If you ask me what I recommend and what my wife took, it was the Walmart version of Flintstones vitamins, two a day. Bottom line, it has the recommended folic acid, has safe levels of the other vitamins, is cheap, tastes good (in a nostalgic sort of way), and doesn’t seem to make the morning sickness worse.

Most people have already spent a small fortune on a fancy prenatal vitamin before they come in for the first visit. If this is you, it’s ok. Those that are labeled as prenatal vitamin and that are bought at a reputable store or pharmacy are generally going to be just fine. If they settle well, stick with it. My experience is that prenatal vitamins try to be a one size fits all and pack a lot of extra iron that may not be needed until the 3rd trimester. In the first trimester, too much iron can lead to constipation and increased nausea. 

Fish oil supplements that advertise omega 3 fatty acids or DHA and EPA are also in style right now and there are claims that they will help increase brain development. While there is good data that shows that eating fish high in DHA/EPA is beneficial for the newborn brain, there is no convincing data to date that taking a supplement form does any consistent good. It can often increase heartburn and halitosis. I’d put these supplements in the category of “if you already bought them and it doesn’t make you sick, it’s probably ok to keep taking it.”

After your initial labs come back, we may need to alter things slightly, but the above statements work generally for most patients.
Another common misconception is that prenatal vitamins have extra vitamins. Next time you’re at the store compare the nutrition facts between a prenatal vitamin and a women’s one-a-day vitamin. Actually, prenatal vitamins have substantially less of the fat soluble vitamins (vitamin A, D, E & K). These vitamins in excess can accumulate and lead to increased risk of malformations early on if too much is consumed. Less is really more in the case. This is why sticking with a labeled prenatal vitamin or children’s vitamin is generally safer.

Finally, it’s worth commenting on additional supplements. We see a lot of moms who are in the middle of a 30-day challenge of the latest nutritional product and find themselves pregnant. Most of these will say “talk to your doctor before taking if you are pregnant or think you might be pregnant.” This is probably good advice and we can look at it on a case-by-case basis.

Kyle P. McMorries, MD, FACOG