleted.

But for simplicity’s sake, let’s take a mama who isn’t suffering from hyperemesis. What are her nutritional needs? One of my favorite sources is my friend Heidi Murkoff. She does an excellent job of delineating what pregnant mama needs nutritionally in her book, What to Expect When You’re Expecting. I’m not going to copy the entire section, but here is a summary of mama’s nutritional needs:

  • An additional 300 calories daily (if you are average weight and are having one baby. Nutritional needs will vary if you are over or under weight and/or carry multiples.
  • 3 servings of protein daily. Total protein consumption should be approximately 75 grams daily.
  • 4 servings of Calcium daily.  Total consumption should be about 1200 mg daily
  • 3 Servings of Vitamin C daily.
  • 3-4 servings of green leafy and yellow vegetables daily.
  • 1-2 servings of other fruits and vegetables daily
  • 6 or more servings of whole grains and beans (legumes) daily
  • Iron rich foods daily
  • 4 servings of fats daily
  • At least 8 eight oz glasses of fluids daily.

Heidi gives great explanations of why each food group is necessary, what it is used for in the development of your baby and what to do if you have food limitations such as lactose intolerance, vegetarian/vegan, etc… And at the end of this summary, she recommends a that every woman take a prenatal supplement.

Prenatal supplements are being recognized as an essential component in prenatal health. Several supplements have been associated with specific benefits such as Omega 3 Fatty Acids (fish oils) helping to prevent post partum depression, Calcium and Magnesium helping to lower the risk of Pregnancy induced hypertension and Pre-Eclampsia and Inositol in addition to folate to prevent neural tube defects. While there are still no standardized levels for some vitamins and supplements, many have recommended dosages for pregnancy.

Heidi gives a great overview of what a prenatal vitamin should contain. I also looked at the Cleveland Clinic’s as well as the Mayo Clinic’s recommendations and compared them all to well known prenatal vitamin, Prenate-The Essential, Elite and DHA formulas. It’s very interesting to say the least. Here is how they compare:

Vitamin/supplement              Mayo           Cleveland             Prenate Elite         Prenate DHA            Prenate Essential

Vitamin A                                       —           4000-5000IU                2500 IU                        —                               —

Vitamin C                                 70 mg                   70 mg                   80 mg                      85mg                       85mg

Vitamin D3                               400 IU                 400 IU                   400 IU                     200 IU                     200 IU

Vitamin E                                  10 mg                  10 mg                     10 IU                       10 IU                       10 IU

Folate                                     400 mg           800-1000mg                1 mg                         1 mg                        1 mg

Vitamin B1 (thiamine)             3mg                    1.5mg                      10mg                        —                               —

Vitamin B2 (Riboflavin)           2mg                     1.6mg                     3.4mg                    12mcg                         —

Niacin                                        20mg                    17mg                      20mg                         —                             —

Vitamin B6 (pyidoxine)             —                       2.6mg                      20mg                     25mg                       25mg

Vitamin B12                             6mcg              2.2-12mg                      12mcg                        —                       12mcg

Calcium                       200-300 mg           200-300mg                      120mg                    140mg                  140mg

Iron                                            17mg                   30mg                          27mg                      27mg                     28mg

Zinc                                           15mg                    15mg                         15mg                        —                              —

Magnesium                                 —                         —                              30mg                      45mg                     45mg

Iodine                                           —                         —                          150mcg                   150mcg                 150mcg

Copper                                         —                         —                                 2mg                        —                             —

Biotin                                            —                         —                          300mcg                         —                      250mcg

Pantothenic  Acid                       —                         —                                 6mg                        —                             —

Omega 3 (EPA*)                          —                         —                                —                             —                           40mg

Omega 3 (DHA** )                         —                         —                                —                          300mg                   300mg

*EPA= Eicosapentaenoic acid

** DHA= Docosahexaenoic acid

As one can see, there are some basic essentials to prenatal vitamins, and then a wide variety of variation. When selecting a prenatal vitamin (provided your OB has not prescribed one for you) look for a vitamin that will provide you with as close to the recommended daily allowances as possible, with the necessary modifications for pregnancy. For example, pregnant women should not ingest more than about 5ooo IU of vitamin A, but if the Vitamin A used is alpha or beta Carotene, the non-toxic forms of the vitamins, then more a can be taken, up to 7500 IU in some vitamins. Pregnant women should get 1000-1200 mg of Calcium daily, yet in divided doses so that the body can absorb it. Doses larger than about 600mg result in the excess being excreted in the urine. While many sources cite only 400IU of folate, research has confirmed a pregnant mama’s folate needs are closer to 800-1000mg daily. And while not as well known, women should be supplementing with Omega 3 Fatty Acids (DHA and EPA) especially during the third trimester as these fatty acids have been shown to help reduce the risk of developing post partum depression. (See our blog on this!)

Choosing a prenatal vitamin can be confusing, but a good, preferably pharmaceutical grade prenatal supplement one of the best ways to ensure that your body has all the essential nutrients it needs to sustain your health and to develop a healthy baby.

Want a free copy of What to Expect When You’re Expecting? Be one of the first 3 respondents to this blog and you’ll receive a copy of the book-free!


The Mayo Clinic

The Cleveland Clinic


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