Prenatal supplements fall far short of providing proper nutrition during pregnancy – and many women don’t know it.

If there’s one thing doctors agree on, it’s that all their pregnant patients should take prenatal supplements. As a result, almost 3 out of 4 expectant mothers follow their doctor’s advice.

But while they are important for the health of mother and baby alike, prenatal supplements are not tested for safety and effectiveness in the same way that food and drug products are. There are no rules that require these supplements to contain any nutrients at all, let alone the appropriate amounts.

It is not surprising that studies show that none of the most popular supplements available over the counter prenatal – be it tablets, capsules, soft gels or gummies – provide adequate amounts of five essential nutrients: folic acid, iron, vitamin D, calcium and docosahexaenoic acid, a member of the omega-3 fatty acids family.

All of these nutrients are recommended by the American College of Obstetrics and Gynecologists, and getting enough is associated with better health outcomes for pregnant patients and their babies.

As a family medicine resident with a Ph.D. nutritionally, I started researching these products after my patients started asking questions about them. I found that many important nutrients needed during pregnancy were missing from these products. Meanwhile, some supplements had insufficient or excessive amounts.

Flat

Folate, which reduces the rate of birth defects by 50%, is the main reason behind the introduction of prenatal supplements.

But folate only prevents birth defects when taken before the 28th day of pregnancy. In other words, certain birth defects are only prevented if a woman takes prenatal medicine before she knows she is pregnant.

For this reason, the American College of Obstetrics and Gynecology recommends that women start taking birth control pills at least three months before pregnancy.

However, only a third of women do so – and only 10% of African American women. For them, an apartment meant to prevent birth defects comes too late.

Even women who take supplements before pregnancy may not be getting the nutrients they need. That includes 400 micrograms of folic acid – a synthetic form of folate – from their daily prenatal supplement. About 27% of birth control pills contain less than that amount.

On the other hand, although it is rare, it is not possible to find products that contain more than one milligram of folic acid – an amount that can be dangerous in relation to impaired mental development, especially -holo is reduced in words.

Omega-3 fatty acids

After their introduction in the 1980s as a simple multivitamin with added folic acid, prenatal supplements have evolved to provide an extra nutritional punch. One of those supplements, omega-3 fatty acids, act as building blocks for the construction of the baby’s brain. In fact, 40% of the human brain is made up of omega-3s.

Another study of rats showed that not eating enough omega-3 during pregnancy caused a significant decrease in the level of omega-3 in the mother’s brain. Although such a study cannot be done in humans, this suggests that mothers may be giving up omega-3s from their brains to support their baby’s brain development.

But other studies linking low omega-3 levels to postpartum depression, child psychology or other important outcomes have produced mixed results.

However, there appears to be a link between omega-3s and premature birth, with increased intake leading to a reduced risk. Preterm births – births less than 37 weeks’ gestation – are on the rise in the US and around the world, with more than 1 in 10 babies born prematurely.

The new guidelines recommend that pregnant women who do not regularly eat enough omega-3 fatty acids should get 600-1,000 milligrams of omega-3s daily. Studies have shown that this is almost impossible to find a supplement for pregnant women.

However, patients who eat fatty fish twice a week – this can be salmon, mackerel, herring, sardines or anchovies – may only need an additional 100-200 milligrams per day of omega-3 during pregnancy. And about 40% of commercial pregnancy supplements offer this amount.

But most Americans don’t eat two servings of oily fish each week. So 95% of pregnant and lactating women in America are not getting enough omega-3. Although many women avoid fish during pregnancy due to concerns about mercury, fatty fish rich in omega-3s are low in mercury and are not among the types of fish that should be avoided. avoid during pregnancy.

Choline

Choline is also important for the development of the baby’s brain. Its need increases during pregnancy to 450 milligrams per day, and more during lactation – 550 milligrams per day.

Other than organ meats, such as beef liver, few foods contain enough choline to meet that requirement. An egg contains about 150 milligrams of choline, a 3-ounce steak has 117, and a half cup of soybeans has 107. Salmon, broccoli, brussels sprouts, cauliflower, green peas and Kidney beans also contain some choline.

Because these are not high amounts, pregnant women need to eat more choline-rich foods each day, and may need a supplement to reach the recommended amount.

But apparently, almost no one does: 95% of pregnant women consume insufficient amounts of choline, and more than half of prenatal supplements do not contain choline. Those that offer them usually offer very little – less than 100 milligrams.

Additionally, some research suggests that consuming more choline than guidelines recommend may provide additional benefits.

One study showed that doubling the recommended amount in the third trimester of pregnancy may improve a child’s attention span. Another found that some of the effects of fetal alcohol syndrome can be reduced by four times the recommended amount of choline.

Solutions

These three examples clearly show that taking prenatal supplements does not guarantee a healthy pregnancy.

Part of the problem is a lack of education: Doctors are taught very little in medical school about nutrition, and I’ve noticed that many patients just assume they’re getting what they need from their pregnancy medications. .

Because there are no regulatory standards for these products, there is no incentive to improve them. No one is ordering these companies to change their approach, so it’s not important to them.

My goal here is not to disparage these products, but rather to show that they alone are not enough.

Finding the best supplement with the right amount of each nutrient – ​​not too much and not too little – is difficult, if not impossible. Even price is not an indication of quality.

To make sure they get enough of these nutrients, anyone who is pregnant, or planning to become pregnant, should do these three things:

1) Choose a prenatal supplement that contains no more and no less than 400 micrograms of folic acid daily, and take it three months before conception.

2) Eat two weekly servings of oily fish and consider taking a daily omega-3 fatty acid supplement of 100-200 milligrams. Or if you don’t normally eat oily fish, take a supplement with 600-1,000 milligrams.

3) Assess their current intake of foods containing choline, and if they are deficient, consider taking a choline supplement.

Finding the right nutrition during pregnancy takes a lot of effort, and it can feel like you’re alone.

I provide my patients with guidance to help them manage their nutritional needs during pregnancy. This can help provide the information needed to overcome the limitations of prenatal resources.

This article was updated on June 4, 2024, to clarify the US government’s limited role in regulating birth control pills.