10 Important Nutrients to Look for in a Prenatal Vitamin

By Madhavi Gupta, M.D.

Prenatal Vitamins: Why They Matter and What to Look For

Although a well-balanced, whole-foods diet is a good way to get the nutrients needed for a healthy pregnancy and baby, taking a high-quality prenatal multivitamin is the best way to fill in any nutrient gaps. 

Because some of your baby’s most important development happens in the first few weeks after conception, often before you even know you are pregnant, it is ideal to start taking prenatal vitamins 3-6 months before you plan to conceive. It’s important to look for vitamins made with the following 10 ingredients to help support you and your baby’s growing needs at every stage of pregnancy.

 

Folate

Folate is an essential B-vitamin, important for  neuronal cell replication and growth (1). Demands for folate increase during pregnancy because of folate’s role in the methylation and synthesis of DNA and RNA, which is essential for the growth and proliferation of all body cells. Folate:

  • Supports healthy neurodevelopment
  • Promotes energy production
  • Improves memory & brain processing speed
  • Supports the creation of DNA
  • Helps make neurotransmitters

    Folate supports the neurodevelopment of your baby (2, 3, 4), including visual, language, and memory skills (5).  It also supports your body’s energy production (6, 7), brain’s processing speed (8), and memory. 

    It’s been well-established that folate protects against the development of neural tube defects, specifically, anencephaly and spina bifida (2). This is why a folate supplement is advised as soon as you are planning to become pregnant. 

    Folate helps make neurotransmitters, such as serotonin, melatonin, dopamine, noradrenaline, and adrenaline (9). The neurotransmitters serotonin and dopamine (10) affect sleep (11), cognitive function (12), and mood (13).

     

    What’s the difference between folic acid and folate?

    Folic acid, methylfolate, folinic acid, and food folate are all forms of folate or vitamin B9. But, these forms are not the same. 

    Your health-care provider may recommend a supplement with folic acid. But, to get an active folate that the body can immediately use, look for methylfolate. Folic acid is the synthetic form and is processed differently in our bodies. A majority of people (up to 60%) have a variation in their MTHFR gene that doesn’t allow them to properly convert folic acid into active methylfolate.

    MTHFR (Methylenetetrahydrofolate reductase) is the key enzyme that regulates this conversion process. This means that those taking folic acid may not be absorbing it as intended.  Furthermore, taking folic acid can block the absorption of methylfolate for many people with the MTHFR variant (14). If you are trying to get pregnant, consider getting a genetic test to determine if you have the MTHFR genetic variation. 

    Even for people without the MTHFR variant, it’s preferable to get folate from whole food sources and supplements that contain the natural active form of folate, methylfolate, instead of synthesized folic acid. Folic acid has to go through several steps in the body to become the active form, methylfolate, whereas a supplement with methylfolate is ready to go in the active form.

    Along with methylfolate, our prenatal vitamins contain folinic acid. It is important to note that folinic acid is very different from folic acid. Folic acid is synthetic and does not exist in nature, whereas folinic acid (5-formyltetrahydrofolate) is a naturally occurring folate. It can convert easily to methylfolate without the enzyme dihydrofolate reductase. This allows your body to regulate the amount of methylated vitamins it needs, without flooding your body and causing unpleasant side effects.

    Methylfolate is needed to bypass the MTHFR mutation and support methylation. Folinic acid is needed to support DNA base production, DNA repair, energy production, and neurotransmitter formation. During growth periods when a lot of DNA is being made, such as in pregnancy, it is very important to have both.

     

    The Collective Benefits of B Vitamins

    Beyond folate, there are two other important B vitamins to look for when choosing a prenatal multivitamin, B12 and B6.

    Vitamins B6, B9 (folate), and B12 are particularly important when choosing a prenatal vitamin.  Their collective effects are prevalent in numerous aspects of brain function, including energy production, DNA/RNA synthesis/repair, genomic and non-genomic methylation, and the synthesis of numerous neurochemicals and signaling molecules (13).


    Vitamin B12

    During pregnancy, vitamin B12 is important for brain and central nervous system development. Vitamin B12:

    • Supports brain and central nervous system development
    • Helps make serotonin, which affects mood, sleep, memory
    • Promotes the making of red blood cells
    • Is necessary for the creation of DNA
    • Improves production of SAMe, which is involved in healthy immune function

    In neurodevelopment, vitamin B12 is crucial for normal cell division and differentiation, and necessary for the development and myelination of the central nervous system. Your baby’s brain development starts from conception, and pregnancy is a period of rapid growth and development for the brain (15).

    Vitamin B12 is needed to make serotonin, which can help with mood. It is also needed for your body’s energy production, something especially appreciated during pregnancy. Vitamin B12 can help with memory as well. Folate and vitamin B12 deficiencies are associated with metabolic diseases that may impair memory function (16).

    Vitamin B12, along with folate and iron, is important for red blood cell production. Deficiency of vitamin B12 or folate can result in anemia from ineffective red blood cell production (17).

    Vitamin B12 might also be helpful in preventing preterm labor. Studies have indicated that clinical vitamin B12 deficiency may contribute to preterm delivery (18).

    Maintaining healthy levels of micronutrients, including vitamins B6 and B12, can be helpful in shoring up the immune system. Immune function may be improved by restoring deficient micronutrients to recommended levels (19).

    Because vitamin B12 is almost exclusively found in animal products, it is especially important for vegetarians and vegans to supplement with vitamin B12. Many vitamin B12 supplements contain cyanocobalamin as the active ingredient, which the liver must first change into adenosylcobalamin and methylcobalamin before using it. We use methylcobalamin and adenosylcobalamin, the two active forms.

     

    Vitamin B6 

    Vitamin B6 is another important nutrient to look for in a prenatal vitamin. Vitamin B6:

    • Helps make several neurotransmitters
    • Supports a healthy immune system
    • Promotes healthy blood vessels

    During pregnancy, vitamin B6 is vital for your baby's brain development and immune function. As with the other B vitamins, vitamin B6 is a water-soluble vitamin. Your body needs vitamin B6 for several functions. It’s needed for protein, fat and carbohydrate metabolism, and the creation of red blood cells and neurotransmitters.

    There are indications that B6 can support healthy immunity. Studies in both animals and humans suggest that deficiency in vitamin B6 affects immune responses, lymphocyte (the body’s main immune cells) differentiation and maturation, and antibody production (20).

    Vitamin B6 is required for the biosynthesis of several neurotransmitters like serotonin, dopamine, and γ-aminobutyric acid (GABA). Serotonin can affect your appetite, sleep, and cognitive functions, and it is also well known for its ability to improve overall mood. Dopamine is involved in the regulation of blood pressure and heart rate, while GABA is a major inhibitory neurotransmitter that widely controls the excitability of neurons. Vitamin B6 is even considered an “anti-stress” agent (21).

    Vitamin B6 promotes the development of healthy blood vessels.  Preventative prenatal B6 supplementation is suggested for the health of neonatal coronary arteries (22).

    Another reason to look for vitamin B6 in your prenatal multivitamins is that it may help reduce nausea during pregnancy. Some research suggests that taking vitamin B6 for morning sickness greatly improves nausea for many pregnant women (23).

     

    DHA

    DHA is an omega 3 essential fatty acid that is incredibly important during pregnancy (24, 25). It’s all about the brain. DHA makes up over 90% of the omega-3 fatty acids in your brain. It regulates neurogenesis (the formation of new brain cells called neurons), neurotrophic factor (regulates growth of neurons), and synaptogenesis (the formation of connections between neurons). DHA:

    • Plays a big role in early brain growth and development
    • Supports a healthy immune system
    • Promotes the formation of new brain cells
    • Contributes to the growth of brain cells
    • Needed for the connections between brain cells
    • Helps release serotonin for memory, sleep, mood, and behavior

    Without DHA, a baby's brain, spinal cord and eyes cannot develop properly (26), so it's vital that you get enough of the nutrient throughout pregnancy. It also boosts mom’s mood, sleep, and memory (27, 28, 29). 

    High intakes of omega-3 fats have been shown to lower the risk of preterm birth (30). Higher intakes of foods containing omega-3 long-chain polyunsaturated fatty acids, such as fish, during pregnancy have been associated with longer gestations and improved perinatal outcomes (31) 

    Everyone needs EPA and DHA omega-3 for healthy immune function, but most people are not consuming the minimum intake recommendations for EPA and DHA for healthy immune function. The body doesn’t make it and, unfortunately, women must limit their consumption of fish during pregnancy. As a result, many moms-to-be struggle to get the DHA they and their babies need through diet alone. The recommended amount by the March of Dimes is over 200 mg of DHA.

    Choline

    Choline is vital during pregnancy. Several studies have demonstrated the positive effects of prenatal and perinatal choline on neurodevelopment (32, 33). Choline:

    • Boosts attention and memory
    • Supports prenatal neurodevelopment
    • Promotes cell to cell communication
    • Improves gene expression
    • Helps muscle movement and liver function

    Choline is a micronutrient necessary for normal brain growth and development. It plays a pivotal role in maintaining structural and functional integrity of cellular membranes. Choline also regulates cholinergic signaling in the brain via the synthesis of the neurotransmitter acetylcholine. Choline is related to memory and cognitive functions at different stages of development. (34).

    In a study on choline’s critical role during fetal development, the Annual Review of Nutrition reported that choline influences stem cell proliferation and apoptosis, thereby altering brain and spinal cord structure and function and decreasing risk for neural tube defects and influencing lifelong memory function (35).

    Like methylfolate, choline acts as a methyl donor and can change gene expression. This is so important because it means you can change your phenotype or gene expression through environmental factors, such as what you eat. And if you have the MTHFR gene variant, choline requirements are increased even more (36).

     

    Vitamin D3

    It’s important to include vitamin D while pregnant to support you and your baby’s needs. Along with vitamin D's more well-known benefits, like supporting immunity (37), (38), and helping to build healthy bones, it can be especially supportive to you when on your pregnancy journey (39, 40). The vitamin D receptor is found in 900 genes in the human body, an appreciable part of the human genome. The brain is filled with vitamin D receptors and proteins that are turned on by vitamin D. Vitamin D:

    • Builds nerve cells
    • Supports nerve function and communication between brain cells
    • Boosts immunity and mood
    • Regulates minerals necessary for healthy bone growth

    Elevating vitamin D levels can help support a full-term birth. While vitamin D repletion during pregnancy minimizes the risk of certain adverse outcomes (e.g., preterm birth, asthma, preeclampsia, and gestational diabetes), the mechanisms of how these processes occur are not yet fully understood (41).

    Vitamin D boosts immunity and mood. Vitamin D can modulate the innate and adaptive immune responses. A deficiency in vitamin D is associated with increased autoimmunity as well as an increased susceptibility to infection (42).

    Growing bones need vitamin D. Vitamin D regulates minerals necessary for healthy bone growth and promotes calcium homeostasis (42).

    Iron

    Additional iron is often needed during pregnancy. Iron deficiency rates are highest for young women, infants, and children under the age of two years old. Without it, the brain doesn’t get enough oxygen to make energy. Iron:

    • Supports learning and memory
    • Helps make red blood cells (43)
    • Improves attention span (44)
    • Boosts energy
    • Supports your body’s immune response

    Proper iron levels can improve attention span, which is helpful if you experience mom brain during pregnancy or postnatally.  Micronutrient deficiencies related to iodine and iron are linked to cognitive impairments such as attention span, intelligence, and sensory perception, as well as to potential changes associated with emotions and behavior, often directly related to the presence of iron deficiency anemia (45).

    Iron supports fundamental cellular functions including energy-yielding metabolism, DNA synthesis, oxygen transport, and neuronal functions critical for brain and muscular function. 

    This translates into positive effects on cognitive and psychological processes, including mental and physical fatigue (46).

     

    Zinc

    Zinc is a trace mineral present within all bodily tissues and needed for healthy cell division. Zinc:

    • Supports a healthy immune system
    • Contributes to brain cell processing
    • Promotes communication between brain cells
    • Improves learning, thinking, and reasoning
    • Plays an important role in fertility

    Our brain contains a significant amount of zinc, which is a cofactor for more than 300 enzymes. Zinc contributes to brain cell processing, promotes communication between brain cells, and improves learning, thinking, and reasoning. It provides the basis for the functioning of more than 2000 transcription factors, and is necessary for memory formation and learning processes in the brain (47).

    Antioxidant vitamins and trace elements (including zinc) counteract potential damage caused by reactive oxygen species to cellular tissues and modulate immune cell function, helping maintain an effective immune response (48). This is especially important during pregnancy and lactation, when our bodies have additional micronutrient demands needed to support immune function.

    Zinc may also help reduce incidence of preterm labor. Research trials showed evidence for a 14% relative reduction in preterm birth for zinc compared with a placebo (49).

     

    Vitamin A

    Vitamin A is categorized into two specific groups: retinoids and carotenoids. Retinyl palmitate is a retinoid and beta-carotene is a carotenoid. We recommend both forms to help support those who have trouble converting provitamin A compounds (beta-carotene) into the active retinyl/retinol forms. Both types of vitamin A:

    • Support a healthy immune system
    • Promote visual development and maintenance
    • Help with the formation of new brain cells
    • Support skin health
    • Promote reproductive health
    • Contribute to learning and memory

    Recently vitamins A and D have been shown to have a crucial effect on the regulation of the immune response. Researchers see the potential of vitamin A and D metabolites for modulating tissue-specific immune responses (50).

    The connection between nutrition and eye health goes back over 3,000 years to the ancient Egyptians. At the turn of the twentieth century, fat-soluble vitamin A was shown to be the essential factor. Vitamin A is a precursor to the light-sensitive visual pigment molecules in our photoreceptors and has been shown to play a role in maintaining overall health.

    Animal studies show that dietary vitamin A supplementation improves learning and memory and can ameliorate cognitive declines associated with normal aging (51). It regulates numerous gene products, and modulates neurogenesis, neuronal survival and synaptic plasticity.

    Vitamin A promotes mammary gland development and lactation. Retinol and carotenoids from diet during pregnancy and lactation influence their concentration in breast milk, which is important in the long term, not only for baby, but also for maternal health. Researchers have found that vitamin A plays a role in mammary gland metabolism.  It is needed for adequate milk production and also affects the weaning process (52).

     

    Probiotics

    In addition to digestive benefits, probiotics can support the gut-brain connection and address brain changes that happen during pregnancy, sometimes called “mom brain.” Probiotics:

    • Balance intestinal flora
    • Promote better digestion and healthy regularity
    • Help make the feel-good neurotransmitter serotonin
    • Influence brain function through the Gut Microbiome System to address brain fog and slight memory issues
    • Support your immune response (53)

    Inside your gut is what scientists call your enteric nervous system - your second brain! Your intestinal microbiome is a collection of bacteria, yeasts, and viruses that live in your gut and do an enormous amount of work to keep you healthy. 

    It’s important to tend to the gut-brain connection. A growing body of evidence has shown two-way signaling between the gut and the brain. This includes multiple neuro and endocrine signal mechanisms. Changes to the gut microbiome affect brain health (54).

    Recent research suggests that probiotics could promote positive pregnancy outcomes by maintaining overall health and mitigating complications. The gut microbiome has been identified as a key factor for maintaining health outside of pregnancy. 

    Additionally, the vaginal and the recently revealed placental microbiome are altered in pregnancy and may play a role in pregnancy complications. Probiotic supplementation could help to regulate unbalanced microflora composition. There are indications for a protective role in preeclampsia, gestational diabetes mellitus, vaginal infections, maternal and infant weight gain and allergic diseases (55).

     

    When to start taking prenatal vitamins

    The earlier you start, the better. Ideally, you'll start taking prenatal vitamins before conception. In fact, it's generally a good idea for women of reproductive age to regularly take a prenatal vitamin. 

     

    Prenatal supplements

    It can be challenging to get everything you need for an optimum pregnancy through diet alone. Our prenatal supplements are designed to support you and your baby’s growing needs at every stage of pregnancy.

    Mama Bird ® Prenatal Multi+ is a once-daily neuro-nutritional prenatal providing an ultra-packed, vegan-friendly vitamin crafted with organic herbs, probiotics, a digestive enzyme blend, and methylated vitamins and minerals. Also available are Mama Bird AM/PM Prenatal Multi+ with Choline and Mama Bird Prenatal Multi+ Iodine & Iron Free. 

    One Fish, Two Fish ™ Prenatal DHA was created to help women bridge the diet gap and avoid DHA deficiencies before and during pregnancy and while breastfeeding. We only use real, pure triglyceride oil, not synthetic ethyl ester oil. Also available as a purified vegan supplement. No Fish, No Fish™ Vegan Prenatal DHA is made with sustainable algae.

    Sunny Skies™ Vitamin D Drops are made from pure fractionated coconut oil (MCT oil) and vitamin D3. This sunshine-in-a-bottle supplement helps restore and maintain vitamin D levels. Pure and potent, they contain no vitamin K2, which can interfere with medications.

    Not all prenatal vitamins are created equally. Choosing a supplement may seem overwhelming, but by looking for one that includes the 10 nutrients outlined here, you’ll feel confident about the choice you’ve made.


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