During pregnancy, women are often advised to take a daily prenatal multivitamin/mineral supplement to optimize their baby’s growth and development and to support their own health.
While it’s best to rely on food to meet nutrient needs, the extra health demands of pregnancy for both mom and baby can make it difficult to eat all the nutrients needed. In addition, nobody eats perfectly on a daily basis, especially women experiencing “morning sickness” which can last all day and limit food intake. Dietary supplements can fill in gaps for several nutrients.i
Although no worldwide government recommendations dictate which nutrients should be in a prenatal supplement, the following stand out as particularly important.
Lutein and Zeaxanthin
Lutein and zeaxanthin are found in brightly colored fruits and vegetables, such as kale, spinach, and broccoli, and in corn and egg yolks. The body cannot make lutein and zeaxanthin, so baby and mom must get these important nutrients from foods or supplements, or a combination.
As early as the second trimester of pregnancy, lutein and zeaxanthin start accumulating in the retina of baby’s eyes. During the third trimester, when baby’s eye and brain development are at their peak, the levels of lutein in mom’s bloodstream are also at their highest.ii A recent study found that children born to moms who had higher lutein and zeaxanthin levels in their blood just before delivery had a lower risk for poor visual acuity – the ability to see fine detail – at three years of age.iii
Lutein and zeaxanthin are found in areas of the brain related to sight, learning and memory.iv
Currently there is no global health organization recommendation for lutein and zeaxanthin intake during pregnancy.v However, health professionals suggest adults consume 10 milligrams (mg) of lutein and 2 mg of zeaxanthin daily to support eye health and to insure adequate levels of lutein and zeaxanthin in the retina.vi
Docosahexaenoic Acid (DHA)
During pregnancy, DHA, an omega-3 fat, accumulates in baby’s brain and retina. Mom supplies baby with DHA from stores in her body and her diet. vii
Seafood, and the algae that ocean fish consume, provide DHA. Women who don’t eat enough fish or DHA-fortified foods may not be consuming adequate DHA to maximize baby’s brain and vision.viii ixExperts recommended a daily minimum of 200 mg of DHA during pregnancy. x
Vitamin B12 assists in the production of DNA and red blood cells and supports baby’s central nervous system development.
Vitamin B12 is found naturally only in animal foods. Women who eat small amounts of animal products or who avoid them can quickly become deficient in vitamin B12 because it is not stored in the body. Some plant foods have added vitamin B12, but it’s probably best to rely on a supplement during pregnancy.
The suggested intake for vitamin B12 during pregnancy is 2.6 micrograms (mcg) daily. xi
Folic acid is the form of the B vitamin folate added to fortified foods and dietary supplements. Folic acid helps produce healthy red blood cells in baby and mom, and to prevent defects of the neural tube which becomes the baby’s spinal column and brain. Look for a daily prenatal supplement with 600 mcg of folic acid.xii
Studies show that choline is critical for the development of the brain, particularly the hippocampus, the brain’s so-called memory center. xiii
Research suggests women need 450 mg of choline daily during pregnancy. xiv It’s possible to get adequate choline from foods, but evidence shows that the majority of pregnant women don’t consume enough choline-rich foodsxv, making the need for supplemental choline important.
Iodine plays a major role in formation of the brain and nerve cells during pregnancy. Women of childbearing age living in the U.S. are among those most likely to consume inadequate amounts of iodinexvi and research suggests that the number of pregnant women with insufficient iodine intakes is on the rise.xvii
The American Thyroid Association recommends consuming 150 mcg of iodine in supplement form every day during pregnancy. Choose a supplement with potassium iodide as the source.xviii
Iron is vital to the production of hemoglobin, the part of red blood cells that transports oxygen to cells. Iron also plays a role in building a strong immune system, ensuring a healthy birth weight, and in the proper development of a child’s brain and nervous system.xix
Iron requirements increase significantly during pregnancy, as the body boosts red blood cell production to support a growing baby.
Experts recommend pregnant women consume 27 milligrams (mg) of iron every day during pregnancy. It’s difficult for most women to reach the suggested intake for iron during pregnancy with food alone, so pregnant women should consider taking supplemental iron.xx
The Bottom Line for Mom and Baby
While prenatal supplements support pregnancy, they are not intended as a substitute for a balanced eating plan. The nutrients discussed – lutein, zeaxanthin, DHA, B12, folic acid, choline, iodine and iron – are not exclusive to the needs of mom and baby, but are backed in a foundation of science.
Elizabeth Ward is a registered dietitian and author of several books, including Expect the Best, Your Guide to Healthy Eating Before, During, and After Pregnancy. Read more of Elizabeth’s work on her web site: www.BetterIsTheNewPerfect.com.
iMarch of Dimes. Vitamins and Other Nutrients During Pregnancy. https://www.marchofdimes.org/pregnancy/vitamins-and-other-nutrients-during-pregnancy.aspx
iiBeluska-Turkan K, Korszak R, Hartell B, Moskal K, Maukonen J, Alexander DE, Salem N, Harkness K, Ayad W, Szaro J, Zhang K, Siriwardhana N. Nutritional gaps and supplementation in the first 1000 days. Nutrients. 2019;11(2891). 10.3390/nu11122891
iiiLai JS, Veetil VO, Lanca C, Lee BL, Godfrey KM, Gluckman PD, Shek LP, Yap F, Tan KH, Chong YS, Ong CN, Ngo CS, Saw SM, Chong FF. Maternal lutein and zeaxanthin concentrations in relation to offspring visual acuity at 3 years of age: The GUSTO study. Nutrients. 2020;12(74). 10.3390/nu12020274.
ivJohnson EJ, Vishwanathan, R, Scott TM, Schalch W, Wittwer J, Hausman D, Davey A, Johnson MA, Green RC, Gearing M, Poon, L. Serum carotenoids as a biomarker for carotenoid concentrations in the brain. FASEB J. 2011;25.
vRanard KM, Jeon S, Mohn ES, Griffiths JC, Johnson EJ, Erdman JW. Dietary guidance for lutein: consideration for intake recommendations is scientifically supported. Eur J Nutr. 2017;56(Suppl 3):37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715043/.
viAmerican Academy of Opthalmology. How is AMD diagnosed and treated? https://www.aao.org/eye-health/diseases/amd-treatment.
viiLauritzen, L, Hansen HS, Jørgensen MH, Michaelsen KF. The essentiality of long chain n-3 fatty acids in relation to development and function of the brain and retina. Prog Lipid Res. 2001; 40(1-2):1. https://www.ncbi.nlm.nih.gov/pubmed/11137568.
viiiEickstaedt, M, Beck KL, Conlon, Cathryn A. New Zealand women have suboptimal intakes of long chain omega-3 polyunsaturated fatty acids during pregnancy—a cross sectional study. N Z Med J. 2017;130. https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2017/vol-130-no-1462-22-september-2017/360.
ixGreenberg JA, Bell SJ, Ausdal WV. Omega-3 fatty acid supplementation during pregnancy. Rev Obstet Gynecol. 2008;1(4):162. https://www.ncbi.nlm.nih.gov/pubmed/19173020.
xKoletzko B, Cetin I, Brenna JT for the Perinatal Lipid Intake Working Group. Consensus statement- Dietary fat intakes for pregnant and lactating women. Br J Nutr. 2007;98:873. https://www.ncbi.nlm.nih.gov/pubmed/17688705
xiInstitute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press, 1998.
xiiInstitute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press, 1998.
xiiiCaudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J. Published online March 29, 2018. https://www.fasebj.org/doi/abs/10.1096/fj.201700692RR?journalCode=fasebj
xivInstitute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press, 1998.
xvBrunst KJ, Wright RO, DiGioia K, Enlow MB, Fernandez H, Wright RJ. Racial/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population. Public Health Nutr 2014;17:1960-70.
xviAlexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. March 2017;3.
xviiBeluska-Turkan K, Korszak R, Hartell B, Moskal K, Maukonen J, Alexander DE, Salem N, Harkness K, Ayad W, Szaro J, Zhang K, Siriwardhana N. Nutritional gaps and supplementation in the first 1000 days. Nutrients. 2019;11(2891). 10.3390/nu11122891
xviiiAmerican Thyroid Association, Public Health Committee. Iodine Supplementation for Pregnancy and Lactation – United States and Canada: Recommendations of the American Thyroid Association. Thyroid. 2006;16.
xixInstitute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc : a Report of the Panel on Micronutrients. Washington, DC: National Academy Press; 2001.
xxInstitute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc : a Report of the Panel on Micronutrients. Washington, DC: National Academy Press; 2001.