Do I Really Need to Take Prenatal Vitamins Before I’m Even Pregnant?
Doctors don’t always go to bat for the wide range of supplements lining drug-store shelves—but prenatal vitamins seem to get the green light from them. The thing is, the Food and Drug Administration (FDA) doesn’t regulate the safety or effectiveness of supplements before they hit the market, so there’s not a ton of quality control going on when it comes to bottled vitamins and supplements. So, why are doctors typically so quick to suggest prenatal vitamins to anyone who’s thinking about becoming pregnant—and even sometimes people who aren’t?
Ask your ob/gyn about prenatal vitamins and they’ll likely recommend you start taking them, whether you’re planning to have a baby soon or not. Why is that? If you’re skeptical (or balking at the thought of adding yet another thing to your colossal daily to-do list), read on to find out the reasoning.
Prenatal vitamins are essentially supplements with at least 400 micrograms of folic acid, which is known to be important in supporting a healthy pregnancy.
Folic acid is a B vitamin that plays a key role in DNA production and making new cells. Getting enough of it can help reduce the risk of neural tube defects, which are problems affecting the structure that eventually forms an embryo’s brain and spinal cord. These defects occur in the first month of a pregnancy and include conditions that impact the brain, skull, and spine, like spina bifida and anencephaly, according to the Centers for Disease Control and Prevention (CDC).
Again, supplements aren’t regulated by the FDA, so it’s tough to say exactly how much folic acid (or other nutrients) is in every single prenatal vitamin out there. But any supplement that has folic acid generally contains 400 to 800 micrograms per dose, according to the CDC.
That includes prenatal vitamins, which are basically just multivitamins with an emphasis on nutrients pregnant people need more of, like folic acid, Fahimeh Sasan, D.O., an assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai, tells SELF. But there are also supplements out there with just folic acid, and supplements that have a mix of B vitamins including folic acid.
You can get folate, the food-based form of folic acid, from foods like dark, leafy greens, nuts, beans, and eggs, but it can be hard to get enough of it from what you eat, unless you’re getting it from a fortified cereal.
So, who should be taking prenatal vitamins?
According to the CDC, all people between the ages of 15 and 45 should consume 400 micrograms of folic acid every day, whether that’s in the form of a prenatal, a supplement that only contains folic acid, or fortified cereal.
You might be like, wait, record-scratch, everyone who can get pregnant is supposed to care about folic acid, even if they’re not planning on having a baby now or ever? Yup, this recommendation goes for everyone who may become pregnant, and that’s not just according to the CDC. The American College of Obstetricians and Gynecologists (ACOG) also recommends that anyone who can become pregnant should take a daily supplement with folic acid. (They don’t include fortified cereals in this guideline.)
This recommendation comes down, in part, to about 45 percent of pregnancies in the United States being unplanned. Then there’s the fact that the window for proper neural-tube formation is super early on in pregnancy: Neural tube defects develop only 21 to 28 days after conception. Since this is long before some people realize they’re pregnant (especially if the pregnancy is unplanned), taking folic acid serves as preemptive protection of sorts, just in case. (Though, yes, can we acknowledge for a second that this recommendation kind of assumes we’re all just baby vessels? OK, moving on.)
Also, as Dr. Sasan notes, folic acid is a water-soluble vitamin, meaning you pee out anything you don’t need. Translation: Your body doesn’t store extra amounts it can then call upon when necessary, like during pregnancy. That’s yet another reason why doctors often recommend taking prenatals before you get pregnant instead of waiting until you know you are, even if you find out as early as possible. It might feel a little The Handmaid’s Tale-y, but those are the recommendations as they stand today.
The only real deviation from that 400-microgram rule is if you’ve already had pregnancies affected by neural tube defects and want to get pregnant again. In that case, you should take 400 micrograms daily when you’re not planning on becoming pregnant, but if you do want to conceive again, you should speak with your doctor, who may want to increase your dosage. They might recommend getting up to 4,000 micrograms daily to lower the chances of a recurrence, according to the CDC. (However, the CDC notes that you should only aim to get this much folic acid under recommendation from your doctor.)
OK, so folic acid is clearly important. What about all the other stuff in prenatals, though?
Most prenatals also have minimum recommended amounts of other vitamins, Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine, tells SELF.
Iron is the other biggie besides folic acid. This mineral is important because your body needs it to produce red blood cells, but it becomes even more necessary during pregnancy, Dr. Sasan says. Iron helps sustain a fetus’s growth and development, according to the Mayo Clinic. It also helps pregnant people prevent what’s known as iron deficiency anemia, which is when you don’t have enough healthy red blood cells.
In order to make sufficient hemoglobin, a protein in red blood cells that carries oxygen throughout your body, you need a good supply of iron. When you’re pregnant and, you know, supplying blood and oxygen to a fetus, you need more blood—and thus, even more iron than usual. All this extra demand can easily tax your iron stores.
To get the 27 daily milligrams of iron you need during pregnancy (up from 15 to 18 milligrams when not pregnant, depending on your age), the ACOG recommends eating iron-rich foods like lean red meat, poultry, fish, dried beans and peas, iron-fortified cereals, and prune juice. Better yet, have them with vitamin C-rich foods like citrus and tomatoes, since that can make it easier for your body to absorb the iron. If you’re still not positive you’re getting enough, the ACOG notes that taking a prenatal vitamin can help ensure you’re consuming as much iron you need when pregnant.
Some prenatals also contain calcium, according to the Mayo Clinic. To support bone strength in themselves and their fetuses, pregnant people should get either 1,300 milligrams of calcium a day (if they’re 14-18) or 1,000 milligrams a day (if they’re 19 or over), according to the National Institutes of Health. This is the same amount non-pregnant people should be getting. It’s pretty easy to get enough calcium from food, like milk, yogurt, cheese, kale, and broccoli, which is why many prenatals have low amounts of calcium. This can be around 150 to 300 milligrams, or none at all.
To help with calcium absorption, prenatal vitamins may also have some vitamin D, which may be hard to get enough of during the day depending on your diet and sun exposure. Vitamin D helps your body absorb calcium, making it important for bone strength in pregnant people and their fetuses alike. People older than 14, pregnant or not, need at least 15 micrograms of vitamin D every day. (But, again, you may be able to get this without a supplement.)
On top of that, the ACOG suggests that vitamin B6, present in many prenatals, may make it easier to combat dreaded morning sickness. “We don't know the exact mechanism of action, but it seems that vitamin B6 helps reduce nausea and vomiting in pregnancy,” says Dr. Minkin. Pregnant people should get 1.9 milligrams each day, up from 1.2 to 1.3 milligrams of the stuff when not pregnant.
If you’re not pregnant and are considering taking prenatals, know that there are always potential risks to taking supplements you don’t need, so you should definitely consult your doctor.
It’s easy to think that organizations like the CDC recommending prenatals means you can add them into your daily regimen without thinking, but that’s not true. Nutrients have what’s known as a tolerable upper intake level, or the highest amount you can ingest every day without any real risk of negative side effects, according to the CDC. Depending on your diet and any other vitamins you might be taking, a prenatal could potentially push you over the tolerable upper intake level for various nutrients.
Take calcium, for example, which you store in your bones and teeth and which has a tolerable upper intake level of 2,000 to 3,000 milligrams in non-pregnant people over a year old, depending on age. While it’s hard to get too much calcium from food, the National Institutes of Health notes that you’re much more likely to go overboard with supplements. Having too much calcium in your system can lead to issues like constipation and increase your risk of developing painful kidney stones. Taking any calcium supplements at all can also interfere with a range of medicines, such as drugs to prevent bone-density loss (ironically enough) and antibiotics. Then there’s iron, which your body can store in your hemoglobin, liver, spleen, bone marrow, and muscle tissue, according to the National Institutes of Health. The tolerable upper intake level is 45 milligrams in non-pregnant people 14 and over; going beyond that can cause issues like nausea and constipation. Iron can also interfere with medications, including some meant to treat hypothyroidism and Parkinson’s disease.
The story can be similar with fat-soluble vitamins, such as A, D, and E, which may be present in prenatals. Your body can store fat-soluble vitamins in your fatty tissue. In excessive amounts, this can can cause different symptoms depending on the vitamin in question.
For instance, over time, getting more than 10,000 micrograms a day of vitamin A can cause headaches, diarrhea, liver damage, and bone thinning, the Mayo Clinic notes. Exceedingly high vitamin D supplementation (the tolerable upper intake level is 100 micrograms for anyone 9 and over) might contribute to weight loss, frequent peeing, and even heart arrythmias.
These vitamins can also all interfere with various medications, so it’s not as simple as just tossing a bottle of prenatals in your shopping cart then going about your day. Instead, you should get some medical advice first.
Whether or not you’re pregnant, you should talk to your doctor before adding any prenatals or other supplements to your health routine.
If there’s any chance you could get pregnant soon, yes, experts do suggest taking some form of folic acid. If not, it’s really up to you. Either way, running any prenatal you’re going to take by your provider is always a good idea, Dr. Minkin says. If you have no idea where to begin in your quest to find the right prenatal vitamin for you—or want someone to confirm that your choice is a good one—speaking with a medical provider is a great first step.
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