A Holistic Approach to Prenatal Supplements
The main consensus of health professionals is that pregnant mothers should consume a prenatal vitamin. The recommendation comes with good intentions as not all women can obtain every nutrient from food alone. However, many women view their prenatal as complete, in that taking a prenatal supplement each day ensures the mother gets all she needs and diet doesn’t matter much.
According to Lily Nichols, RDN, in her book Real Food for Pregnancy, this preconceived notion is far from accurate. In fact, her research shows that the recommended daily allowance (RDA) of many vitamins during pregnancy is actually too low. Put simply, the prenatal should always remain supplemental to a first and foremost nutrient-dense diet. The rest of this blog post should be read in that light.
Furthermore, most prenatal vitamins are low in quality and bio-availability, and contain imbalanced ratios of vitamins and minerals which can disrupt cellular health and metabolic processes.
There are 3 approaches to pregnancy supplementation I speak with my clients about, each requiring different levels of investment, both financially and in attention.
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Approach #1: a ready-made prenatal supplement
This approach is by far the most common, but if you’re just going to your local pharmacy and grabbing one off the shelf, chances are it’s not serving you as well as you might think. While I am no longer opposed to synthetic supplementation (after all, man-made health problems like we have in the 21st century will often demand some form of man-made solution to properly correct), I tend to prefer a more holistic prenatal focusing on bioavailable nutrients.
For starters, you want a prenatal that contains activated B-vitamins (folate – not folic acid – and methylated B’s), choline, iodine, selenium, magnesium (and other minerals), vitamin K2, and vitamin A in the form of retinol. This will provide the body with more usable vitamins and a more complete list of minerals.
A few of my favorite brands include:
- Needed Prenatal Multi: Needed does a great job at offering a supplement with higher doses of each nutrient that the standard RDA, plus includes choline and K2 (as MK-7). It also keeps iron out, since iron competes with Calcium for absorption. It is available in either capsule form or powder form.
- Seeking Health Optimal Prenatal: I’ve always been a fan of Seeking Health for its quality and research. Their prenatal is no different, offering methylated B’s, Boron (often forgotten, but helpful for calcium and magnesium absorption), and additional herbs to support digestion.
- FullWell Women’s Prenatal Multivitamin: this supplement is very well-tested, and offers the essentials of all the others, with added betaine HCL for digestion and myoinositol for blood sugar support.
Note: the above links are to the brand websites, but you can shop our Fullscript for both Needed and Seeking Health products to get 20% off.
Pros of a prenatal supplement:
- While a high quality prenatal is not cheap, it is often a more affordable option than DIY.
- Having a standard prenatal can be helpful for women struggling with nausea (Needed and Seeking Health both offer an essentials option that can work for the first trimester, when taking pills may be most uncomfortable).
- While a prenatal is not the perfect solution, it gives peace of mind to potentially cover any missed gaps.
Cons of a prenatal supplement:
- It is not tailored to you and your unique needs.
- It still contains gaps that would generally require additional supplementation, and most women do not seem to be aware of this.
- Not all women will tolerate the same forms of nutrients.
Approach #2: craft your own whole foods prenatal
Crafting your own prenatal with a collection of whole-foods based supplements has become increasingly more popular. I, myself, did this with baby #3. This option requires more attentiveness, but is for the woman looking to nourish herself with bioavailable, nutrient-dense, whole foods (typically through an ancestral lens), with a focus on individual supplements.
In practice, what does this look like?
- Desiccated liver: beef liver is said to be nature’s multivitamin. While I’m not as into its widespread usage as I once was (it’s not as if our ancestors had liver to eat everyday), I think it can be supplemented wisely in pregnancy (this is not a blanket recommendation though). This is, of course, if you choose not to consume liver in your diet, which is more of my preference. Liver contains nutrients like vitamin A (retinol), certain B vitamins, iron, copper, and zinc.
- Cod Liver Oil: many people who follow ancestral eating prefer CLO to a standard fish oil (not without reason). With a high quality CLO (like Rosita’s), you’re getting vitamin A, vitamin D, and a bit of EPA/DHA.
- Desiccated oysters: admittedly, I’m not a huge fan of this now. Unfortunately, our oceans and waterways seem to be universally contaminated with heavy metals, which makes it difficult for me to recommend an oyster supplement. If we forget about the potential mercury and cadmium toxicities, oysters are truly a superfood with a collection of minerals that are the hallmark of the ocean (iodine, copper, zinc, selenium, etc.). I’d say go ahead and eat oysters in moderation (sardines would be a better choice IMO), but I no longer would go out of my way to suggest an oyster supplement.
- Vitamin E: vitamin E is known to be a great hormone balancer. It can help to smooth out the messiness between progesterone and estrogen, but is also anti-inflammatory with antioxidant properties.
- Vitamin K2: there are many documented benefits of vitamin K for pregnancy, but one big one is that it helps form the structure of the baby (think bones and teeth). It also supports normal blood clotting, which is very important for mothers and babies. There are many options out there for K2 supplements, in the form of capsules, drops, or good ole fashioned emu oil.
- Magnesium: oh we all know magnesium is important! The body loves to burn through this mineral in pregnancy, especially during the first trimester. The form of magnesium you take does matter (they all do something different!), but many women who go this route prefer magnesium bicarbonate added to their water (bonus, when consumed between meals this can help with acid reflux or heartburn).
Pros of the DIY ancestral option:
- You’re feeding your body bioavailable nutrients! And if you are eating a lot of nutrient-dense whole foods in your regular diet (ie: beef liver, seafood, raw dairy), you may not need to be taking all of these supplements all the time.
- The sense of ownership that comes from an option like this is actually pretty wonderful. You really get the sense that you are taking charge of yours and the baby’s health.
- Rather than relying on one company to source everything for you, you can evaluate individual sources to see if they meet your standards.
Cons of the DIY ancestral option:
- While in theory this is bioindividual, it’s often not in practice. Women end up consuming a ton of liver, which honestly is massive daily dose of copper (a delicate mineral that, while so important, can cause vast issues when out of balance). My experience with mineral balancing has shown me that most women actually struggle to metabolize/use copper, and consuming an excess of this nutrient leads to a cascade of hormonal and widespread health issues later on.
- You may unintentionally leave out a big nutrient when trying to hodgepodge it all together – it can be a lot to mentally manage.
- It can get rather pricey buying everything individually.
- Prepare to be questioned by your provider; it is not unlikely for an OB or midwife to push back on what you are taking.
Approach #3: supplement based on functional labwork to meet your needs
The final option that I’d recommend is to get functional labwork done and figure out what your needs really are, and supplement based on that. There are pregnancy nutritionists who will recommend a spectrum of tests (HTMA, micronutrient panel, comprehensive blood chemistry). While this is a solid option if you’ve got those kinds of funds, that amount of testing and work can be burdensome to the average woman. I personally stick with Hair Tissue Mineral Analysis (HTMA), and build a protocol based on that.
This doesn’t look too different from mineral protocols outside of pregnancy, which is actually kind of the point. We’re looking at the stress state of the body, where depletions and imbalances are, and are often testing 2-3 times during pregnancy to adjust course. This also means it’s a great option for before, during, and after pregnancy, as long as one continues retesting every 3-4 months.
Pros of supplementing based on labwork:
- The biggest benefit to this method is that you are assessing what your body actually needs, and then following through to meet those needs. No major gaps or question marks.
- Based on your results, you may decide to proceed with a more multivitamin option, or craft your own unique protocol. It’s up to you, but at least you are making. a more informed decision.
- You have the peace of mind of knowing that you’re not leaving things up to chance.
Cons to supplementing based on labwork:
- This can be a more expensive option, depending on the kind of lab work you and your practitioner choose (oh, and you’d need to work with a practitioner). While the supplements themselves may or may not be more of a financial investment, the entire package likely would be.
- If you choose to build your own regimen, you will likely be questioned or met with skepticism by a standard OB or midwife.
- If you are not up for periodical retesting, this may not be the best option for you. As an HTMA practitioner, I would never advise someone to stay on the same protocol for more than 4 months. The body’s chemistry is too fluid for that!
Currently, in my fourth pregnancy, I am proceeding with a full mineral balancing protocol. I simply continued what I had been doing for the previous year and a half, and then have been retesting every 3-4 months.
Additional Nuance & Considerations
Regardless which option you choose (I’m not recommending any specific path for you!), there are a few considerations to keep in mind. First, while supplements serve an important purpose and are necessary (in my opinion), they can never replace a nutrient-dense diet. Consuming a wide variety of whole foods, eating enough calories, timing meals and snacks appropriately – this is all indispensable. If you’re looking for more guidance in this area, we have resources for you! Our Viriditas guide outlines everything you need to integrate holistic wellness habits into your home life, and our Ember app offers community, articles, recipes, and more to support you on your journey!
These resources (plus our quarterly magazine, of course) will also help you incorporate foundational practices that support overall health and wellness: circadian rhythm, sleep, hydration, and much more.
Finally, there are a few extra supplements that I would consider baseline, with the ability to be incorporated into any of the approaches above.
- BodyBio PC: BodyBio has created a unique phospholipid supplement that is truly foundational in nature, supporting cellular function. It is a pure liposomal phospholipid complex, providing the building blocks to our cell membranes. This one is so good for mama and baby! (Use code EMBER for 15% off your first order.)
- Quinton Hypertonic Seawater: Hypertonic (and isotonic) seawater most closely resembles human plasma, making it a great option for hydration. It also is an exceptional support for the sodium/potassium pump that sits on the outside of our cells, and this pump is crucial for overall health and vitality. There is a long history with this hydration support, and some of it seems borderline conspiracy. But as I was researching during my 3rd pregnancy, I came across information that mentioned isotonic/hypertonic seawater as being a preventative and curative supplement for hemorrhaging in labor/early postpartum. I’m not putting that out there as fact but something you could look into if it interests you. (Purchasing through our Fullscript account gets you 20% off.)
- BodyBio Fish+: essentially encapsulated caviar, this is a unique fish oil supplement that takes quality and sourcing far beyond that of your average brand (for a long time I was against fish oil supplements because of these issues). But the essential fatty acids found in Fish+ are supportive for any pregnancy (and would be a personal choice over cod liver oil for this life stage).
There is always more to say on this topic, and it ever-evolving for sure! Have you, like me, made different choices with each pregnancy? Are you weighing your options right now? Please share your thoughts!
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