Sceptical of prenatal vitamins. Do I really have to take them?

January 10, 2011 6:57 PM

Prenatal vitamins - aside from folic acid, is supplementation really necessary given healthy nutrition and lifestyle?

I am currently in my first trimester of pregnancy (thus the anonymous question...) and gather that supplementation with prenatal vitamins is recommended in the US. I live in the US, but am originally from Germany, where prenatal vitamin supplementation is not common; pregnant/TTC women usually only take folic acid.
I have taken folic acid since TTC and continue to do so; I have not taken a complete prenatal vitamin though. I understand that folic acid is crucial for warding off neural tube defects. But the evidence for other supplementation routines seems sketchy or non-existent. Is it really medically necessary for me to take a "complete" prenatal vitamin combination instead of just folic acid?

Everything I can find online basically says that since there's "no risk" in taking a prenatal vitamins, one should do it "just to be on the safe side" (this is also the stance of my OB/GYN). I am extremely sceptical of this type of pregnancy advice and find it rather condescending, to be honest. Aside from possible side effects and cost, I would prefer to make my own risk assessment, and generally I'd rather only take stuff that is positively proven, or at least assumed with some empirical evidence, to be advantageous given my personal circumstances (healthy, early 30s, varied nutrition that complies with all recommendations, healthy lifestyle and no risk factors like drinking or smoking).
I am under medical supervision and assume that, should a deficiency crop up, I could still supplement (e.g. iron later in pregnancy), and of course I would not subject to supplementation then.

tl;dr - Aside from folic acid, and given a good diet and generally healthy constitution/lifestyle, is there positive empirical evidence for the advantageousness of prenatal vitamin supplementation? I'm not really interested in personal pregnancy anecdotes, please aim for the hard facts. I have searched Google Scholar, but was not very successful... Thanks in advance!

posted by anonymous to health & fitness (22 answers total)

If I recall correctly, pregnancy predisposes you to anemia, so the iron in the prenatal vitamin is important too.

The folic acid is the really important thing, though.
posted by gaspode at 7:05 PM on January 10, 2011

Actually, folic acid is actually most important *before* pregnancy and during the the first trimester and really the first month. The CDC recommends it throughout your whole pregnancy, but we Americans tend to be extra cautious about these sorts of things, as you know.
posted by bluedaisy at 7:12 PM on January 10, 2011

If you don't get enough calcium during pregnancy, your body may pull it out of your bones, which can lead to osteoporosis later in life. Source.
posted by limeonaire at 7:15 PM on January 10, 2011

For me, it was the iron that I needed. I ended up having to take supplements (Bifera) on top of my prenatals because I was slightly anemic during my entire pregnancy.
posted by Leezie at 7:16 PM on January 10, 2011

(Also, given that this is a mostly American website, I doubt you're going to find many responses here supporting your idea not to take supplements. You might try searching British ob-gyn sites, or German.)
posted by bluedaisy at 7:16 PM on January 10, 2011

I've had similar thoughts during my pregnancy. I can't attest to the positive effects of supplements other than folic acid, but I learned early on that a regular women's multivitamin has all the essential vitamins that prenatal vitamins do. At a small fraction of the cost. Before I started trying to conceive, I had a discussion with my doctor about this. She asked if I was taking prenatals, I said no, but I take a women's daily multivitamin, and her response was, "yeah, it's the same thing."

I've compared the ingredient lists on my vitamins versus prenatals, and I haven't been able to see any substantive difference in their composition.
posted by Tooty McTootsalot at 7:19 PM on January 10, 2011

Although, if you have FSA dollars to spend, Prenatals qualify for the program and regular vitamins do not, as far as I can tell. So if that matters to you, just get the prenatal ones.
posted by Medieval Maven at 7:25 PM on January 10, 2011

anecdata: i stopped taking prenatals once i got out of my first trimester, because they caused me serious GI issues and my midwife said they weren't necessary as long as i ate a varied and nutritious diet. (i am in the united states.) my kid is three months old and perfectly fine.
posted by woodvine at 7:36 PM on January 10, 2011

Prenatals made my already bad nausea worse. With the midwive's blessing, I stopped taking them before the end of my first trimester and substituted a children's vitamin instead.
posted by theBigRedKittyPurrs at 8:14 PM on January 10, 2011

My US midwife advised me to only take folic acid and calcium, rather than a prenatal vitamin. (And the calcium had to be calcium citrate or calcium lactate, not calcium carbonate, for absorption reasons.)
posted by xo at 8:30 PM on January 10, 2011

I was unable to tolerate prenatal vitamins, and instead my midwife suggested I try to eat two bowls of Total Cereal each day, and take a children's chewable vitamin, if I thought I could keep it down.

I had a lot of problems keeping food down through 20-ish weeks; my midwife felt that it was important to take some kind of supplement at least until I could keep more than a very limited number of foods in my digestive system.
posted by anastasiav at 9:03 PM on January 10, 2011

Unless you are eating locally grown fresh food, chances are most of your produce was picked a long time ago, shipped across the continent, and stored for a while before it was displayed in the grocery store. Then you bought it, and it may have sat in your refrigerator for several days before you ate it. A lot of the nutrition has deteriorated by then. Unless you are eating entire animals - skin, bones, stomach contents, etc. - you are not getting the full, varied nutritional value that your body was designed to obtain from animals. If you are vegetarian/vegan, then you are most likely not getting everything your baby needs if you aren't supplementing. (Note:I'm not criticizing. I have been a vegetarian since 1980. I took prenatal vitamins faithfully.)

Basically, current society's lifestyle and food production methods mean that most of the nutrition is gone from our food before we eat it. You only have one chance to build a healthy baby; why risk it? Why not take every precaution to make sure your developing baby has absolutely everything it needs?
posted by MexicanYenta at 9:10 PM on January 10, 2011 [1 favorite]

I had folic acid and vitamin D due to being deficient in the latter. This was okayed by my ob. - although he couched it as the lesser option. Mostly due to morning sickness + comorbid vitaming issues with the D thing.
posted by geek anachronism at 9:13 PM on January 10, 2011

I'm in the first trimester too and my Doctor told me that as long as I was taking folate and my iron levels were ok, that was all I needed to worry about.

(My understanding is the fetus will strip out the nutrients from your body it needs and any deficiencies that may, however unlikely, develop will most likely be in YOU and not the fetus - ie, anaemia.)

However, while I'm generally anti-supplementation as well - I eat a very healthy diet generally - morning sickness robbed me of my will to eat anything but bread, cheese, eggs and weetbix.

This is basically my concern now, that I am not getting enough nutrients from my now rather restricted diet, and with my nausea worsening as I enter my sixth week of pregnancy, I've decided to start taking a pregnancy multi-vitamin instead.
posted by jasperella at 11:53 PM on January 10, 2011

I completely understand your worry about unnecessary vitamins. Folic acid in late pregnancy has been tied to an increase in asthma recently!?!

In addition to watching out for the vitamins listed by others above, I would also check out DHA supplements. Many prenatals don't have them, but the research seems decent about needing them (and not getting enough when pregnant because it's generally found in organ meats and fish--foods pregnant women avoid).
posted by Kronur at 2:13 AM on January 11, 2011

I have issues with Vitamin D, calcium, and iron, so prenatals were a must for me throughout my entire pregnancy because my vitamin d and iron levels are lower than normal, even with a healthy diet, and because I couldn't tolerate much dairy in the first trimester, I needed calcium.

My sister had hyperemesis throughout her pregnancy that her doctor took her off the prenatals because it was making that worse. She did put her on the Flinstone kids vitamins, which had everything she needed but the iron.
posted by zizzle at 6:43 AM on January 11, 2011

You probably get good nutrition in your diet. Once past the folate requirement, they are not like necessary. Take one every couple of days if you want to split the difference.
posted by theora55 at 9:01 AM on January 11, 2011

If your tests find you anemic, then iron. Your blood volume increases so much during pregnancy and you need the extra iron. This helps with fatigue and shortness of breath during pregnancy, and protects you when you lose blood during delivery. I very nearly needed a blood transfusion when I had some mid-pregnancy bleeding (rare circumstances) because I was so low on iron. For many women, their multivitamin is sufficient, but I take an additional supplement. YMMV.
posted by Knowyournuts at 9:42 AM on January 11, 2011

Oh, sorry, I just reread that you said no personal anecdotes. Look at me, rushing to talk about myself. Just facts. To clarify, your blood volume will start increasing right away, while building up an adequate iron supply takes months. This is according to my OB. So if there's any doubt about your dietary iron intake, start supplementing right away rather than toward the end of your pregnancy, which could be too late to facilitate a real increase. You probably won't have the mid-pregnancy bleed like I did, or deliver prematurely, but better safe than sorry.
posted by Knowyournuts at 9:49 AM on January 11, 2011

1: Goh YI, Bollano E, Einarson TR, Koren G. Prenatal multivitamin supplementation
and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can. 2006
Aug;28(8):680-9. Review. PubMed PMID: 17022907.


Yes, prenatal multivitamins help, not just folic acid.
posted by the young rope-rider at 12:25 PM on January 11, 2011

One of the bigger worries about parents who don't load up on the vitamins (specifically folic acid/folates) is a much higher incidence rate of Spina Bifida, which is a really tough, painful thing to have to live with. Some cases are severe enough that walking is an impossibility.

It's the sort of thing where if you *know* you can have a hand in preventing it, you really want to.
posted by Citrus at 1:46 PM on January 11, 2011

(this is also the stance of my OB/GYN). I am extremely sceptical of this type of pregnancy advice and find it rather condescending, to be honest.

In my case they were cheaper because they were five dollars a month, rather than buying assorted other vitamins all the time. But I agree with your general point and that the many of the policies of US governing bodies of pregnancy (I forget the acronym) are pretty condescending overall.

Never got so much finger wagglin' in all my life.
posted by A Terrible Llama at 6:35 PM on January 11, 2011