Wondering what you should and shouldn’t eat during pregnancy? What are the best prenatal supplements to take, and why? It’s not always easy to find the answers on google. This post is a comprehensive overview of pregnancy nutrition, including some of the best prenatal supplements for pregnant women.
Pregnancy guidelines vary depending on the country or organization. Nutrition is always changing as new research is being conducted, therefore, it’s hard to find concrete answers!
I’ll be breaking down all the latest research and recommendations so it’s easy to understand which nutrients you should be focusing on. The information you’ll find here comes from an overview of guidelines from different organizations, both in the United States as well as other countries around the world.
The American Pregnancy Association, the American College of Obstetricians and Gynecologist (ACOG), and most other associations agree that calorie needs increase in the second and third trimester to help support the growth of the fetus.
For a singleton pregnancy (one fetus), very little additional calories are required in the first trimester. This increases to ~300 calories/day in the second trimester, and 300-452 calories/day in the third trimester. For twins, 600 calories per day is recommended in the second and third trimester.
It’s important to note that these needs vary based on a women’s metabolism and pre-pregnancy weight (1). New research has shown that obese women may not need as many additional calories throughout their entire pregnancy.
Adequate hydration has been shown to decrease pre-term delivery, especially spontaneous and late pre-term delivery (2). Recent research has shown that most pregnant women are not meeting the recommended fluid water intake per day.
The recommended water intake increases during pregnancy, by at least 1000 ml per day above basic needs. This isn’t an exact science, and the actual requirements vary depending on different sources. That being said, a pregnant woman should try to drink at least 10 8-ounce glasses of water daily, or 2400 ml total per day.
Protein is a very important nutrient during pregnancy. It is recommended to consume sources with high-biological value such as lean meats, poultry, fish, eggs, tofu, seeds, legumes, beans and nuts.
Most organizations don’t have a specific recommendation for carbohydrates, but agree that adequate fiber consumption is helpful in preventing and treating constipation (5). The hormone progesterone increases during pregnancy, which leads to less frequent bowel movements.
Pregnant women should aim to consume at least 25 grams of fiber per day. Some high-fiber options are whole grains, oatmeal, beans, flaxseeds, chia seeds, barley, quinoa, fruits and vegetables.
Adequate amounts of long-chain fatty acids, such as α-linolenic acid (ALA), docosahexaenoicacid (DHA), and eicosapentaenoic acid (EPA), have been linked to improved fetal brain development and reduction of the risk of pre-term labor (5). Therefore, omega-3 fatty acid supplementation is recommended. However, excessive intake has been linked to prolonged gestation and higher birth weight.
Saturated fats should be limited, as excessive intake has been associated with neurobehavioral development in infants. What does this mean? Cut back on foods like fatty meats, bacon, sausage, butter, cakes, cheese, and fried foods
Omega-3 fatty acid intake in the form of a supplement can be beneficial, but not in excess. Look for a pre-natal vitamin which includes 200-400 mg DHA daily or aim to eat 8-12 ounces of seafood each week.
Avoid fish high in mercury, such as shark, swordfish, king mackerel, or tilefish. Limit white tuna, or albacore tuna – canned light tuna is a better option.
Vitamin A has actually been linked to increased risk of congenital malformations with excessive consumption during pregnancy (5). Therefore, overconsumption of Vitamin A through supplementation is not recommended.
There is some evidence which shows that those with a deficiency in Vitamin A may benefit from supplementation. The World Health Organization encourages adequate Vitamin A consumption through foods, and cautions the use of Vitamin A supplementation greater than 25,000 IU/day.
Most guidelines are against the routine supplementation of vitamin A in pregnant women, whereas it should be considered only for cases with proven deficiency. Many prenatal vitamins have Vitamin A, but pregnant women should avoid high doses – look for less than 100% daily value.
Vitamin D is a fat-soluble vitamin found in foods such as fatty fish. It can also be synthesized by the skin through the sun’s ultraviolet rays. Vitamin D is commonly lacking in most Americans’ diets, therefore, deficiency is common in pregnant women.
Research has shown that maintaining a normal Vitamin D status may improve perinatal outcomes. A systematic review of vitamin D supplementation in pregnant women found that supplementation was associated with a lower risk of birth of a small gestational age neonate (6).
The specific amount of Vitamin D supplementation varies between different organizations, but most agree that some additional Vitamin D is beneficial for most pregnant women – usually in the form of their pre-natal vitamin.
Folic acid is an important nutrient for preventing neural tube defects, specifically in the first trimester of pregnancy. All guidelines recommend folic acid in the form of supplementation, either alone or in a pre-natal vitamin. The recommended dose is set at 0.4-0.5 mg/day, or 400 mcg/day, for the first 12 weeks of pregnancy.
Folic acid can be consumed from diet as well. It is found in many foods, such as include dark, leafy vegetables, sunflower seeds, beans, whole grains, asparagus, broccoli, and eggs.
The guidelines for iron during pregnancy are quite confusing, with some organizations recommending supplementation while others do not. For people with a poor diet or in low-income countries, the risk of developing iron deficiency is higher – and therefore, supplementation is recommended.
There are research studies that confirm that maternal anemia is associated with adverse maternal and neonatal outcomes and iron supplementation is beneficial. On the other hand, high ferritin levels (iron stores) can be shown to increase gestational diabetes (7).
Due to this, iron supplementation should be carefully considered. The World Health Organization recommends supplementing with 30-60 mg of iron, but should start on the lower end and increase if a deficiency is identified.
Calcium consumption should be encouraged during the second and third trimesters of pregnancy, as it helps assist with fetal skeleton development. High calcium foods include dairy products, green leafy vegetables, baked beans, edamame, chia seeds and some cereals.
Supplementation has been show to help with pre-eclampsia, as it has been shown to decrease the risk of high blood pressure, neonatal mortality, and pre-term birth (8).
Therefore, most organizations recommend calcium supplementation of 1.5-2.0 grams of oral elemental calcium, or consume at least 1,000 mg of calcium from diet.
Magnesium is an essential mineral which is involved in many bodily processes. Research has shown that pregnant women with a magnesium deficiency have been associated with adverse outcomes such as fetal growth restriction, pre-term labor, pregnancy-induced hypertension, gestational diabetes, and leg cramps (9).
However, there is insufficient evidence to suggest that magnesium supplementation is needed. More research is needed to assess the affect magnesium has on pregnancy cramps.
Try to consume foods high in magnesium on a regular basis, such as pumpkin seeds, chia seeds, almonds, avocado, spinach, cashews, and peanuts.
Choline and Iodine
Both of these micronutrients play an important role in fetal brain development, therefore, it’s important to consume adequate amounts during pregnancy.
Choline can be found in egg yolks, red meat, tilapia, salmon, cod, and chicken breast. High iodine foods include fish, shellfish, “iodized” salt, dairy, eggs and chicken.
If your diet is poor, supplementation is recommended. Check your pre-natal vitamin to ensure these nutrients are listed.
Currently, there are no specific probiotic recommendations in pregnancy.
A recent meta-analysis did find that probiotic supplementation may reduce the risk of gestational diabetes, however, another review found no benefit or harm with the use of probiotics (5).
Probiotic use may have a beneficial impact to the mother during pregnancy, but the impacts of routine supplementation are not yet known.
The World Health Organization and the Society of Obstetricians and Gynecologists of Canada both recommend limiting consumption of caffeine to less than 300 mg/day to reduce the risk of pregnancy loss and low-birthweight.
ACOG has more strict guidelines, recommending 200 mg of caffeine per day or less, or about 12 ounces of coffee.
There are research studies that suggest potential associations between coffee and pregnancy loss, as well as fetal growth restriction. However, most organizations agree that 200-300 mg of caffeine per day is safe.
Summary of Findings
Overall, there is agreement among various guidelines regarding:
- higher calorie needs for second and third trimester
- increased consumption of protein (from high-biological value sources)
- limiting foods high in saturated fats
- increased need for omega-3 fatty acids
- vitamin supplementation of A, C, and E should not be “required”
- benefits of folic-acid, calcium, and vitamin D supplementation
- iron supplementation for high-risk individuals, but not so much the average American
- upper limit of caffeine is 300 mg/day (but some organizations recommend under 200 mg/day)
What Foods Should You Avoid During Pregnancy?
A common question that can result in some confusing answers.
- Seafood high in mercury: shark, swordfish, king mackerel, tilefish. Limit white albacore tuna.
- Unpasteurized cheese or milk: It should be noted that most cheese in the United States is pasteurized. Also, if a cheese is cooked past 165 degrees Fahrenheit, it is safe. That’s because high temperatures kill Listeria.
- Unwashed fruits or vegetables.
- Undercooked or raw fish or poultry.
- Raw sprouts: ideal for growth of salmonella.
- Deli Meat: Due to the risk of listeria, deli meat should be avoided (although the risk is small). Heated up deli meat is safe (as stated above, the Listeria would be destroyed during cooking).
It’s interesting to note that Listeria can be present in a number of foods that are not listed as “avoid” during pregnancy. For example, there was a Listeria outbreak in lettuce this past year – but they don’t tell you to avoid salads.
Best Prenatal Vitamins (2024)
Although routine supplementation is not universally recommended for many micronutrients, a prenatal vitamin can help prevent deficiencies – especially when the diet of a pregnant women can be so variable.
Below is a list of recommended prenatal vitamins with a description on why these are great choices- using the above information as guidelines. The vitamins listed below all contain omega-3 fatty acids, since they are very important for prenatal nutrition.
They are all third-party tested for purity and potency.
*This post does contain affiliate links, in which I will receive small compensation at no additional cost to you.
- Contains Omega-3 (DHA only), Folate, Choline, Iodine, Vitamin D3, Iron, Biotin, Vitamin E, Vitamin C, Vitamin K2 and Magnesium
- Contains Boron, which helps absorption of calcium, but does not actually contain calcium
- Only 18 mg of Iron, so likely not to lead to excessive consumption.
- Claims to be gentle on the stomach
- Two capsules daily, which might not be good for women who can’t remember to take one.
- Provides only 10% recommended daily value of choline
- Reviews complain of fishy aftertaste
- Contains most nutrients in a multi-vitamin (Vitamin A 59% daily value). Includes magnesium, iodine, folic acid, Vitamin D, Iron, and Calcium Carbonate
- Does not contain choline
- Omega-3 fatty acids EPA + DHA included
- One capsule daily, inexpensive
- 4.6 rating on Amazon
- Some reviews complain of fishy aftertaste
- OB-GYN formulated
- Vegan, as well as egg, fish, nut, gluten-free
- Expensive for 30 packets, which contain 5 capsules in each
- Includes Vitamin A (57% DV), Folate in its most active form, Choline, 450 mg DHA, Iodine, 27 mg Iron, Vitamin D, Calcium and Magnesium
- Not ideal for people who don’t like taking multiple pills
- 4 gummies per serving, ideal for people who don’t like taking pills
- Contains omega-3 fatty acids EPA and DHA
- Vitamin A (40% DV), Vitamin D, Folate, Choline and Iodine included
- Does not contain Magnesium, Iron or Calcium
- #1 best-seller in prenatal vitamins on Amazon
- Allergen and gluten-free
- One tablet + one softgel (omega 3’s) daily
- The tablet contains vitamin D, B6, Vitamin A, Vitamin D, Calcium, Magnesium, Iron, Iodine and choline
- Contains omega-3 fatty acids DHA and EPA
- Complaints about the packaging
- Overall, a very well-rounded prenatal vitamin
- 1 scoop provides Vitamin D, Folate, Calcium and Iron
- Does not provide Choline, Iodine, Magnesium, or Vitamin A
- 430 mg vegetarian DHA
- 20 grams of protein
- Ideal for morning sickness or women who can’t tolerate taking pills
Let’s Wrap it Up
As you can see, finding the perfect prenatal vitamin is difficult. Choose which one works for you, and be aware of some of the nutrients that vitamin is lacking and try to make up for it in your diet.
If you choose a prenatal that does not have DHA or EPA in it, it is recommended to consume omega-3 fatty acids from your diet. You could also take a prenatal DHA supplement along with your prenatal vitamin.
Since calcium is not often included in a prenatal, ensure you are eating or drinking calcium rich foods.
It’s important to remember that medical findings are always changing, and there is still so much research needed to understand the exact nutritional recommendations for a pregnant woman.
Prenatal nutrition is important for both the mother and the baby, but adverse outcomes may not be related to anything the mother did (or ate)! After all, we are just trying to do our best!