Vitamins to Take Before Getting Pregnant

Ordinary one-a-day type or women’s specialty? Prenatal or multi? Prescription or not? When you’re trying to get pregnant, the choices become even more confusing.

For years, ob/gyns have routinely given pregnant women prescriptions for specialized prenatal vitamins at their first prenatal visit. Now, more and more docs are advising women to “pump up” their supplements even before they conceive. And with some prenatal vitamin formulas now available without a prescription, that’s easier than ever to do. But what to take?

“Women of childbearing age should be sure to get enough folic acid, iron, and calcium—three essential nutrients for keeping a woman and her developing baby healthy,” advises Siobhan Dolan, M.D., M.P.H., associate medical director for the March of Dimes, a non-profit group that works to prevent birth defects. “Don’t wait for your doctor to give you a prescription [for prenatal vitamins] at your first prenatal visit; start taking them at least one month before you get pregnant.”

The catch: Who knows when it’s one month before you’ll get pregnant? What if it takes almost no time—or seemingly forever? And what if the pregnancy isn’t precisely planned? What kind of vitamin should you take then?

Turns out you may be able to get what’s most crucial for the development of a healthy baby from a regular one-a-day multivitamin. According to the March of Dimes, taking 400 mcg of folic acid every day in addition to what you get in a balanced diet, before and just after conception, can prevent up to 70 percent of neural tube defects (a problem with the developing baby’s spinal cord that can be devastating). That amount is found in many one-a-day multivitamin/mineral formulas, especially in those designed for women. It’s also the amount that the American Dietetic Association notes can help lessen the risk of pre-term delivery, low birth weight, and fetal growth restriction. You may not even need an adult-only formula to match that goal (see chart). What’s key is that you take the vitamin every day.

During pregnancy, you also may need more iron and calcium; and since you probably won’t know you’re pregnant for the earliest weeks, it’s a good idea to start boosting your intake of both these minerals as soon as you start “trying.” For iron, the recommended intake for adult women is 18 mg per day, and that’s what you’ll find in most multivitamins. Pregnant women need more—27 mg daily—and that’s typically the threshold for prenatal formulas. And when it comes to calcium, even prescription supplements often don’t match up to the levels of calcium that nutrition experts recommend for women approaching childbearing, which is 1000 mg each day. That level of minerals makes the pills very big…too big to include in a multivitamin. Taking separate calcium supplements (or Tums, which have 200 mg each) is one option, as is taking an over-the-counter prenatal formula, which sometimes has more calcium (but less of other nutrients) than the prescription versions. And women should be sure to get plenty of calcium in their diets, from dairy products and leafy greens.

One thing NOT to do, however, is combine vitamin formulas, thinking that more is better. For instance, DON’T take a prenatal formula in addition to a standard multivitamin, or an OTC plus a prescription version; you could easily go beyond the levels of some of these nutrients considered safe by the National Academy of Sciences.

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And don’t be surprised if your body lets you know you’re taking the wrong formula—as I found out all too clearly after my doctor recommended a prescription prenatal formula when I told him I was going to try to become pregnant soon. That first month, I was sure I was pregnant. My typically impervious stomach was misbehaving like crazy—morning sickness, I thought. I was wrong. After several months of miscues, my pharmacist suspected that the high dose of iron in the prenatal vitamin pills was responsible for my queasy stomach. I got my doctor’s okay to switch to a brand with less of the mineral, taken before bedtime to lessen the reaction. I was surprised to learn that all prenatals, even the prescription offerings, aren’t alike.

“Prenatal vitamin-mineral products have not been approved as drugs by the Food and Drug Administration,” says Kimberly Rawlings, an F.D.A. spokesperson. That means the pills are treated as dietary supplements, which don’t require standardization. It also means that you can buy some brands without a prescription; the manufacturers choose how they want to sell their products. Some pills contain herbs, others have longer lists of vitamins and minerals, and there’s no consistency in the amount of each ingredient from brand to brand. And prescription versions may not vary much from a standard multivitamin.

Because the preparations can vary so much, it’s up to you to be informed: read the labels, talk to your doctor and pharmacist, and choose the best pill for you. The right one will depend on your diet (if you’re cutting back on carbs, for example, or aren’t very good at eating a variety of foods), your tolerance for different pills, and whether or not your insurance covers prescription pills (if it does, they may be the least expensive option). If you choose an over-the-counter brand, the March of Dimes recommends looking for “USP” on the label—that indicates that the vitamins have been given a stamp of approval from the U.S. Pharmacopeia, an organization that checks safety and quality.

If you have problems tolerating the vitamins for any reason, work with your doctor and keep trying until you find one that works for you. A friend of mine, when she was pregnant at 37, also had problems taking the vitamins her doctor prescribed. “I've never been able to swallow pills well, and I was so nauseous I kept throwing up when I tried to swallow the big prenatal vitamins,” she recalls. Comparing the contents of the prescription formula with regular vitamins, she found little difference. “My diet was pretty healthy, so with my doctor’s approval, I took Flintstone's Chewables throughout my pregnancy,” she says. Her pregnancy and her son, now 10, were perfectly healthy.

So if you take prescription pills and run out, take a multivitamin until you get your refill. For many women, as for me, the higher level of iron in prenatal vitamins can be tough to stomach. If you’re not anemic (a simple blood test can check), you might be able to skip the extra dose of iron, says Dr. Dolan. If you do need the iron but have digestive problems, you can treat constipation with a high-fiber diet, extra fluids, natural bulk laxatives such as Metamucil, or a stool softener such as Colace.The other ingredients in prenatal vitamins will vary considerably from one bottle to the next. Look over the labels carefully and discuss with your doctor whether or not you want to take herbs, such as the dandelion that’s in the Doctor’s Choice Prenatal Formula (for indigestion). And if you run into trouble swallowing pills, kid’s chewables are no longer the only choice. Now there are chewable and liquid forms of prenatal vitamins that didn’t exist 10 years ago when my friend was pregnant.

How The Pills Stack Up

The following chart shows the three vital ingredients for six brands of vitamins: two prescription prenatals, two over-the-counter prenatals and two multivitamins.

A version of this article originally appeared in the Winter 2005 issue of Conceive Magazine.

Related Topics: Boost Your Fertility; Fertility Health; Fertility Nutrition; Fertility Supplements; Fertility Tips