Now that I am coming into the home stretch of my pregnancy I am at a point where I can start to form opinions on the trimesters that have past and the choices I have made. I am the type of person who researches everything. This wasn’t always the case, but since making the decision three years ago to take my health and the management of my autoimmune disease into my own hands, I have become an avid researcher. This mentality has definitely carried over into my pregnancy. I have researched just about everything from ovulation to gestational diabetes testing to optimal fetal positioning and beyond. One of the first things that I started researching, long before I got pregnant, was the vast realm of prenatal vitamins.
The day I found out I was pregnant I went to the doctor to get a confirmation blood test and on the way out the door they handed me a bag full of information on pregnancy and a a bunch of samples of prenatal vitamins. Talk about overwhelming…. I had literally known I was pregnant for all of about 2 minutes and already there were decisions to be made. Thankfully, I had already done my research but I was still incredibly overwhelmed. My goal in this post is to simplify the process for you and hopefully minimize your confusion and stress. So let’s go:
Should I take a prenatal vitamin?
It may seem like a given that you will take a prenatal vitamin, but it is still a question worth asking yourself. Some people prefer to take a number of separate supplements rather than one multi vitamin, other people decide to rely solely on diet.
As much as I am a huge advocate for getting your nutrients primarily from food, I feel that pregnancy is a special circumstance. There is a lot happening in your body at a fast rate, and in fact, your body is actually two bodies both of which are requiring a substantial amount of nutrients. Even women with the best diets and supplementation routines should expect to have some vitamin and mineral deficiencies by the end of pregnancy because, especially towards the end of pregnancy, it becomes next to impossible to eat enough to replenish what the baby and your body are requiring. As long as you are mindful of this you will be able to recover and replenish postpartum, but obviously the goal is to minimize the severity of any postpartum issues. As a result, I decided to go ahead and supplement my paleo/AIP diet with a prenatal vitamin as well as some other supplements that I will talk about later.
When Should I Start Taking My Prenatal Vitamin?
This is not a question that everyone may find themselves asking. If you were surprised by your pregnancy, you found out later in your first trimester, or you just didn’t think about this topic until the stick turned pink then that is just fine. However, if you, like me, find yourself researching this topic before trying to conceive than you might be wondering when to start supplementing.
I am a strong advocate of preconception health. Understanding your body, nurturing it with real food and minimizing inflammation before trying to conceive can save a lot of people a lot of heartache and it also helps set the stage for a healthy low risk pregnancy. Before pregnancy you should definitely be more focused on diet than on supplementation. A prenatal vitamin alone will not regulate your cycles, reduce inflammation or improve your egg quality, all of which diet and lifestyle changes can help with. That being said, if you are already following a real-food diet and paying attention to your overall health, than starting to supplement with a prenatal vitamin before conceiving may not be a bad idea.
The main reason for supplementing before conceiving has to do with your levels of folate, a substance your baby needs right from the start of pregnancy. I am going to go in depth on this topic in the next section but suffice it to say that there is really no harm in starting to take a good quality prenatal vitamin up to three months ahead of trying to conceive, as long as you are not using it in place of a healthy diet and lifestyle.
What is the Deal on Folate vs Folic Acid?
This is the big question that requires the research. In every single mainstream pregnancy book, website, resource, brochure… you will hear about the importance of folic acid. You may not see the word folate at all or you may see the terms used interchangeably. This alone is confusing. If you have spent much time on paleo, or holistic wellness sites you may have heard the term MTHFR thrown around and heard that folate and folic acid are not the same thing… cue more confusion. I am not a doctor but I will break down my understanding for you.
Folate is a natural vitamin found in food. It can sometimes be called vitamin b-9. Folic acid is a synthetic compound found in dietary supplements and fortified foods. Folic acid was not developed until 1943 and it was not introduced as a mandatory food fortification until 1998.
Folate has been found to play a role in minimizing neural tube defects in developing embryos.
Many people have no trouble turning synthetic folic acid into a useable form of folate in their bodies. However, people with a certain gene mutation known as the MTHFR gene mutation have trouble turning folic acid into a useable form of folate. As a result, they can end up with dangerously high levels of folic acid in their system but very low levels of useable folate. This can cause of a number of problems, but in regards to pregnancy, it can increase the risk of miscarriage and neural tube defects.
Some doctors and researchers are now starting to think that there may be a higher rate of the MTHFR gene mutation in people who have a history of autoimmune disease.
So what do you do? Well first you can go get tested for the gene mutation. Most functional medicine practitioners are aware of it and will test for it and knowing you status will give you a lot of information about your health beyond pregnancy.
However, regardless of your gene status there is nothing wrong or harmful in choosing to supplement with folate rather than folic acid in a prenatal vitamin (If you are not pregnant or trying to conceive do not supplement without consulting a doctor). Leafy greens, cauliflower, broccoli and beets are all good dietary sources of folate as are pastured calf’s liver and chicken liver.
You should aim to eat these foods regularly, but even with that it may be hard to get the recommended pregnancy amount of 800-1200 mcg per day. As a result, you should look for supplements that use the terms Metfolin, methyl-folate, 5-methyltetrahydrofolate, or 5-MTHF.
What are the AIP Friendly Brands and Ingredients?
If you have followed the autoimmune protocol for any length of time you know that finding compliant supplements can be tricky, sadly shopping for a prenatal is no different. There are two brands that I have found that are entirely AIP friendly and two that are just shy of hitting the mark.
This is the best prenatal vitamin I have been able to find. It contains folate rather than folic acid, it doesn’t have any non AIP ingredients and it didn’t make me sick to my stomach at all. The downsides to this vitamin are the it is expensive, the capsules are small and easy to take but you have to take 8 per day which is annoying, and it does not contain iron or DHA. I took this vitamin before getting pregnant and through my first trimester, when I felt I needed the most supplementation and then I stopped it due to cost.
This is also a very high quality prenatal vitamin. It also contains folate rather than folic acid, and contains no non-AIP ingredients. The capsules are small and you only need to take 3 per day so that is also a big plus. This vitamin also contains iron which, if you need it, may be a benefit. It is also much more affordable than the Optimal brand. Most of the reviews I read on this product said that it did not bother people’s stomachs so I thought for sure this would be my go-to vitamin. I had also had great luck with Thorne supplements in the past. However, no matter when or how I took this vitamin it made me sick. I started taking it a few months before trying to conceive and every time I took it I got terribly nauseous. That being said, I have heard that the formula has been changed recently and I still think it is a great supplement and worth a try. It also does not contain DHA.
This is a food-based supplement which is great for anyone who has a sensitive stomach as it should not make you sick at all. Since this is food based, it contains folate also as well as iron. It is also affordable and easy to find in a lot of health food stores. However, the downsides are that the biotin in this brand is sourced from rice. 1 serving contains 60 mg of biotin and the biotin is extracted from the rice, however rice is not AIP friendly so if you are worried about that than you need to be aware. Also, these tablets are larger than the previous two supplements and may be difficult for some people to swallow. It does not contain DHA. I ended up switching to this vitamin in my second trimester because it was more affordable and it didn’t mess with my stomach. Personally, I have had no problems with it but again I must stress that it is not 100% AIP friendly.
This vitamin is actually formulated by the Dr. who runs the functional medicine practice I go to. It is easy to swallow, uses folate, and has iron. However, it does contain rice flour as an additional ingredient, s it is not entirely AIP compliant. It also does not contain DHA.
In addition to taking a prenatal I chose to take a few additional supplements as well.
Since none of these prenatals contain DHA, which is important for baby’s brain development but also for your mood and pregnancy brain I supplement with this AIP friendly brand of DHA.
I also highly recommend taking a good quality probiotic throughout pregnancy to help reduce your chances of testing positive for group B strep in the third trimester. This is the one I have been taking.
Magnesium is my number one recommendation for a comfortable pregnancy. Taking oral magnesium will help keep you from getting constipated when progesterone slows down your digestion, it helps with pregnancy insomnia and it can help with morning sickness and restless leg syndrome.
Iron, if you decide on a prenatal without iron and you want to supplement or if you become anemic during pregnancy I highly recommend this iron supplement. I have taken it in the past and during pregnancy and it has never bothered my stomach or made my constipated.