The Ultimate Guide to Prenatal Multivitamins When Trying To Conceive

The million-dollar question in fertility conversations: What is the best prenatal multivitamin?! The prenatal multivitamin industry is confusing (to say the least!), with the sheer number of products and claims (often conflicting!) made by different companies. 

What’s more, if you’re trying to conceive and looking for a prenatal to support your fertility, you need slightly different ingredients and daily amounts than people who are already pregnant. It’s no wonder that most people end up feeling lost and overwhelmed.

We created a science-backed process for evaluating prenatal multivitamins when TTC, and we’re going to walk you through it. By the end, you’ll understand exactly how and why to make decisions about a prenatal multivitamin right for you. 

Before we dive in, the most important takeaway is this: The best prenatal supplement for you is one that you will take consistently. Even the best prenatal supplement won’t help if you don’t actually ingest it, so you always need to consider your budget, lifestyle, and preferences. 

PS. We don’t make supplements, so you can trust this guide is based on the latest fertility science — no slick marketing language here!

Most prenatal multivitamins are formulated based on estimated nutrient requirements during pregnancy. When we evaluate prenatal multivitamins from the lens of trying to conceive, we care about two things: 

• Nutrients that are important to support a healthy pregnancy – We want your body to enter pregnancy with sufficient amounts of these crucial nutrients. Think about it as “building your body’s stores” of nutrients that will help your baby grow and develop.

• Nutrients that can impact your fertility or egg quality – Research has shown that your body needs certain nutrients to fuel your reproductive system. While it’s great to get these in your diet, your prenatal acts as a “backup” to make sure you don’t have any critical nutrition gaps that might be limiting your fertility potential.

So how do we know what these nutrients are? We look at nationally established Recommended Daily Intake (RDA) levels, and dig further into the research to see if any nutrients really should be included in higher amounts than the RDA (the unfortunate reality is that population-based recommendations take time to catch up to research, so we’re not just accepting the status quo). 

There are nine nutrients that we’re most concerned with when it comes to picking a prenatal: 

• Folate

• Vitamin B12

• Vitamin B6

• Choline

• Vitamin D

• Vitamin A

• Iodine

• Iron

• DHA
  

How much of these nutrients should my prenatal have?

For each of these critical ingredients, here are the best-case scenario amounts we’d recommend based on latest fertility research.

That said, it’s hard to find a prenatal that perfectly meets these recommendations, so we’ve also listed a minimum amount – make sure your prenatal has at least that amount in it!

*We’re always on the lookout for new or reformulated products, and we’ve always got our eye on new research. 

** DFE stands for "Dietary Folate Equivalent." It's a unit used to measure the amount of folate in food and supplements. It takes into account that the body absorbs different forms of folate (ex. folic acid vs. methylfolate) differently. This helps standardize folate intake recommendations so you can worry less about the form and more about the amount your body is getting.

Folate is crucial in early conception to prevent neural tube defects, which is why there is strong public health messaging around the importance of taking folic acid for anyone who could become pregnant.

The US Preventive Services Task Force on Folic Acid Supplementation to Prevent Neural Tube Defects recommends that a supplement contain 400 to 800 mcg of folic acid (in line with other major medical and public health bodies).

Psst: Folic acid is the only form of folate shown to be effective in preventing fetal neural tube defects in randomized control trials and food fortification programs. The effectiveness of other forms (including 5-MTHF or methylfolate) in preventing fetal defects has not been studied, but theoretically should also be effective. We break down the hype around methylfolate here. 

A supplemental folic acid intake of 400 to 800 mcg is enough to reduce the risk of neural tube defects; however, it’s on the lower end of what some studies show can support fertility (1,2,3).

That’s why we recommend that prenatal multivitamins contain at least 800 mcg of folic acid. This equals 1330 mcg of dietary folate equivalents (DFEs), which is what you’ll see listed on a multivitamin label.

In early conception, vitamin B12 works alongside other B vitamins and choline to support brain and spinal cord development. Amongst people undergoing assisted reproduction, adequate vitamin B12 status may be associated with better embryo quality, improved embryonic growth and even higher chances of clinical pregnancy and live birth (the holy grail of outcomes!). 

Research suggests that vitamin B12 intakes higher than the RDA are likely necessary to adequately support vitamin B12 status in the body (1, 2). Vitamin B12 is well-tolerated at high doses and has no established upper intake level, so we recommend that products contain at least 10 mcg.

Vitamin B6 is involved in amino acid metabolism, red blood cell formation, and brain and spinal cord development in a developing baby. 

Unfortunately, accurate data on vitamin B6 are difficult to obtain because we don’t have a clear understanding of how levels of B6 biomarkers (specifically, plasma pyridoxal-5-phosphate) relate to clinical outcomes, and at which point levels are expected to have adverse impacts.  

What we do know is that vitamin B6 supplements are a crucial source of the vitamin (1, 2), and supplementation can greatly reduce the prevalence of deficiency. However, typical doses included in multivitamins may be too low to prevent a drop in maternal B6 levels in late pregnancy. 

For now, we’re confident recommending that products contain at least 5 mg of vitamin B6. 

Choline, along with the B vitamins, is a nutrient that contributes to preventing neural tube defects. During pregnancy, choline is critical for the development of your baby’s brain and spinal cord, and may be associated with long-term cognitive function (1, 2).

We’d love to see at least 450 mg of choline in prenatal multivitamins. However, given how bulky choline is as a nutrient, we understand that it’s not feasible for many products (at least for now, but we also trust that technology will catch up!). 

The next best option is a product that contains at least 150 mg. Typical population intake from food sources among women of reproductive age and pregnant women is approximately 300 mg per day (only 4% of the population consumes the recommended intake of choline!), so getting an extra 150 mg in your prenatal will bring you up to the 450 mg that we’re aiming for (1,2).

A significant amount of research time and dollars have been dedicated to finding causal associations between vitamin D and reproductive outcomes, but unfortunately, there are few clear conclusions. That said, what we do know is that vitamin D is involved in many crucial processes in the body (including reproduction!), and deficiency can negatively impact fertility potential.

We don’t like taking chances – since vitamin D deficiency and insufficiency are common among the US population, and typical intake is low, we recommend a minimum of 20 mcg (800 IU) in your prenatal multivitamin. This will help ensure you enter conception with adequate vitamin D levels.

If you live in a colder climate, have darker skin or spend little time outside, then a supplement with 50 mcg (2000 IU) is likely a better choice for you.vitamin D deficiency and insufficiency are commontypical intake is low

Vitamin A is involved in egg production, meiosis (cell division), embryo formation, early fetal development and optimal placental function — a lot of important stuff (1, 2)! Vitamin A comes from foods like green leafy vegetables, orange and yellow vegetables, liver, fish and egg yolks, and deficiency at harmful levels in the US is rare. However, approximately 50% of women of childbearing age have a vitamin A intake lower than recommended. 

Unfortunately, the RDA for vitamin A is not derived from solid data. We would love to see more research on vitamin A requirements in preconception and pregnancy, but for now, we recommend that prenatal supplements contain at least 1200 mcg of vitamin A. 

Ideally, we would like to see prenatal multivitamins with a source of preformed vitamin A (retinol or retinyl esters), as it has the highest bioavailability. Many supplements contain carotenoids (precursor molecules to preformed vitamin A), which still provide an important source of vitamin A, but research suggests that their absorption is highly variable among individuals.  

Vitamin A is a fat-soluble vitamin (meaning that excess amounts are stored in fat tissue), so there are potential harms related to excessive intake. Supplements should not contain more than 3000 mcg of preformed vitamin A (this applies only to preformed vitamin A, not carotenoids). 

Iodine is crucial during pregnancy because of its relationship to the thyroid, which impacts fetal brain development. But early research also suggests that iodine might matter in the preconception period, and a low intake may be associated with reduced fertility (1, 2). 

While severe iodine deficiency is rare in North America, recent research has identified areas with a rising prevalence of sub-clinical iodine deficiencies. This is thought to be due to several factors, including public health messaging around salt and dairy intake (two major sources of iodine intake), switching to non-iodized salt for home use (such as sea salt instead of iodized table salt) and increased consumption of processed foods, which often do not utilize iodized salt in their products. 

We recommend that prenatal supplements contain 220 mcg of iodine. 

Iron is crucial during pregnancy to prevent maternal anemia. While research has not consistently related iron to fertility, we want you to enter conception with adequate iron levels and stores. Supplemental iron requirements are highly individual and largely dependent on diet and genetics. 

We recommend that prenatal multivitamins contain the full non-pregnant RDA of 18 mg. This is ideal in the preconception period to help ensure you conceive with adequate iron stores. 

If you know your iron levels are adequate and you have a high-iron diet (for example, you regularly consume red meat, poultry and fish), you may choose a product with lower or no iron. On the flip side, if you follow a plant-based diet or know you have lower iron levels, a product with higher iron will be more appropriate. Since many products are designed for pregnancy, when iron requirements increase to 27 mg/day, there are many options with higher levels. If you already take an iron supplement, consult with your doctor about the iron dose that is right for you. 

Tip: Iron can cause constipation. If you are experiencing gastrointestinal issues from iron supplements, speak to your doctor to get your levels tested to determine how much iron you really need. Iron requirements really shoot up during the second trimester of pregnancy, so you may be able to avoid some unnecessary discomfort in the preconception period. 

DHA is an omega-3 fatty acid associated with many positive fertility- and pregnancy-related outcomes, including increased probability of natural conception, and improved embryo morphology, clinical pregnancy, and live birth rates among individuals undergoing assisted reproduction. 

DHA is often included in prenatals, but like choline, it’s a bulky nutrient and difficult to get the amount you need in a prenatal alone. We love to see products with 200-500 mg DHA, but at the end of the day, even this amount is lower than evidence shows can increase fertility potential. So we typically recommend a separate DHA supplement while TTC to Doveras members.

Putting giant doses of certain vitamins into prenatal supplements has become a bit trendy. But, there are a few things to be aware of: 

• You can’t out-supplement a poor diet, even with mega doses. Prenatal multivitamins are an insurance policy, not the main event. Instead of trying to “fix” deficiencies with a ton of supplements, look to dietary changes instead to get the nutrients you need.

• Mega doses are often provided for water-soluble vitamins, such as vitamin B12 and vitamin B6. While these doses are likely safe, the body will rapidly excrete the excess vitamins in urine (AKA expensive pee!). 

• Your physician should guide you on whether a mega dose of a vitamin is necessary. For example, there are cases when a physician would recommend very high doses of folic acid; in other cases, those doses could be potentially harmful. 

• Brands that include mega doses often make claims about the health benefits of these high doses. However, we do not have robust research on any of these mega doses just yet, and it’s unlikely that doses 100s of times higher than the estimated requirements would be beneficial. 

Be a savvy consumer – if a supplement company makes a claim that sounds too good to be true, it probably is! 

Is A Prenatal Capsule Better Than Powders?
Like we said at the beginning, the best form for your prenatal is going to be the one that you will take consistently. If capsules or tablets don’t work for you, then a powder might be the way to go. If you’re better with routine, then daily capsules or tablets with a meal might make more sense for you. 

With capsules and tablets, you can typically expect to take 2-4 pills per day for a high-quality product that contains the nutrients you need. 

Are Gummy Prenatal Vitamins Good?

The only caution we have is with gummies – it’s difficult to get all the nutrients that we recommend in a gummy form. If you’re struggling with tolerating capsules or tablets, we’d recommend looking at powdered products before gummies.  

Phew, we know it’s a lot of information. But, now let’s get you on a great prenatal. If you already have a prenatal, look at the ingredient label and see how it stacks up against our “best case” and “we’ll take it” scenarios above. 

If you are picking out a new prenatal, compare our scenarios to the brand options you’re considering. Remember, fancy branding and expensive prices are not always the best options. The rise in designer prenatals has ballooned the price of prenatals, but there are great options for less than $40/month. If a brand is trying to charge you more than $70/month, we’d suggest looking elsewhere because you’re likely paying up for sleek marketing.

Still need more help? We’re here for you, and you’re not alone. Over 89% of our members share that finding a prenatal to support their fertility is challenging. 

All of our members get matched with a prenatal brand right for them. Our “Prenatal Matchmaker Quiz” is a member favorite: share your price point, nutrition gaps, pill count, and dietary preferences, and we will share the best prenatal options for you on the market. 

These recommendations are based on our review of over 60 products (and counting!). We looked beyond (well beyond!) the surface-level marketing claims and scrutinized products to make recommendations that we feel confident standing behind. 

As always, we’re all about putting unbiased fertility science in your hands so you can make informed decisions to support your fertility.