As a fitness professional, I get a lot of questions about supplementation, nutrition, and health. The truth is, while there is intersectionality in these topics with fitness, I don’t know the answers all the time. I am not qualified to give medical advice, and I won’t pretend like I have education in nutrition. But as a woman in my child bearing years, I hear frequently on social media, from my midwives, and from my friends that I should be taking prenatal vitamins. I have a lot of questions, and so I asked a professional who DOES have scope on this topic.

Below you’ll find a back and forth between me and my friend Dr. Cypress Garrett. As a doctor of chiropractic who specializes in women’s health (and practices at a traditional OBGYN office!), she has a wealth of knowledge on these topics. I didn’t realize that chiropractors have a basic level of education on nutrition as part of their accreditation. Cypress has also taken further education on nutrition and supplementation. Enjoy our conversation, and let me know if you have any questions I missed!

Dr.-Garrett-e1516920099709.png — **Dr. Cypress Garrett**

Joselyn: Hey Cypress, why do women need prenatal vitamins?

Dr. Cypress: The bottom line here is that as Americans and humans, we tend to actually be walking around malnourished and most of us could use at the very least a good multivitamin. Prenatal vitamins are special because they are formulated to provide a good balance of nutrients that both mom and her developing baby need. Growing a human is hard work and can take a lot out of mom. Baby's nutritional needs will always come first, and as long as it is available, baby will take it from mom's system leaving mom with a deficiency.

Joselyn: Ok, that makes total sense. You have a reserve, and the baby gets first dibs. But when should a woman start taking a prenatal vitamin?

Cypress: If a woman is planning on conceiving, or at the very least is not preventing pregnancy, she should be taking a prenatal vitamin. A lot of early development depends on mom's basic nutritional status..... and a lot of this can begin before mom even knows that she is pregnant. That's why it's recommended to be taking one if you are trying to become pregnant. If you weren't taking one before you found out you were pregnant, don't worry. It's not too late. But start taking one as soon as you find out.

As far as stopping the prenatal, there are a lot of answers to that. There are some providers that actually recommend prenatals instead of multivitamins for their patients because they provide more complete nutritional support. At the very least you should take it through the duration of your pregnancy, and if you continue to breastfeed, through that time period as well. If you are wanting children close together though, you might as well just keep taking it.

Joselyn: Yeah, that could be a long time! It’s so interesting to note that women could take a prenatal as a multivitamin. I personally have been pregnant, breastfeeding, or both for four straight years now. I think it’s easy to forget with a nursling that is older, like my 20 month old, that we still give those toddler nurslings a lot of our nutritional reserve. So what should a mama be looking for in a prenatal vitamin? Are there some that are better than others? I know medical professionals can prescribe them to you too. Is that a good option?

Cypress: We want the product to contain bioavailable forms of the nutrient. Ingredients you definitely want to include are-

DHA

Vitamin A

Vitamin C as ascorbic acid - bonus points if contains bioflavinoids, but not essential

Vitamin D3 as cholecalciferol

Thiamin (B1)

Riboflavin (B2)

Niacin

Vitamin B6 as pyridoxine hydrochloride

FOLATE - this one is important - this should include the words methyltetrahydrofolicacid - you do NOT want the one that just says folic acid. This may be safe for some women, but not all and is harder for mom to convert to the active form

Vitamin B12 - as Methylcobalamin

Biotin

Choline

Calcium as Calcium citrate - NOT Calcium Carbonate like you find in Tums. Those might help your heartburn, so don't hear me saying not to use those... but don't count on them for calcium supplementation. Calcium carbonate is CHALK.... yup the stuff you write on a black board with. It has its places, but it's not a solid source of calcium.

Iron - this one is also touchy. If your OB tells you that you need iron, they will tell you to get ferrous sulfate. In the next breath they will recommend that you also get a stool softener and take this product with orange juice. Ferrous sulfate tends to be very constipating, and will be much better absorbed if you take it with vitamin C, like in OJ. I usually recommend iron products containing Ferrous Bisglycinate chelate at 30mg.This is considerably lower than the 350mg of ferrous sulfate that your OB will likely recommend, but the bioavalable components are actually comparable. Because this one is much better absorbed, it takes less to get what you need. It is also much gentler on the digestive system and far less constipating.

Iodine from Potassium Iodide

Zinc Bisglycinate Chelate

Selenium Glycinate

Chromium

Really, most prenatals contain similar ingredients. It's the quality and bioavailability of the ingredients that makes the difference. By the label, often the prenatals sold at the big box stores have the same ingredients as higher quality, pharmaceutical grade supplements. The difference is in the bioavailability of those nutrients.

Joselyn: That’s a pretty extensive list. It’s good that these are in most available prenatals. But what does bioavailability mean?

Ortho Molecular Products Prenatal Complete with DHA

Cypress: Bioavailability means, in a form that your body can easily assimilate and use. It gets broken down better, it’s more easily digested. For example, with the methylated B vitamins, they are already in the chemical form that your body can use. Some vitamins, your body has to alter the chemical compound so that it can be used. It’s more work.

Joselyn: Ok, so that kind of ties into the questions of “are there some that are better than others.” But what about quality? I’ve heard you talk about that a lot, how is the “quality” of a prenatal determined?

Cypress: Supplements are not regulated the same way as prescription medications. For the most part, it is on the manufacturer to disclose what is in the bottle and there is very little standardized quality control. For simplicity’s sake, let's talk about a single, common, supplement, fish oil. All of the commercially available fish oils originate from a very small number of companies. So whether you are buying a premium, pharmaceutical grade fish oil or a generic dollar store fish oil it probably came from the same place. The difference is at what point in the manufacturing process the manufacturer gets their product. The earlier in the process, the higher the quality. You can think of this the same way as we look at extra virgin olive oil as compared to regular olive oil. The extra virgin is made earlier in the process, it is unrefined and will contain more nutrients. When you put the two side by side, extra virgin olive oil will be greener and have a deeper color. In terms of fish oil, this means that it contains more of the healthy oils that you are taking it for, it also usually means that it has less of a fishy taste. If your fish oil has a strong fishy taste and smell, it is probably rancid. This comes from sitting in the barrell longer. The other component of high quality is that due to a lack of external controls, there are companies that engage in rigorous internal quality control to ensure that what they say is on the label is actually what is in the supplement. So while some of these do end up costing more, you know that you are actually getting the product that you are paying for.

Joselyn: Wow, I did not know that’s what Extra Virgin means in relation to olive oil… You learn something new every day. Is it true that fish oil is a source of DHA? What is DHA, I know we need it as women and especially while pregnant but I’m not sure why.

Cypress: DHA is an essential fatty acid, a component of fish oil. Specifically, this comes from herring, salmon, trout, anchovies, halibut, catfish, shrimp and tilapia. Most of us don't eat nearly enough of those natural sources. This component is essential for the healthy development of baby's nervous system, and especially the brain. We can all benefit, but this is especially critical when baby's brain is developing.

Joselyn: Super cool stuff. I know that some providers like an OBGYN or a midwife will sometimes offer to prescribe prenatal vitamins. Would those be a good choice, or do you prefer other brands?

Cypress: The prescription prenatals that a lot of insurance companies, pharmacies, and programs like medicaid cover 100% are, unfortunately, lower quality. There are higher quality products available, but in the supplement world “you get what you pay for” really is a true saying. There are higher quality prescription prenatals available, but they are also priced at a higher prescription tier of course. Some brands I like are Orthomolecular, Metagenics, NOW, Solgar, and Garden of Life.

Joselyn: I feel like I have heard some people don’t like Garden of Life.

Cypress: Yes, Nestle bought them. And some people don’t love that such a big corporation owns them, but it’s still a good product in my opinion.

Joselyn: Ok cool. Does it matter where I buy these? Can I get them on Amazon???

Cypress: You can, but like so many other things, you are not guaranteed that you are getting what you ordered. Have you ever ordered something that didn’t hold up to what you expected based on pictures or descriptions? The same can be true with supplements. The first two, Orthomolecular and Metagenics, are pharmaceutical grade supplements. The people that can legitimately sell them (chiropractors, doctors, nutritionists, functional medicine practitioners, etc.) sign agreements that they will not sell to third parties, like Amazon, for this reason. You may end up with a product that is expired or repackaged and you wouldn’t even know. The other options I suggested that are purchasable over the counter I just suggest getting from a reputable retailer. That does include Whole Foods, which is now part of Amazon.

Joselyn: This all makes sense. And convenience is super important to mothers, I know I personally need this to arrive on my doorstep. I told you that when we first started talking prenatals, and it’s definitely possible. I now purchase my Ortho Molecular products through you, and have them on auto-ship. You mentioned many reputable retailers have that option which is great because lord knows mamas don’t need to be remembering to purchase their vitamins along with everything else.

Hey I have also heard on podcasts and maybe social media, that doing a blood panel would also be a good idea. Do you agree? What would you look for in a blood panel? Who even takes a blood panel? Tell me things.

Cypress: There are a couple of pieces of blood work that I would be interested in seeing, but none of it is required. Generally, it is good to know a mom's iron status. It doesn't change the recommendation, but she may need additional iron supplementation. It's also helpful to know if she has any disorders of the methylation pathways, although these tests aren't typically done. You can ask for it, but insurance doesn’t typically pay for it unless it is medically indicated by previous pregnancy losses, known bleeding disorders, or infertility. Specifically, knowing if mom has a MTHFR mutation which would make it even more essential that she takes supplements with reduced forms of folic acid and B-12. A doctor or a midwife can do a blood panel, and in most states chiropractors and dieticians can order them as well.

Joselyn: Yes, I’ve heard a lot about MTHFR lately. I personally am going to see my midwives soon to have a panel done before my husband and I conceive next. I’m also having some menstrual cycle issues I want to ask about. I’m wondering if they’re gut related. I know “the gut” could probably be a whole other blog post here, but do you think I could benefit from a probiotic? Should pregnant women be on a probiotic?

Cypress: There are different schools of thought on this one to be sure… and I'm not sure any of them are WRONG. This is an area where women's needs vary greatly. If you are a woman who struggles with GI health when you're not pregnant, are prone to UTI's and vaginal infections, or need to take antibiotics during pregnancy I would absolutely add a probiotic. If you need an antibiotic, a brief course of any high quality probiotic is probably sufficient. If you are a woman who tends toward IBS, constipation, or diarrhea when you aren't pregnant you should be taking a probiotic anyway and I would NOT discontinue that during pregnancy. You also would not need to change your probiotic if you have found one prior to pregnancy that works for you. If you are prone to vaginal infections or UTI's when you aren't pregnant.... or if you tend to get more of them when you are pregnant this is the only place where I have one specific recommendation beyond just saying that it should be high quality. The product that I like for this is Metagenics UltraFlora Women's product. It has solid research behind it and truly helps. For you personally, you may do better with a digestive enzyme but let’s talk about that later.

Joselyn: Haha, thanks! I’ll bug you about it later. Thanks for letting me pick your brain Cypress, this is great information!

If you’re curious about prenatal supplementation, or have more questions for Dr. Cypress, she can be reached via email at cgarrett@stlifm.com or at Saint Louis Women’s Healthcare Group, linked below. Other resources and information are also posted below.

Find Dr. Cypress Garrett at Saint Louis Women’s Healthcare Group: https://stlobgyn.com

Other resources:

https://metagenics.com/quality

https://www.health.harvard.edu/blog/whats-in-your-supplements-2019021515946

https://www.health.harvard.edu/blog/should-you-use-probiotics-for-your-vagina-2019122718592

https://www.health.harvard.edu/blog/patients-doctors-know-vitamins-supplements-2018031613418

https://www.scientificamerican.com/custom-media/setting-standards-for-supplements/