Even the healthiest diets need a vitamin boost. Our experts explain what supplements you need during pregnancy.
Q: When should I begin taking a prenatal vitamin? A: Start three months before you begin trying to get pregnant, if possible. "The egg starts maturing about three months before it's released, and it's critical that the proper nutrients are present during the earliest stages," says OB-GYN and reproductive endocrinologist Robert Greene, M.D., F.A.C.O.G., a fertility specialist at cny Fertility center in Syracuse, N.Y.
"Neural-tube defects [such as spina bifida] happen in the first four to six weeks of pregnancy," says Sudeep Kukreja, M.D., associate director of the neonatal intensive care unit at Children's Hospital of Orange County in Orange, Calif. If you think you're pregnant and are not taking a supplement, don't wait until your first appointment for a prescription because you will have missed this crucial developmental period. Start taking an over-the-counter folic acid supplement with 600 micrograms right away.
Q: Which vitamins and minerals are most important and why? A: "The three most important nutrients, based on very good research, are folic acid, iron and calcium," says Kukreja. Folic acid helps prevent neural-tube defects; iron is important for the delivery of oxygen to the baby and prevents anemia in the mom; and calcium helps build your baby's bones and prevents bone loss in the mother.
Q: Are all prenatal vitamins pretty much the same? A: No. Prescription vitamins are regulated by the Food and Drug administration, but they're not required to contain certain nutrients. "There are many different formulations available, with different concentrations of each nutrient," says Kukreja. Some have a little of everything; others contain only a handful of nutrients. If you have special health considerations, your OB may suggest a supplement with added nutrients to meet your needs.
Q: What should I do if I have morning sickness and am throwing up? A: "Try to take the vitamin before you go to bed at night, so you can sleep through the nausea," says Bronx, N.Y.-based OB-GYN Ashlesha Dayal, M.D.
Q: Do I need to take anything in addition to my prenatal vitamin? A: "Supplement with calcium if your prenatal doesn't contain enough," says Kukreja. Most don't because adding too much calcium to a multivitamin makes it unstable. Pregnant women need 1,000 milligrams a day; many supplements only contain 150 milligrams to 250 milligrams. You can take a tums tablet daily to supplement it.
In addition, many pregnant women don't get the institute of medicine's recommendation for 600 IUs of vitamin D per day. But most prenatal vitamin formulations contain 400 IU, and this should be adequate when combined with a healthy diet, Dayal says. The March of Dimes also recommends that pregnant women get at least 200 milligrams of DHA daily. Found in fish and some plant-based, vegetarian sources, DHA is an omega-3 fatty acid that's essential to fetal brain and eye development, Dayal says. Many prenatals contain DHA, but you also can take fish oil capsules; they're mercury-free.
Q: I'm a vegetarian. Should I be taking any additional supplements? A: "Because [strict] vegetarians are not consuming animal products, the nutrients they tend to need are vitamin B12, zinc, iron and omega-3 fatty acids like DHA," says greene. "Look for supplements that contain these vitamins plus DHA from algae, a vegetarian source, rather than from fish."
Read More: Nine Meatless Months
It's best to get your obstetrician's approval before picking an over- the-counter prenatal vitamin. "Pills containing certain herbs could be a concern, and those containing too much of a certain nutrient, such as vitamin A, can adversely affect a fetus's development," says Ashlesha Dayal, M.D., an associate professor of obstetrics and gynecology and women's health at the Montefiore Medical Center in Bronx, N.Y.
Some safe choices:
Brainstrong Prenatal vitamins include a vegetarian DHA supplement. ($20 for 30 softgels and 30 tablets, brainstrongdha.com)
Fembody Nutrition Advanced Bone Activator contains vitamin D and 750 milligrams of organic, plant-based calcium. ($40 for 90 tablets, fembodynutrition.com)
Megafood Baby and Me Herb Free is vegetarian, gluten- and soy-free. ($45 for 120 tablets, vitacost.com)
New Chapter Perfect Prenatal Multivitamin contains probiotics, minerals and organic, whole-food vitamins. ($47 for 96 tablets, newchapter.com)
Nordic Naturals Prenatal DHA provides more than double the recommended amount of omega-3s (450 milligrams) in one dose. ($29 for 90 softgels, nordicnaturals.com)
One a Day Women's Prenatal delivers pregnancy nutrients in a multivitamin and a DHA supplement. ($20 for 30 DHA softgels and 30 tablets, oneaday.com)
Rainbow Light Prenatal One Multivitamin is vegan and wheat-, gluten- and sugar-free. ($34 for 90 tablets, rainbowlight.com)