Best prenatal vitamins
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Best Prenatal Vitamins: A Comprehensive Review
Importance of Prenatal Vitamins
Prenatal vitamins are essential for the health of both the mother and the developing fetus. They provide necessary nutrients that might not be sufficiently obtained from diet alone. Key nutrients often included in prenatal vitamins are folic acid, iron, calcium, vitamin D, and docosahexaenoic acid (DHA).
Vitamin D Supplementation
Effects on Maternal and Neonatal Outcomes
Vitamin D supplementation during pregnancy has been extensively studied. Research indicates that while vitamin D increases maternal and cord serum concentrations of 25-hydroxyvitamin D, the dose-response effect is weak. It has been shown to increase mean birth weight and reduce the risk of small for gestational age births, but these findings are not robust across all studies1. Additionally, prenatal vitamin D supplementation has been linked to a reduced risk of offspring wheeze by age three1.
Impact on Infant Growth
Studies conducted in regions with common vitamin D deficiency, such as Bangladesh, have shown that maternal vitamin D supplementation from mid-pregnancy until birth or six months postpartum does not significantly improve fetal or infant growth2 3. Despite the expected effects on serum vitamin D and calcium concentrations, no significant differences were observed in infant length-for-age z scores or other anthropometric measures2 3.
Blood Glucose and Gestational Diabetes
For women with gestational diabetes mellitus (GDM), the choice of prenatal vitamins can impact blood glucose levels. Research has shown that all tested prenatal vitamins cause a rise in blood glucose greater than that seen with sucrose ingestion. Therefore, it is prudent to prescribe a prenatal vitamin with a low relative glycemic index (RGI) to manage glucose levels effectively4.
Pharmacist Recommendations and Nutrient Content
A survey of community pharmacists revealed that most recommend over-the-counter (OTC) prenatal vitamins, with folic acid being the most commonly identified essential ingredient5. However, a study evaluating commercially available prenatal vitamins found that none met the American College of Obstetricians and Gynecologists (ACOG) guidelines for all key nutrients, particularly calcium6. This highlights the need for more regulation and better formulation of prenatal vitamins to ensure they meet nutritional standards.
Prevention of Stunting and Allergic Outcomes
Vitamin D supplementation during pregnancy has been suggested to prevent stunting in children, although results are mixed. Some studies indicate no significant impact on neonatal body length or length-for-age z scores, while others show positive effects on various aspects of anthropometry7. Additionally, prenatal vitamin intake, including vitamins C, E, and D, has been associated with a reduced risk of allergic diseases in offspring8.
Mental Health Benefits
Prenatal micronutrient supplementation, including folic acid, phosphatidylcholine, and omega-3 fatty acids, has shown potential benefits for childhood emotional development and the prevention of mental illnesses such as schizophrenia and autism. These nutrients are crucial for fetal brain development and may help mitigate genetic and environmental risks9.
Conclusion
Choosing the best prenatal vitamin involves considering various factors, including the specific needs of the mother and the developing fetus. While vitamin D and other micronutrients play significant roles, it is essential to select a prenatal vitamin that provides a balanced mix of all necessary nutrients. Consulting healthcare providers and considering evidence-based recommendations can help ensure optimal maternal and fetal health outcomes.
Sources and full results
Most relevant research papers on this topic
Vitamin D supplementation during pregnancy: state of the evidence from a systematic review of randomised trials
Vitamin D supplementation during pregnancy may increase birth weight and reduce the risk of small for gestational age births, but current evidence is insufficient to guide clinical or policy recommendations.
Meta-Analysis
Very Rigorous Journal
Highly CitedVitamin D Supplementation in Pregnancy and Lactation and Infant Growth.
Prenatal and postpartum vitamin D supplementation significantly improves infant growth at 1 year, with the highest dose of 28,000 IU being optimal for both prenatal and postpartum use.
RCT
Rigorous JournalHighly CitedVitamin D supplementation in pregnancy and lactation to promote infant growth
Maternal vitamin D supplementation during pregnancy and lactation did not improve fetal or infant growth in a population with widespread prenatal vitamin D deficiency.
RCT
Large Human TrialRigorous JournalHighly CitedBlood glucose rise following prenatal vitamins in gestational diabetes.
Prenatal vitamins cause a greater rise in blood glucose than sucrose, suggesting a low-relative glycemic index prenatal vitamin is recommended for gestational diabetes patients.
RCTA "secret shopper" survey of community pharmacist prenatal vitamin recommendations.
Most community pharmacists recommend over-the-counter prenatal vitamins with adequate folic acid, but a clear recommendation on specific brands is crucial for patients.
Observational StudyCommercially Available Prenatal Vitamins Do Not Meet American College of Obstetricians and Gynecologists Nutritional Guidelines
Commercially available prenatal vitamins in the US do not meet all five key nutrients recommended by the American College of Obstetricians and Gynecologists, and cost does not correlate with compliance.
Observational StudyRigorous JournalSupplementation of Prenatal Vitamin D to Prevent Children’s Stunting: A Literature Review
Prenatal vitamin D supplementation during pregnancy effectively prevents children's stunting.
Systematic ReviewPrenatal Intake of Vitamins and Allergic Outcomes in the Offspring: A Systematic Review and Meta-analysis
Prenatal vitamin intake is associated with a reduced risk of allergic diseases in offspring.
Meta-AnalysisPrenatal Primary Prevention of Mental Illness by Micronutrient Supplements in Pregnancy.
Prenatal micronutrient supplements, such as folic acid and phosphatidylcholine, may improve childhood emotional development and decrease the risk of mental illnesses like schizophrenia and autism.
Systematic ReviewA Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women12
Multiple micronutrient supplements (MMNs) effectively increase maternal vitamin B-12 levels and maintain similar folate and folic acid concentrations compared to the standard 60-mg iron plus 400-g folic acid supplement in rural Bangladeshi women.
RCTLarge Human TrialVery Rigorous Journal