After seeing the dietician, I became extremely interested – or rather, obsessed – in learning about vitamin supplementation in pregnancy.

I had sought out the dietician because of my poor nutrition in my first trimester, my twin pregnancy and, to be honest, because I was feeling horrendous.

When I came home with my bag full of supplements I realised, with moderate disappointment, that I had a very basic understanding (and was taught very little) about nutrition and supplements in pregnancy.

I checked out a book from the library on Orthomolecular Medicine (the study of vitamins) and began comparing the information in the book against the Bioceuticals and Metagenics supplements that the dietician gave me – as well as the two main brands of prenatal vitamins that we recommend to pregnant women here in Australia: Elevit and Blackmores.

Elevit is one of the most popular brands – probably due to great marketing – but it boasts about extra iron, folic acid and iodine, as well as the convenience of one-tablet-per-day.

Blackmores, on the other hand, must be taken twice a day (which can seem like a hassle to the woman with pregnancy-induced brain fog).

Bioceuticals InNatal is the prenatal multivitamin that the dietician put me on, as well as a few extra Metagenics supplements such as Iron, Zinc, Magnesium etc.

As I read through the book, and compared the brands, I was shocked to find that the two most popular brands (mostly) provide the bare minimum of what is needed in pregnancy (and some of the formulations used are difficult to absorb as well).

Below I have outlined a brief summary of what I learned from this book.

Hopefully it is helpful and not too overwhelming.

 Disclaimer: this information is from the book only, and I have not done further research in medical databases or accessed Cochrane reviews for the latest up-to-date data.

RDA – Recommended Dietary Allowance (also known as Recommended Daily Allowance)

IU – International Unit (a unit of activity or potency for vitamins, or other substances)

Below I have compared the total DAILY amount (not the amount per tablet)

 

B1 (Thiamine)

– Vitamin & Pregnancy = Essential for fetal brain development, muscles, nerves & heart. States that it’s safe to take up to 100mg/day.

– RDA is 1.4mg in pregnancy

⁃ Elevit = 1.4mg

⁃ Blackmores = 1.4mg

– InNatal = 50mg

 

B2 (Riboflavin)

⁃Vitamins & Pregnancy = states that B2 is extremely safe. No toxic doses have been reported. Up to 400mg/day has been used for migraines.

– RDA is 1.4mg in pregnancy

⁃Elevit = 1.4mg

⁃Blackmores = 1.4mg

-InNatal = total 50mg (10mg of active B2 and 40mg of riboflavin)

 

B3 (Niacin)

⁃Vitamins & Pregnancy = Helps with mood disorders. Megadoses have been given for Schizophrenia, anxiety, stress & depression. Up to 1000mg can be taken to combat stress.

-RDA is 18mg in pregnancy

⁃Elevit = 18mg of Nicotinamide

⁃Blackmores = 18mg of Nicotinamide

–InNatal = total 50mg (10mg of Nicotinic Acid + 40mg of Nicotinamide)

 

B5 (Pantothenic Acid)

⁃ Vitamins & Pregnancy = no tolerable upper limit has been set.

-RDA is 6mg in pregnancy.

⁃Elevit = 6mg

⁃Blackmores = 5mg

–InNatal = 54mg

 

B6 (Pyridoxine)

⁃ Vitamins & Pregnancy = 40-100mg/day for nausea in pregnancy and 200-300mg/day for carpal tunnel and edema.

-RDA is 2mg in pregnancy

⁃ Elevit = 1.9mg

⁃ Blackmores = 2.3mg

– InNatal = total 50mg (20mg of active B6 + 30mg of pyridoxine)

 

B9 (Folic Acid & Folate)

⁃ Vitamins & Pregnancy =  Reduces risk for NTD (Neural Tube Defects/spinal deformities like spina bifida) and Cleft palate/lip. Best bioactive form is metafolate or metafolin, but folic acid or folate in any form is good.

– RDA is 400mcg for women of childbearing age (best if taken 3 months PRIOR to getting pregnant).

– RDA is 600-800mcg in pregnancy but higher doses (1-5mg) recommended for those at risk (twin pregnancy, history of spina bifida or cleft palate etc).

⁃ Elevit = 800mcg of folic acid

⁃ Blackmores = 500mcg of folic acid

– InNatal = total 500mcg (300mcg of activated folinic acid + 200mcg of active B9 levomefolic acid)

 

B12 ( Cobalamin)

⁃Vitamins & Pregnancy = Prevents pernicious anemia and neurological damage in baby. Methylcobalamin is the better formulation for absorption. Recommends up to 5mg if Vegan – as B12 is primarily found in animal products.

⁃ RDA is 2.6mcg in pregnancy

⁃ Elevit = 2.6mcg of Cyanocobalamin

⁃ Blackmores = 2.6mcg of Cyanocobalamin

– InNatal = total 700mcg (350mcg of active co-methylcobalamin + 350mcg of cyanocobalamin).

 

Vitamin H (Biotin)

⁃Vitamins & Pregnancy = Produced in the gut. Deficiencies are rare, except in pregnant women as it is broken down more rapidly. 300mcg is the dose normally found in a multivitamin.

– RDA is 30mcg in pregnancy

⁃ Elevit = 30mcg

⁃ Blackmores = 30mcg

– InNatal = 300mcg

 

Choline (not a vitamin, but grouped with the B Vitamins)

⁃ Vitamins & Pregnancy = Vital for cell membrane integrity and early brain development. Some evidence to show it also reduces the risk of NTD. Improves brain function & sleep. Choline is found in lecithin (in beans, nuts, grains etc. which is necessary for brain matter). Can help with ligament pain & blocked ducts. Some choline is produced in the liver, but is not sufficient so dietary intake from choline-rich foods is necessary.

– RDA has not been established, though research has shown that up to 95% of pregnant women do not consume enough choline in their diet alone, so a supplement is encouraged.

⁃ Elevit = NIL *

⁃ Blackmores = 150mg total (100mg of Lecithin + 50mg of choline)

– InNatal = 200mg

 

Vitamin C

⁃Vitamins & Pregnancy = Strengthens the immune system.

– Decreases lead in the body.

– Can also help prevent UTI (Urinary Tract Infections).

– Also builds collagen so the recommendation for stretch marks is 2g/day in the first trimester, 4-6g/day in the second trimester and 10g/day in the 3rd trimester.

– 10g/day has also been prescribed to decrease labor complications: has been shown to strengthen blood vessels – possibly helping prevent PPH (post-partum hemmorrhage) and also varicose veins.

⁃ Elevit = 85mg

⁃ Blackmores = 60mg

– InNatal = 200mg

 

Vitamin E

⁃Vitamins & Pregnancy =  Antioxidant.  Very difficult to get enough Vitamin E from diet alone. 200-400 IU/day may reduce risk for miscarriage.

D-alpha tocopherol with mixed natural tocopherols and tocotrienols (d-alpha, d-bets, d-gamma and d-delta) is BEST. D1 indicates synthetic form. Wheat germ is a cheaper way to get natural Vitamin E. Topical application also helps skin heal (can be used for stretch marks).

– RDA is 22.41 IU during pregnancy.

⁃ Elevit = 22.41 IU of d1-alpha* (synthetic form)

⁃ Blackmores = 10.44 IU of d-alpha

– InNatal = 22.41 IU of d-alpha tocopherol

 

Vitamin A

⁃ Vitamins & Pregnancy = essential for fetal growth, development and immune function. Vital for eyesight, calcium absorption and bone development. Up to 10,000 IU/day is safe, though conservative recommendation is not to exceed 8000 IU (of retinol).

– RDA is 2500 IU (this is referring to RETINOL not betacarotene).

⁃ Elevit = NIL*

⁃ Blackmores = 5mg of betacarotene

– InNatal = 3mg of betacarotene

 

Vitamin D

⁃ Vitamins & Pregnancy = Needed for the absorption of calcium and phosphate. Needed for bone health. Also needs vitamin K for absorption (75-90mcg safe). K1 is the dietary supplement & K2 is the natural form (same as gut).

– Can help with depression in pregnancy.

– Helps decrease risk of gestational diabetes, pre-eclampsia and low birth weight.

– Can help decrease risk of eczema and asthma in children.

– Research recommends 4000 IU in pregnancy, or enough to get serum (blood) levels between 50-70 ng/ml (40-60 considered the minimum necessary).

⁃ RDA is 600 IU in pregnancy (or 4000 units/day for those diagnosed with low vitamin D)

⁃ Elevit = 200 IU

⁃ Blackmores = 1000 IU

– InNatal = 1000 IU of cholecalciferol D3 PLUS 60mcg of menaquinone K2.

 

Boron

⁃ Vitamins & Pregnancy = Fruits and vegetables are the main source. 3mg/day sufficient (though safe up to 20mg when pregnant and breastfeeding).

⁃ Elevit = Nil

⁃ Blackmores = Nil

– InNatal = Nil

 

Calcium

⁃ Vitamins & Pregnancy = 1,000 – 1,300mg/day recommended in pregnancy to prevent bone loss from the mother (up to 3,000mg safe).

– Should be taken with Magnesium.

– Vitamin D also needed.

– Craving pickles may be a sign of calcium deficiency.

– Calcium Citrate is absorbed better than Calcium Carbonate.

⁃ Elevit = 125 mg Calcium Phosphate and Carbonate *

⁃ Blackmores = 100mg Calcium Carbonate *

– InNatal = 50mg of Calcium Phosphate

The dietician put me on magnesium powder which also had an extra 400mg of calcium in it.

 

Chromium

⁃ Vitamins & Pregnancy = Helps with glucose metabolism and can help prevent gestational diabetes (especially beneficial for women with polycystic ovaries). Very little chromium found in food so need to supplement.

– Vitamin C and niacin (B3) enhance chromium absorption.

Safe to take up to 1000mcg/day.

– RDA is 30mcg/day

⁃ Elevit = Nil

⁃ Blackmores = 30mcg

⁃ InNatal = 50mcg

 

Copper

⁃ Vitamins & Pregnacy = Most people have excess so supplementation is not really recommended.

– High copper levels associated with depression and postnatal psychosis.

– Vitamin C and zinc help reduce high serum copper levels.

RDA is 1mg/day.

⁃ Elevit = 1mg

⁃ Blackmores = Nil

– InNatal = Nil

Iodine

⁃ Vitamins & Pregnancy = Crucial for thyroid function, brain and nervous system development. Deficiency causes mental retardation, lower IQ, stunted growth and atypical sexual development.

– Iodine deficiency is becoming an epidemic worldwide.

– RDA is 220-290mcg/day in pregnancy and breastfeeding.

⁃ Elevit = 220mcg

⁃ Blackmores = 150mcg

– InNatal = 270mcg

 

Iron

⁃ Vitamins & Pregnancy = Most women are deficient. Iron is important for the proper functioning of ALL our cells in our body and is vital for oxygen transportation, healthy cells, energy, immunity, healthy skin etc.

– Ferrous sulfate makes you the most sick and constipated. Ferrous fumarate and ferrous gluconate tolerated better. Iron Glycinate is a new generation oral iron supplement that is absorbed better with little side effects.

– Minerals (like Calcium, Magnesium, zinc etc.), vitamin E and caffeine affect absorption as they compete for the same biding sites. Vitamin C enhances absorption.

– Non-heme Iron (from plants) is harder to absorb. Heme-Iron (from meat) is better absorbed.

– An Iron Infusion (given intravenously) can be given if iron levels are very low.

RDA in pregnancy is 27mg/day though most women are deficient and need more.

⁃ Elevit = 60mg of ferrous fumarate.

⁃ Blackmores = 10mg of iron glycinate

– InNatal = 15mg of iron (as amino acid chelate – meaning it’s formulated for improved absorption)

– The dietician also put me on 40mg/day of Iron bisglycinate (Metagenics brand).

 

Magnesium

⁃ Vitamins & Pregnacy = Magnesium helps with leg cramps, constipation, gestational diabetes, pre-eclampsia, migraines, anxiety and insomnia. Research recommends up to 600mg/day in pregnancy.

– Magnesium Oxide is poorly absorbed (only 4%). Magnesium is well absorbed from foods – but magnesium levels in food is much lower now as soil is becoming depleted.

– Supplements recommended in pregnancy. Powder of Magnesium Citrate is absorbed best. Epsom Salt (Magnesium sulfate) well absorbed transdermally in bath.

– RDA is 350-400mg/day in pregnancy

⁃ Elevit = 100mg of Magnesium Oxide *

⁃ Blackmores = 70mg of Magnesium Oxide *

– InNatal = 30mg Magnesium Phosphate

– The dietician also put me on 450mg of Magnesium bisglycinate in Powder form

 

Selenium

⁃ Vitamins & Pregnancy = Protects against heavy metals and damage to fetus.

– RDA Is 60-70mcg (the amount found in 1 Brazil nut) but up to 400mcg is safe upper limit.

⁃ Elevit = 50mcg

⁃ Blackmores = 65mcg

– InNatal = 35mcg

 

Zinc

– Vitamins & Pregnancy = needed for brain function, immunity and prevention of premature birth. Zinc supplements can give you nausea and vomiting if taken on an empty stomach. Oysters are high in zinc (and low in mercury).

– At least 15mg/day recommended to help prevent stretch marks.

– RDA 11-40mg/day in pregnancy

⁃ Elevit = 11mg

⁃ Blackmores = 11mg

⁃ InNatal = 20mg (as amino acid chelate – meaning it’s formulated for improved absorption)

– The dietician also put me on a 250mg zinc tablet (Metagenics brand)

 

CoQ10

⁃ Vitamins & Pregnancy = Antioxidant and micronutrient. Fat soluble. Needed for the basic function of ALL cells. Small amounts found in meat, fish & nuts.

– Can help with migraines and pre-eclampsia. Also used in conjunction with IVF to improve egg quality.

⁃ Elevit = Nil

⁃ Blackmores = Nil

⁃ InNatal = 60mg

 

Omega 3’s

⁃ Vitamins & Pregnancy = Crucial for fetal visual and neurodevelopment (and impacts childhood development if taken in pregnancy). Also affects the nervous system and can halve the risk of postnatal depression. Supplements are more important in the second half of pregnancy when fetal brain growth accelerates.

– RDA is 300-500mg/day of DHA: a combination of low-mercury fish (wild salmon) and supplementing (must have EPA & DHA). Algae Omegas are becoming more popular now in an effort to protect and conserve the oceans.

⁃ Elevit = Nil *

⁃ Blackmores = 250mg DHA plus EPA

– InNatal = Nil *

⁃ The dietician put me on 400mg of pure DHA (with EPA).

 

Probiotics

⁃ Improves immunity of mother and baby. Helps with constipation due to iron supplements and can help prevent yeast infections.

⁃ Dietician put me on 1 tablet/day of BioCuiticals Pregnancy Care Probiotics.

⁃ Recent study showed 2/3 reduction in gestational diabetes when probiotic supplement taken in pregnancy.

⁃ Another study showed reduction in pre-eclampsia with probiotics (from just milk products, not supplements).