Updated: 06.22.26 The PA Sisters

Vitamins and minerals found in prenatal vitamins, and what they do

If you were to look on the back of a prenatal vitamin, there is a core group of vitamins and minerals that are generally included across the board. Those vitamins include:

1. Vitamin A²: Helps with formation of the heart, lungs, and the eyes.
   • Two forms: retinol and carotenoids
     • Retinol is found in eggs, fish, meat, dairy products (animal products). Beef liver, sweet potato, and spinach have some of the highest levels.
     • Beta carotenoids are found in vegetables and leafy greens
       • There are certain carotenoids you might see in a prenatal at the bottom of the ingredients list: lutein and zeaxanthin. These do not convert into Vitamin A, but are essential for reducing eye damage by filtering blue light that can damage the retina of the eye.
   • One of the fat soluble vitamins — meaning it is absorbed by the intestines and stored (stored in the liver), and is more easily absorbed by consumption with other fats. Because they are stored, they can lead to toxicities if consumed in excess.
     • You would have to consume very large amounts of this vitamin to cause a toxicity (>100x the recommended amount). It is recommended to take no more than 3,000 mcg RAE, but please ask your healthcare provider if you have more questions about dosage.
2. B vitamins¹:

3. Vitamin C³: Helps create other essential compounds, needed to absorb iron, and supports the immune system

• Serves as a cofactor (meaning that it is used to help convert another compound to another by binding to an enzyme (protein that helps break down something)) to form collagen.
• Cannot be made in the body, so this vitamin must be solely absorbed through food
  • Green leafy vegetables and fruits (i.e., oranges, lemons, etc.)
• “Stabilizes vitamin E and folic acid”
• Antioxidant (meaning this vitamin protects the body against molecules that cause stress and damage to our cells).

4. Vitamin D⁴: Helps maintain bone density by helping the absorption and balancing levels of Calcium, bone remodeling and formation, prevents muscle spasms, and reduces inflammation

• One of the fat soluble vitamins — meaning it is absorbed by the intestines and stored (stored in the liver), and is more easily absorbed by consumption with other fats. Because they are stored, they can lead to toxicities if consumed in excess.
• Can be found naturally in foods, but can also be synthesized by UV rays coming into contact with our skin
  • Fatty fish, beef liver, eggs, cheese, and milk

5. Vitamin E⁵: Antioxidant that helps prevent cell damage, supports our immune system, and our skin health

• Active form is called α-tocopherol
• One of the fat soluble vitamins — meaning it is absorbed by the intestines and stored (stored in the liver), and is more easily absorbed by consumption with other fats. Because they are stored, they can lead to toxicities if consumed in excess.
• Found in nuts, leafy green vegetables, avocados, seeds
• Can increase the risk of bleeding if concurrently on a blood thinner (typically only high doses)
• Can play a role in helping fertility in women with PMOS. See our blog on PMOS.

6. Vitamin K⁶: Well known for its role in the clotting cascade to produce a clot to stop bleeding

• Has four forms, but two often are found in supplements, and those are K1 and K2
  • K1 is found in plants, has a low bioavailability
  • K2 is produced from bacteria with most sources from dairy products, like fermented cheese or vegetables like sauerkraut
    • more easily absorbed, which is potentially due to its presence with fats
• Can potentially play a role in decreasing calcification of arteries, which can decrease risk of cardiovascular disease
• One of the fat soluble vitamins — meaning it is absorbed by the intestines and stored (stored in the liver), and is more easily absorbed by consumption with other fats. Because they are stored, they can lead to toxicities if consumed in excess.

7. Iodine⁷: Used by the thyroid gland to produce thyroid hormones, such as T4 and T3 which overall regulate our ~homeostasis~ (heart rate, metabolism, energy to our cells, etc.). Therefore, this vitamin is essential for the development of a fetus and their body’s regulation.

• Well-absorbed in the gut, greater than 90% absorption rate
  • soybean flour can inhibit absorption

• May play a positive role in fibrocystic breast disease

8. Choline⁸: Its main functions are to support cholinergic functions and our cell membrane

• Forms:
  • Alpha-GPC
  • Citicoline
  • Phosphatidylcholine (PC) – great absorption, has a different dosing standard than other supplement forms
  • Choline Bitartrate – found in supplements
  • Choline chloride – found in supplements
  • Betaine

• Cholinergic? This is a type of transmission pathway in our parasympathetic nervous system (commonly known as the “rest and digest” system, in contrast to the “fight or flight” sympathetic nervous system). Our neurons (transmission of cell signals to our organs to tell them what to do) involved in this system have receptors for cholinergic effects that receive a neurotransmitter (the signal chemical) called acetylcholine. Acetylcholine utilizes choline for its synthesis.
  • “Choline” found in Acetylcholine and cholinergic – makes sense!
• Supports the formation of phospholipids (these are types of molecules) that create the cell membrane.
• Key for brain (including memory development), liver, and muscle health in the growing fetus
• Found in eggs, chicken, beef, and dairy products

9. Magnesium⁹: Effects on our muscle health, energy supply

• Forms
  • Organic: better bioavailability and absorption
    • Glycinate – better for sensitive tummy, good benefits for anxiety and sleep
    • Citrate – great water-solubility, meaning it has an effective absorption. Used as a gentle laxative.
    • Malate – energy and muscle support
    • Lactate – absorbed well, also known to help with sensitive tummy
    • Taurate – combined with taurine (good for the cardiovascular system) to promote good heart health
    • Aspartate – used in vitamins, good absorption
  • Inorganic: decreased bioavailability and absorption
    • Oxide – not absorbed well, but commonly found in vitamins over-the-counter. Has decent laxative effects.
    • Sulfate – known as Epsom salt, can cause decreased blood pressure and has a laxative effect
    • Chloride – relaxes the muscles
    • Carbonate – antacid
  • Citrate and glycinate are considered best tolerated for tummy, absorption, and effects.
• Stored in our bones and muscles and other tissues
• In leafy greens, whole grains, bananas, nuts, black beans, avocados, bone broth, some herbs²⁶

10. Calcium¹⁰: Key vitamin needed for our bones and teeth, helps with muscle function, blood vessel contraction/dilation, and many more.

• Needs vitamin D to be absorbed
• Dairy products – milk, cheese, yogurt, etc.
• May play a role in reducing preeclampsia
• Very high levels can increase risk of kidney stones

If you were reading the above and thinking, “Wow, vitamin D, calcium, and magnesium seem to be connected and have similar functions,” you would be correct. A quick summary of Vitamin D, Calcium, and Magnesium:

11. Omega-3¹¹: Key for fetal eye and brain health²⁰, decreases inflammation

• Forms
  • EPA
  • DHA – concentrations are obtained by mom’s intake in her diet.
• Must be consumed in our diet in order to be absorbed and used effectively by the body.
  • Found in seafood (limited to 2 servings per week according to USDA)
    • See types of seafood that poses a greater risk of mercury toxicity
• May play a role in decreasing risk of allergies in infants who are breastfeeding from mothers consuming omega-3 supplementation while lactating.

12. Iron^12,13: Vitamin that is a part of hemoglobin, which is the molecule that binds oxygen on our red blood cells. Also helps with cell functions and supports muscle/connective tissue.

• Forms
  • Heme – in meat, seafood, lean meats
  • Nonheme – in plants, meat, nuts, legumes, fortified cereals and breads
• Can be better absorbed with Vitamin C
• Supplemental forms
  • Ferrous fumarate – high absorption but harsh on GI system
  • Ferrous sulfate – most commonly used in supplements, since well absorbed
  • Ferrous gluconate – contains less elemental iron but gentler on the GI system
  • Ferrous bisglycinate – gentle on the stomach, well absorbed
• Stored in different forms in the body to be used for later
  • Ferritin
  • Hemosiderin
• Deficiencies could lead to certain neurodevelopmental outcomes in infants (i.e., ADHD, ASD, etc.)

13. Zinc¹⁴: Plays a role in immunity, wound healing, and treatment for diarrhea

• Must be consumed from diet
  • Found in meats and seafood
• Role in prevention of metabolic syndrome (syndrome that involves increased blood pressure, cholesterol, glucose levels, and excess weight in the belly)
• Great resource when fighting common colds

As you can see, many of these vitamins are intertwined. By no means do you need to memorize the below figure! But it is helpful to appreciate just how complex these processes are, and how they are essential for our body to function.

Other ingredients that can be in prenatal vitamins include:

1. Selenium
2. Copper
3. Manganese
4. Chromium
5. Boron
6. Molybdenum
7. Inositol
8. L-carnitine
9. Probiotics
   • Lactobacillus species

Evidence-based recommendations on prenatal vitamins

But what does some of the most robust evidence say? What nutrients are essential?

• Let’s first look at resources from OBGYNs, dietitians, and health organizations. The table below highlights the recommended intake from the National Institutes of Health (NIH), American College of Obstetricians & Gynecologists (ACOG), and the American Pregnancy Association (APA). Also stated is the Tolerable Upper Intake Levels in pregnancy, in order to compare to recommended guidelines.

• As you can see from above, most of the recommended vitamin and mineral amounts are similar when comparing national health organizations. For example, the ACOG recommendations are similar to that of the APA. Most of these align with the Recommended Dietary Allowance (RDA) created by the Food & Nutrition Board (FNB). The RDAs are estimated upon a value that meets the requirements of 97% of healthy individuals in the group (groups being nonpregnant/nonlactating, pregnant (14-18 y.o.), pregnant (19-30 y.o.), and pregnant (31-50 y.o.).¹⁵

• In the last several years, more research has been published regarding prenatal vitamins and minerals. Here are some of the major points of a few articles:
  • Women are at risk of not obtaining all the nutrients they need for a healthy pregnancy with just diet alone.^18,20 This is where the prenatal vitamin comes in. It acts as a supplement to where the bulk of where our nutrients come from – our diet.
  • Studying necessary dosage needed for each vitamin and mineral is difficult. For example, women with a history of a condition in pregnancy or an infant with a congenital issue have different vitamin needs in pregnancy based on their history.¹⁸ Therefore, dosages are not always a one-size-fits-all.
  • Many prenatal vitamins contain vitamins and minerals that exceed the Tolerable Upper Limit.¹⁸
    • But as you will find below, several health professionals (dietitians in particular) argue that the RDA levels are not high enough to meet the requirements needed in pregnancy.
    • Deficiencies in folic acid, vitamin D, iron, omega-3, and calcium can lead to poor outcomes in mom and in baby.²⁰
    • In a study observing 48 prenatal vitamins (PNVs), none met the requirements outlined by ACOG when observing calcium, iron, omega-3, vitamin D, and folic acid. Concerningly, 25% of the prenatal vitamins reviewed did not meet folic acid intake. Folic acid is needed to prevent neural tube defects (i.e., Spina Bifida). Four prenatal vitamins met 4 key nutrients (iron, omega-3, vitamin D, and folic acid), and those included Horbaach Women’s Prenatal Multivitamin, One A Day Multivitamin Complete Advanced Prenatal, Nature Made Prenatal All-in-One Softgel, Theranatal One Prenatal Vitamin, Walgreens Prenatal Multivitamin Softgels, and Zahler Prenatal Vitamin with DHA + Folate.²⁰
      • However, this study does not include all prenatal vitamins out there. Some do come close to the recommended amounts. We have a spreadsheet below comparing many common prenatal vitamins.
    • In a longitudinal study, vitamin supplementation was observed in preconception, pregnancy, and postpartum periods. There were two groups: standard vitamin or enhanced vitamin (extra minerals). In the control group (taking the standard vitamin), they found that vitamins B2, B12, and B6 decreased throughout pregnancy and Vitamin D stayed the same. In the intervention group (enhanced prenatal), vitamin levels were higher than the control group.²¹
    • Prenatal vitamins that are more dense with nutrients have indicated more positive outcomes in infants, even up to 6 months after birth (measured by head circumference, weight, and length).²²
• Studies on individual vitamin amounts:
  • Choline supplementation can reduce the risk of poor maternal and fetal outcomes. 89% of women do not get enough choline.¹⁹ It was found to be the most under supplemented vitamin in one study.²⁰
  • In a randomized controlled trial, women in the second half of their pregnancy were asked to take 480 mg or 930 mg of choline. 7 years later, their offspring were asked to take several tests to analyze aspects of their cognition. They found that the women who consumed 930 mg had children with better sustained attention.³³
    • One major limitation to this study is that the total group of women in the study was 20, which is relatively small.
  • Vitamin A can contribute to fewer neonatal defects, decrease risk of preterm birth and anemia, and increases in neonatal weight. No side effects were reported up to 4000 mcg.²⁸
  • A randomized controlled trial observed the outcomes in women with singleton pregnancies (1 baby) taking three different amounts of vitamin D (400 IU, 2000 IU, or 4000 IU). Vitamin D sufficiency was determined by looking at the concentrations of vitamin D (<80 nmol/L) and some of its downstream metabolites at 1 month from delivery and at delivery. They found that 4000 IU was most effective at maintaining sufficient vitamin D levels.²⁹
  • 70 randomized controlled trials were observed and found that women who took Omega-3 were at a lower risk of preterm birth and possibly lower rates of preeclampsia.³⁰
  • Women who consumed higher doses of Omega-3 (specifically 1000 mg in this study) had a reduced rate of early preterm birth (EPB), which is defined as birth prior to 34 weeks.³¹
  • In a randomized controlled trial, women who took a DHA supplement of 600 mg in the last half of their pregnancy had a longer pregnancy (gestation duration), increased infant weights, and fewer preterm births.³²
• Almost all prenatal vitamins do not meet the recommended requirements. However, it is possible to meet the recommended amounts through diet and additional supplementation.¹⁶
  • Additional supplements/dietary intake?
    • 1. Calcium – High levels can be found in dairy products, tofu, and other greens. See this article for more recommendations. Recommended daily value is 1000 mg.
    • 2. Choline – Can take an extra supplement (see our supplements page for some recommendations) or increase in dietary intake (i.e., eggs, Brussels sprouts, meats). Recommended daily value in pregnancy is 450 mg.
    • 3. Iron – Some prenatal vitamins do not contain iron. This may actually help increase absorption, reduce GI upset, and choose levels based upon your needs. Can be taken in a separate supplement, although some prenatal vitamins do contain iron. See our supplement page.
    • 4. Magnesium – Occasionally low compared to recommended amounts of 350-400 mg. Most contain 50-300 mg. Can be obtained through diet (see examples of magnesium rich foods here) or supplementation (see our supplement page).
    • 5. Omega-3 – Omega-3 is a bulky fat. They are sometimes included in a prenatal, but to get the recommended amount you need (200-600 mg DHA), you may need to take it separately.
    • 6. Vitamin D– Most prenatals contain at least 600 IU of vitamin D. But if they do not it is recommended to take this separately to meet the recommended doses. Vitamin D can also be found in eggs, fatty fish, and fortified foods like cereals and milk.

Other types of evidence and expert opinions: their recommendations

There are differing levels of evidence-based information. The most reliable, sound evidence, also known as filtered evidence, is typically composed of meta-analyses or systemic reviews. These researched topics have been tested under intensive regulations and criteria, and have been reviewed by experts in the field.¹⁷ For example, how the study is designed (best being a systemic review, meta analysis, and randomized controlled trial), the quality of the study (high sample numbers, good reporting), biases, and the objective interpretation of the evidence can provide sound evidence.

But what about articles that research prenatals, but are not as described above, but are other types of evidence? Evidence such as case-studies, narratives, or opinion-based articles make excellent points and arguments. They are known as unfiltered evidence. These types of evidence do not provide the same amount of confidence when the data is intended to be used for clinical-decision making.¹⁷ However, there are many physicians, dietitians, and other health care providers that have written on the subject of prenatal vitamins in some of these formats. They can serve as a foundation and basis for future filtered evidence to form.

Here are a few examples below and their major points:

1. Evidence-Based Recommendations for an Optimal Prenatal Supplement for Women in the U.S.: Vitamins & Minerals²⁴
   • Recommended higher doses of:
     • Vitamins: vitamin A (1.2 mg preformed vitamin A, 1 mg of carotenoids), vitamin C (200 mg), vitamin D (2000 IU), DHA (600 mg), thiamin (6 mg), vitamin B2 (2 mg), niacin (35 mg), vitamin B5 (10 mg), biotin (100 mcg), B12 (25 mcg), and choline (350 mg the first two trimesters, 600 mg the third trimester), and the addition of inositol (500 mg).
     • Minerals: chromium (100 mg), iron (30 mg first trimester, and 60 mg for second and third trimesters), and zinc (30 mg)
   • Recommended lower doses of:
     • Vitamins: folate (400 mcg, 680 DFE).
     • Minerals: calcium (550 mg), iodine (150 mcg), manganese (1 mg), molybdenum (25 mcg)
   • One major limitation of this study is that it did not include food intake into account, nor the Tolerable Upper Intake. Some of the recommendations greatly exceed the recommendations by the RDA.¹⁸ However, it does highlight, as reiterated multiple times in this article, that many prenatal vitamins often do not meet necessary minimum requirements.
2. Dietary Supplements in the Perinatal Period²³
   • Most prenatal vitamins contain ~800 mcg of folic acid.
   • Calcium interferes with iron absorption. Best to take them separately if possible.
   • Prenatal supplements should ideally be started about 2-3 months prior to pregnancy.
   • Mothers with a previous history of specific conditions, such as those that can lead to poor absorption (i.e., inflammatory bowel disease, history of bariatric surgery) or require more nutrients (iron deficiency, multiple gestation) require more amounts of certain vitamins or minerals in a supplement.
3. Real Food for Pregnancy by Lily Nichols²⁶
   • I included Lily Nichols’s book in this blog page as a source of expert opinion. At least in my personal opinion, she is a great resource. I would highly recommend her books for fertility, pregnancy, or postpartum.
   • She emphasizes that above all nutrients from “Real Food” should be the foundation for healthy pregnancy nutrition. I discuss this more below.
   • She does note that prenatal vitamins are helpful as most nutrient needs cannot be achieved through diet alone.
   • I’ll note just a few of her points on prenatal vitamins here:
     • Preference for more bioavailable forms of B vitamins
     • Taking a prenatal vitamin with food
     • Vitamin amounts based on her research:
       • 4000 IU of vitamin D, preferably in the form cholecalciferol
       • 300 mg of DHA, but possible to obtain this amount in diet alone if fish is consumed several times per week
       • Calcium can be easily obtained through diet alone. If taken in a supplement, ensure it is not taken with iron.
       • 300 mg of magnesium, can be easily obtained through food, or even Epsom salt baths
       • Iron is best through diet. Can be enhanced through taking with Vitamin C (citrus fruits, etc.).
       • Vitamin B12 deficiency can occur in pregnancy and in postpartum, even if mothers have met the Recommended Dietary Allowance.
       • Choline research shows 450 mg is needed, but new research shows that even amounts up to 930 mg show positive outcomes in infants.
       • Iron and zinc are difficult to obtain in a vegetarian diet.

The gap in dosages: Recommended guidelines vs. observational studies, case reports, and expert opinion

What does this mean? There is a gap between what current evidence-based guidelines recommend and what the unfiltered levels of evidence recommend (comparing the last two topics).

Why is this important? Even though some of these recommended dosages by expert opinion and observational studies are not at the peak of evidence-based medicine, they can still provide some insight. These suggestions have yet to be studied, but could one day be more heavily researched and potentially recommended as a guideline.

• Major differences noted:
  • Folate versus folic acid.
    • Folic acid is the only form known to prevent neural tube defects. However, there are some concerns by some researchers that folic acid is not the best version of folate for those who have MTHFR gene mutations, because they metabolize folic acid more slowly. Another concern is that unmetabolized folic acid (UMFA) can also have adverse consequences. Even for individuals with an MTHFR variant, the CDC recommends folic acid supplementation over 5-MTHF for prevention of neural tube defects.³⁴
    • Many prenatal vitamins contain folate, in the form of methyltetrahydrofolate (5-MTHF), instead of folic acid.
    • See our article on folate and folic acid on this topic.
    • Although some of the guidelines and evidence-based articles discuss specific dosing of prenatal vitamins, they do not hone in on their bioavailability. Certain forms of these vitamins and minerals have better absorption. There is a major lack of education on how to take supplements.
      • For example, taking iron with dairy products can reduce its absorption.
    • Observational and unfiltered evidence suggests higher doses of vitamin D (up to 100 mcg or 4000 IU a day) and choline (930 mg/day).
    • Expert opinions make more specific notes on how to obtain the necessary vitamins and minerals through diet.
• Similarities:
  • Women are not getting the nutrients they need through diet alone.^18,20,26
  • Higher doses of vitamin D, choline, and DHA can contribute to better maternal and fetal outcomes.^16,23,26
• Gaps in both:
  • Language around folate or folic acid. These terms often are used interchangeably, when, in fact, they are very different. They are also calculated very differently.
  • In terms of dosing, these values can get very confusing. Is the study talking about folate or folic acid when it comes to minimum or maximum amounts?
    • As stated above, DFE stands for “Dietary Folate Equivalent.”
    • Conversions
      • Folic acid
        • 1 mcg DFE = 1 mcg dietary folate
        • 1 mcg DFE = 0.6 mcg folic acid
        • 1.7 mcg DFE = 1 mcg folic acid
      • Folate
        • 1.7 mcg DFE = 1 mcg 5-MTHF²⁷
    • The RDA, ACOG, and other organizations recommend 600 mcg DFE.
      • Using the above formula, that would mean:
        • 600 mcg DFE = 353 mcg folic acid

A summary of what vitamins are essential.

Vitamin/Mineral	Dosage: national guidelines	Dosages: trials, cohort/case control studies, expert opinion	Tolerable Upper Limit (UL)
Vitamin A	770 – 1300 mcg	2200 mcg	3000 mcg
Vitamin C	85 – 120 mg	200 mg	2000 mcg
Vitamin D	15 mcg (600 IU)	50 – 100 mcg (2000 – 4000 IU)	100 mcg (4000 IU)
B6	1.9 mg		100 mg
Folic Acid (B9)	400 – 800 mcg (667 – 1333 mg DFE) folic acid	400 – 1000 mcg (667 – 1700 mg DFE) 5-MTHF or folic acid	1000 mcg (1700 mg DFE) folic acid
B12	2.6 – 2.8 mcg	25 mcg	None established
Calcium	1000 – 1300 mg	550 – 1000 mg	2500 mg
Iron	27 mg	27 – 30 mg	35 mg
Iodine	190 -290 mcg	190 – 290 mcg	1100 mcg
DHA	200 – 600 mg	500 – 1000 mg	None established
Choline	450 mg	450 – 930 mg	None established

• Some supplements may need to be taken separately if they are not in a prenatal vitamin, are contained in a prenatal vitamin but in low amounts, or are better absorbed separately:
  • Iron
  • Magnesium
  • DHA
  • Choline
  • Vitamin D

Are prenatal vitamins all I need to focus on when it comes to nutrients for my baby?

Although this article focuses on the key elements of prenatal vitamins, their functions, and optimal levels that are suggested by national health organizations, practitioners, and evidence-based studies, that does not mean they should be the primary source of nutrition for your baby.

There is no replacement for a well-balanced, nutritious diet. I highly recommend you dive into our blog on nutrition (coming soon…), and recommendations for a diet that consists of foods that are nourishing to you, and especially your baby.

There are also lots of resources we have provided in Our Bookshelf. See our Fertility and Pregnancy books in particular to read more about foods during preconception and pregnancy phases.

Prenatal Vitamin Comparison Spreadsheet

Now that you have a greater understanding of optimal prenatal vitamins and minerals, here is a detailed spreadsheet to highlight the levels in common prenatal vitamins. Different women need different amounts of these vitamins/minerals, depending on their medical history. For example, women with a history of iron deficiency anemia might need additional iron supplementation in each trimester compared to other women. We hope that the more knowledge you gain about the nutrients you put into your body, the better you can apply that knowledge to your own health as you make health decisions alongside your medical provider.

We hope that this spreadsheet is a guide to help choose a prenatal vitamin that works best for you and your health. Please note that there is not one single vitamin that we would recommend, but rather we hope to share information and bring forth new knowledge.

Please see our supplements page if you are interested in some prenatal vitamins that have high quality ingredients. We list some prenatal vitamins that contain 5-MTHF only, some that only contain folic acid, and some that contain both. We recommend you speak with your health care provider about what they recommend for you.

Last updated: 7.13.26

Best,

The PA Sisters

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What other prenatal vitamins would you like us to add to compare in our Google Sheet above? We would be happy to dive in and add that for you. Leave a comment below.

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