Supplement Research

Navigating the Choices: Our Prenatal Multi-Vitamin

by Cassandra Delage, Founder and CEO

Reviewed by Dr. Stan Kubow, Dr. Aaron K. Styer, MD, FACOG, Stephanie Dang, RD, and Valerie Pelletier, Birthworker

Published June 10, 2024 — Last Reviewed March 25, 2024

  • Full Article

  • Contributors

  • References

Excerpt

Choosing a prenatal multi-vitamin can be overwhelming. There's a lot of conflicting information out there, making it hard to know where to start. Many mothers share that they felt lost when trying to find the best option.

"When I first looked into prenatal vitamins, I realized how overwhelming the choices were. Finding trustworthy, transparent brands made all the difference."

— Valerie Pelletier, Birthworker, Doula

We've crafted our prenatal multi-vitamins with these values in mind, emphasizing a "Less is More" approach to provide only the essential nutrients in their most effective forms.

Introduction

We believe in a "Less is More" approach to prenatal multi-vitamins. While certain nutrients are essential for maternal and fetal health, over supplementation can be harmful. Our products focus on providing only the necessary nutrients in their most effective forms. Our philosophy is that these high quality ingredients should complement balanced diet, one co-created with dietitians, if needed.

Our Formulation Process

We brought together a diverse panel of experts to create our prenatal multi-vitamin formula. Our team includes a dietitian and women's clinic founder from Vancouver, a doula with over a decade of hands-on experience, a distinguished researcher specialized in maternal-fetal health from McGill University, and an OBGYN from Harvard Medical School.

 

To ensure the highest quality and safety, our formula underwent a blind-sided peer review process, involving three rounds of rigorous evaluation. Each ingredient was carefully vetted for safety and efficacy, with recommendations backed by the latest scientific research.

Why This Formula?

These nutrients are essential for maternal and fetal health, and their forms were chosen for their bioavailability to ensure maximum absorption and effectiveness.

Vitamin A

Retinyl Palmitate

Mixed Carotenoids

2000 IU

1200 IU

Vitamin A is crucial for promoting healthy vision and immune function, supporting proper bone development, and playing a role in gene expression and neurological development. According to a meta-analysis conducted by Ma et al. (2023), vitamin A supplementation is associated with reduced risk of abnormal fetal growth and improved birth outcomes, including a lower risk of preterm birth, low birth weight, and anemia, with no side effects observed for doses up to 4000 mcg. The chosen dose ensures adequate intake without risking toxicity [1].

Vitamin B2

Riboflavin

1.7 mg

Vitamin B2 promotes the healthy growth and development of tissues, prevents birth defects, and supports energy metabolism. Riboflavin is the biologically active form of Vitamin B2, and its inclusion in our supplement is based on its necessity and blood pressure-lowering effects. The chosen dose of 1.7 mg aligns with the Recommended Dietary Allowance (RDA) for pregnant women, ensuring sufficient intake to meet increased metabolic demands [2].

Vitamin B6

Pyridoxine HCL Granular

1.9 mg

Vitamin B6 regulates gene expression and cell differentiation, promotes healthy skin and immune function, and facilitates nerve function and neurotransmitter synthesis. Pyridoxine HCL Granular is chosen for its proven efficacy and safety profile. The dose of 1.9 mg meets the RDA for pregnant women, supporting essential biochemical processes [3].

Vitamin B12

Methylcobalamin

2.6 mg

Vitamin B12 supports bone mineralization, DNA synthesis, and thyroid hormone synthesis. The dose of 2.6 mcg ensures adequate levels to support fetal development and prevent deficiency [4].

Vitamin C

Ascorbic Acid

85 mg

Vitamin C promotes healthy vision, immune function, collagen synthesis, and supports protein synthesis and muscle function. The American College of Obstetricians and Gynecologists recommends 85 mg of Vitamin C per day. This dose is sufficient to meet increased demands during pregnancy and support iron absorption [5].

Vitamin D3

Cholecalciferol

1000 IU

Vitamin D3 regulates calcium and phosphorus absorption, supports immune function, and plays a role in brain development. Our board maternal-fetal nutrition researcher recommended that vitamin D supplements in Canada should contain 1000 IU, considering the typical deficiency of this vitamin. This dose ensures adequate levels for bone health and immune support [6].

Calcium

Calcium Carbonate

500 mg

Calcium is essential for building strong bones and teeth, supporting muscle function, and regulating the heartbeat. Calcium carbonate is chosen for its well-absorbed form and general safety at recommended doses. The dose of 500 mg supplements dietary intake to meet the increased needs during pregnancy [7].

Choline

Choline Bitartrate

550 mg

Choline supports brain development, cell membrane structure, and gene expression. The dosage of 550 mg is based on recent scientific articles and expert consensus. This dose meets the Adequate Intake (AI) levels, supporting cognitive development and preventing deficiency [8].

Folate

L-5-Methyltetrahydrofolate

400 mcg

Folate prevents neural tube defects, supports DNA synthesis, and contributes to red blood cell production.

 

According to established guidelines from the American College of Obstetricians and Gynecologists (ACOG), women planning to conceive should supplement with 400 mcg of folate daily, beginning three months before conception. Once pregnant, the recommended dosage increases to 600 mcg per day, continuing throughout pregnancy and breastfeeding. However, prenatal supplements should contain only 400 mcg of folate, with the remaining intake obtained from fortified foods and a well-rounded diet. This approach helps ensure adequate folate intake while minimizing the potential adverse effects associated with excessive folic acid consumption.

 

Given that methylfolate, the active form of folate, is not prone to lingering in circulation and competing with metabolized folate, it is considered a preferable alternative to folic acid. Methylfolate is readily absorbed by the body, ensuring optimal utilization for supporting maternal and fetal health [9].

Iodine

Iodine

150 mcg

Iodine supports thyroid hormone synthesis, fetal brain development, and metabolism. There is strong scientific evidence supporting its necessity for neonatal development at this dose. The chosen dose of 150 mcg aligns with recommendations to prevent deficiency and support thyroid function [10].

Magnesium

Magnesium Glycinate

130 mg

Magnesium reduces the rate of pregnancy-induced hypertension, maternal hospitalization, preterm birth, and low birth weight.

 

The average magnesium intake among U.S. women falls 22% below the recommended daily allowance (RDA), and magnesium levels tend to decrease during pregnancy, making supplementation essential for maternal and fetal health.

 

The dosage of 130 mg aims to ensure that pregnant women receive adequate magnesium support to promote maternal and fetal health and reduce the risk of adverse pregnancy outcomes [11].

Zinc

Zinc Citrate

11 mg

Zinc supports DNA synthesis, protein synthesis, and immune function. Zinc citrate is chosen for its superior absorption and reduced gastrointestinal side effects. The dose of 11 mg aligns with the RDA for pregnant women, ensuring adequate intake to support fetal development and immune function [12].

Necessary, But On The Side

Among the ingredients necessary for the healthy prenatal development of both the baby and the mother are Iron and Omega-3. Both are supported by strong scientific evidence. To ensure that mothers have the best experience possible, tailored to their needs, Bia decided to exclude both ingredients from our prenatal supplement.

Iron

Iron is important for maternal and fetal health. However, iron supplementation requirements vary significantly among individuals, with some experiencing constipation even at low doses. A study by Boyle et al. (2017) found that responses to iron supplementation can vary greatly, and over supplementing can lead to gastrointestinal issues. Therefore, Bia has excluded iron from its formulation to allow for personalized dosages tailored to individual needs, ideally with the guidance of dieticians [13].

Omega-3

Docosahexaenoic Acid (DHA)

Eicosapentaenoic Acid (EPA)

200 mg

30 mg

Based on scientific literature, Omega-3 supplementation is strongly recommended during pregnancy. In their article, Koletzko et al. recommend that pregnant and lactating women aim for an average dietary intake of at least 200 mg DHA per day, which can be achieved by consuming one to two portions of fish per week. Globally, most daily DHA intake recommendations suggest 200 mg/day [14].

 

However, Omega-3 DHA is derived from fish oil or algae oil, both of which produce a strong fishy smell that can be particularly difficult to tolerate for individuals already experiencing nausea. To mitigate this smell, DHA should be encapsulated in soft gels.

 

Unfortunately, the rest of the ingredients in our prenatal supplement could not be placed in soft gels, forcing us to separate omega-3 from the rest. Therefore, we are currently developing an Omega-3 DHA soft gel in combination with our daily prenatal supplement.

What We Didn't Include (But Some Others Do)

To decide which ingredients to include or exclude, we also reviewed all the ingredients typically found in prenatal multi-vitamins and examined the associated scientific literature. The list below summarizes the ingredients that are sometimes included in prenatal multi-vitamins but were not supported by sufficient scientific evidence to be included in our formula. 

 

Bia adopts a "less is more" approach, including only necessary ingredients supported by strong scientific literature and emphasizing the importance of a nutritious diet. Multi-vitamins alone are not sufficient for the good health of the mother and baby.

Manganese

Manganese deficiency has not been observed in human adults, including pregnant women. The intestine, through absorption, and liver, through biliary excretion, provide strong homeostatic controls of body manganese. Thus, manganese supplements are not necessary during pregnancy [15].

Copper

Copper deficiency has not been documented in humans during pregnancy. Evidence suggests that copper absorption may actually be more efficient during pregnancy, and such efficiency could result in absorption of an increased amount of copper, therefore no additional increment would be required during pregnancy [16].

Vitamin K

The specific importance of vitamin K during pregnancy is largely undetermined. Data pertaining to vitamin K status of pregnant women are limited but suggest that status is not different from that of non pregnant women, that is, lack of signs of clinical deficiency and comparable circulating vitamin K concentrations. Furthermore, there is no data on the vitamin K content of fetal tissue for estimating additional needs during pregnancy.

 

No vitamin K supplement is indicated in the routine care of pregnant women. No general public health problems have been associated with vitamin K deficiency. There does not appear to be a need to supplement normal pregnant women with vitamin K [17].

Boron

Boron requirement for humans has not been proven. In animals, boron has been shown to have a role in reproduction and development. The collective body of evidence, however, has yet to establish a clear biological function for boron in humans. Therefore, neither an Estimated Average Requirement, Recommended Dietary Allowance, nor Adequate Intake was established for boron.

 

Further investigation is required regarding boron, as comprehensive studies have not yet been conducted on their effects during pregnancy [18].

CoEnzyme Q10 / CoQ10

The safety of use of CoQ10 during pregnancy and breast-feeding hasn't been established.

Supplementation with CoQ10 has only been shown to reduce the risk of developing pre-eclampsia in women already at risk for the condition [19].

Vitamin E

In pregnant women, there have been no definable deficiency syndromes for vitamin E, and intakes below the RDA have not been accompanied by an obvious clinical morbidity. Thus, supplementation of healthy pregnant women appears to be unnecessary [20].

Selenium

Selenium deficiency is very rare in the US and Canada. There is no indication of a need to conduct laboratory tests to assess selenium status during pregnancy or to advise pregnant women to take supplemental selenium [21].

Vitamin B1, B3 and B7

There is a lack of sufficient evidence supporting the necessity of Vitamin B1, B3 and B7 for neonatal development [22], [23], [24].

Focus on the Basics

We know there's a lot of information out there, and it can be hard to make the right choice. But by focusing on essential nutrients, high bioavailability, right dosages and consulting with your healthcare provider, you can find the right prenatal multi-vitamin for you.

Title

References to the research cited in this article can be found in the "References" tab at the top of this page.

Contributors

Author(s)

Cassandra Delage

Founder and CEO of Bia

Reviewer(s)

Dr. Stan Kubow

Researcher, Professor of Pediatric & Maternal Nutrition, McGill University

Stephanie Dang

Registered Dietitian, Co-Founder at CAYA Health Centre & Vancouver Dietitians

Aaron K. Styer, MD, FACOG

Reproductive Endocrinologist/Fertility Specialist, CCRM Fertility Boston

Valerie Pelletier

Nonclinical birth worker, Doula

References

Bia follows strict article guidelines and only uses credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. In addition, when necessary, each article is reviewed by a member of our healthcare community to further ensure up-to-date information.

[1] Vitamin A

Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Panel on Micronutrients, Subcommittees on Upper Reference Levels of Nutrients and of Interpretation and Use of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes 6 x 9, 800 pages, 2002.

Zielińska MA, Wesołowska A, Pawlus B, Hamułka J. Health Effects of Carotenoids during Pregnancy and Lactation. Nutrients. 2017 Aug 4;9(8):838. doi: 10.3390/nu9080838. PMID: 28777356; PMCID: PMC5579631.

Park, J. E., & Yun, J. G. (2020). A systematic review of bibliometric studies of COVID-19 research. Healthcare informatics research, 26(4), 277–288. https://doi.org/10.4258/hir.2020.26.4.277

Ma G, Chen Y, Liu X, Gao Y, Deavila JM, Zhu MJ, Du M. Vitamin a supplementation during pregnancy in shaping child growth outcomes: A meta-analysis. Crit Rev Food Sci Nutr. 2023 Nov;63(33):12240-12255. doi: 10.1080/10408398.2022.2099810. Epub 2022 Jul 19. PMID: 35852163; PMCID: PMC9849478.

Kadam I, Nebie C, Dalloul M, Hittelman J, Fordjour L, Hoepner L, Futterman ID, Minkoff H, Jiang X. Maternal Lutein Intake during Pregnancies with or without Gestational Diabetes Mellitus and Cognitive Development of Children at 2 Years of Age: A Prospective Observational Study. Nutrients. 2024 Jan 22;16(2):328. doi: 10.3390/nu16020328. PMID: 38276566; PMCID: PMC10819807. (Lutein + Zeaxanthin intake of pregnant women has a positive association with cognitive and language development of children in early childhood. GDM decreased lutein levels in the cord blood, which may indicate the need for higher L + Z intake for women with GDM).

Lai JS, Godfrey KM, Ong CN, Tan KH, Yap F, Chong YS, Chan JKY, Chan SY, Chong MF. Perinatal Plasma Carotenoids and Vitamin E Concentrations with Glycemia and Insulin Resistance in Women during and after Pregnancy. Nutrients. 2023 Oct 18;15(20):4421. doi: 10.3390/nu15204421. PMID: 37892496; PMCID: PMC10610276.

[2] Vitamin B2

Adams JB, Kirby JK, Sorensen JC, Pollard EL, Audhya T. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol. 2022 Jul 11;8(1):4.

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients, Food and Nutrition Board, Institute of Medicine 6 x 9, 592 pages, 2000.

National Institutes of Health, Office of Dietary Supplements. (2021, July 15). Riboflavin: Fact Sheet for Health Professionals. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Riboflavin-HealthProfessional/

[3] Vitamin B6

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients, Food and Nutrition Board, Institute of Medicine 6 x 9, 592 pages, 2000.

[4] Vitamin B12

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients, Food and Nutrition Board, Institute of Medicine 6 x 9, 592 pages, 2000.

[5] Vitamin C

Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Panel on Dietary Antioxidants and Related Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of DRIs, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board 6 x 9, 529 pages, 2000.

Brown B, Wright C. Safety and efficacy of supplements in pregnancy. Nutr Rev. 2020 Oct 1;78(10):813-826. doi: 10.1093/nutrit/nuz101. Erratum in: Nutr Rev. 2020 Sep 1;78(9):782. PMID: 31925443; PMCID: PMC7558284.

Adams JB, Kirby JK, Sorensen JC, Pollard EL, Audhya T. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol. 2022 Jul 11;8(1):4.

[6] Vitamin D3

Sauder KA, Couzens GL, Bailey RL, Hockett CW, Switkowski KM, Lyall K, Kerver JM, Dabelea D, Maldonado LE, O'Connor TG, Deoni SC, Glueck DH, Catellier DJ; program collaborators for Environmental influences on Child Health Outcomes. Selecting a dietary supplement with appropriate dosing for 6 key nutrients in pregnancy. Am J Clin Nutr. 2023 Apr;117(4):823-829.

Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride.Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine Updated version for calcium and vitamin D (DRI DIETARY REFERENCE INTAKES Calcium Vitamin D) 2011 See http://books.nap.edu/openbook.php?record_id=13050

Walker KC, Thorsteinsdottir F, Christesen HT, Hjortdal VE, Heitmann BL, Specht IO, Händel MN. Vitamin D Supplementation and Vitamin D Status during Pregnancy and the Risk of Congenital Anomalies-A Systematic Review and Meta-Analysis. Nutrients. 2023 Apr 28;15(9):2125. doi: 10.3390/nu15092125. PMID: 37432271; PMCID: PMC10181330.

Vafaei H, Asadi N, Kasraeian M, Shahraki HR, Bazrafshan K, Namazi N. Positive effect of low dose vitamin D supplementation on growth of fetal bones: A randomized prospective study. Bone. 2019 May;122:136-142. doi: 10.1016/j.bone.2019.02.022. Epub 2019 Feb 21. PMID: 30798000.

[7] Calcium

Adams JB, Sorenson JC, Pollard EL, Kirby JK, Audhya T. Evidence-Based Recommendations for an Optimal Prenatal Supplement for Women in the U.S., Part Two: Minerals. Nutrients. 2021; 13(6):1849. https://doi.org/10.3390/nu13061849

Gomes F, Ashorn P, Askari S, Belizan JM, Boy E, Cormick G, Dickin KL, Driller-Colangelo AR, Fawzi W, Hofmeyr GJ, Humphrey J, Khadilkar A, Mandlik R, Neufeld LM, Palacios C, Roth DE, Shlisky J, Sudfeld CR, Weaver C, Bourassa MW. Calcium supplementation for the prevention of hypertensive disorders of pregnancy: current evidence and programmatic considerations. Ann N Y Acad Sci. 2022 Apr;1510(1):52-67. doi: 10.1111/nyas.14733. Epub 2022 Jan 8. PMID: 35000200; PMCID: PMC9306576.

Domínguez L, Fernández-Ruiz V, Cámara M. Micronutrients in Food Supplements for Pregnant Women: European Health Claims Assessment. Nutrients. 2023 Oct 28;15(21):4592. doi: 10.3390/nu15214592. PMID: 37960245; PMCID: PMC10650409.

Sauder KA, Couzens GL, Bailey RL, Hockett CW, Switkowski KM, Lyall K, Kerver JM, Dabelea D, Maldonado LE, O'Connor TG, Deoni SC, Glueck DH, Catellier DJ; program collaborators for Environmental influences on Child Health Outcomes. Selecting a dietary supplement with appropriate dosing for 6 key nutrients in pregnancy. Am J Clin Nutr. 2023 Apr;117(4):823-829.

[8] Choline

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients, Food and Nutrition Board, Institute of Medicine 6 x 9, 592 pages, 2000.

Obeid R, Derbyshire E, Schön C. Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies. Adv Nutr. 2022 Dec 22;13(6):2445-2457. doi: 10.1093/advances/nmac082. PMID: 36041182; PMCID: PMC9776654.

Mun JG, Legette LL, Ikonte CJ, Mitmesser SH. Choline and DHA in Maternal and Infant Nutrition: Synergistic Implications in Brain and Eye Health. Nutrients. 2019 May 21;11(5):1125. doi: 10.3390/nu11051125. PMID: 31117180; PMCID: PMC6566660.

Korsmo HW, Jiang X, Caudill MA. Choline: Exploring the Growing Science on Its Benefits for Moms and Babies. Nutrients. 2019 Aug 7;11(8):1823. doi: 10.3390/nu11081823. PMID: 31394787; PMCID: PMC6722688.

National Library of Medicine. (2020). Nutrient Profile of Choline in Preterm and Term Mother's Milk at Early Lactation. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10709661/

National Institutes of Health, Office of Dietary Supplements. (2021, March 26). Choline: Fact Sheet for Health Professionals. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

[9] Folate

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients, Food and Nutrition Board, Institute of Medicine 6 x 9, 592 pages, 2000.

Carboni L. Active Folate Versus Folic Acid: The Role of 5-MTHF (Methylfolate) in Human Health. Integr Med (Encinitas). 2022 Jul;21(3):36-41. PMID: 35999905; PMCID: PMC9380836.

Amitai Y, Shental H, Atkins-Manelis L, Koren G, Zamir CS. Pre-conceptional folic acid supplementation: A possible cause for the increasing rates of ankyloglossia. Med Hypotheses. 2020 Jan;134:109508. doi: 10.1016/j.mehy.2019.109508. Epub 2019 Nov 18. PMID: 31835174.

The American College of Obstetricians and Gynecologists. (2024). Nutrition During Pregnancy FAQ. https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy

[10] Iodine

Croce L, Chiovato L, Tonacchera M, Petrosino E, Tanda ML, Moleti M, Magri F, Olivieri A, Pearce EN, Rotondi M. Iodine status and supplementation in pregnancy: an overview of the evidence provided by meta-analyses. Rev Endocr Metab Disord. 2023 Apr;24(2):241-250. doi: 10.1007/s11154-022-09760-7. Epub 2022 Oct 13. PMID: 36227457; PMCID: PMC10023614.

Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Mar;27(3):315-389. doi: 10.1089/thy.2016.0457. Erratum in: Thyroid. 2017 Sep;27(9):1212. PMID: 28056690.

Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Panel on Micronutrients, Subcommittees on Upper Reference Levels of Nutrients and of Interpretation and Use of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes 6 x 9, 800 pages, 2002.

Adams JB, Sorenson JC, Pollard EL, Kirby JK, Audhya T. Evidence-Based Recommendations for an Optimal Prenatal Supplement for Women in the U.S., Part Two: Minerals. Nutrients. 2021 May 28;13(6):1849. doi: 10.3390/nu13061849. PMID: 34071548; PMCID: PMC8229801.

[11] Magnesium

Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride.Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine Updated version for calcium and vitamin D (DRI DIETARY REFERENCE INTAKES Calcium Vitamin D) 2011 See http://books.nap.edu/openbook.php?record_id=13050

Adams, J.B.; Sorenson, J.C.; Pollard, E.L.; Kirby, J.K.; Audhya, T. Evidence-Based Recommendations for an Optimal Prenatal Supplement for Women in the U.S., Part Two: Minerals. Nutrients 2021, 13, 1849. https://doi.org/10.3390/nu13061849

National Institutes of Health, Office of Dietary Supplements. (n.d.). Magnesium: Fact sheet for health professionals. Retrieved from https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#en1

Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington (DC): National Academies Press (US); 1997. 6, Magnesium. Available from: https://www.ncbi.nlm.nih.gov/books/NBK109816/

[12] Zinc

Iqbal S, Ali I. Effect of maternal zinc supplementation or zinc status on pregnancy complications and perinatal outcomes: An umbrella review of meta-analyses. Heliyon. 2021 Jul 10;7(7):e07540. doi: 10.1016/j.heliyon.2021.e07540. PMID: 34368474; PMCID: PMC8326740.

Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Panel on Micronutrients, Subcommittees on Upper Reference Levels of Nutrients and of Interpretation and Use of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes 6 x 9, 800 pages, 2002.

Crawford SA, Brown AR, Teruel Camargo J, Kerling EH, Carlson SE, Gajewski BJ, Sullivan DK, Valentine CJ. Micronutrient Gaps and Supplement Use in a Diverse Cohort of Pregnant Women. Nutrients. 2023 Jul 20;15(14):3228. doi: 10.3390/nu15143228. PMID: 37513643; PMCID: PMC10383608.

Health Canada. (n.d.). Consultation on the Revised Labelling Standard for Acetaminophen: Natural Health Products. Government of Canada. https://www.canada.ca/en/health-canada/services/drugs-health-products/public-involvement-consultations/natural-health-products/consultation-revised-labelling-standard-acetaminophen.html

EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS). (2009). Scientific Opinion on the substantiation of health claims related to zinc and function of the immune system (ID 291, 1757), DNA synthesis and cell division (ID 292), protection of DNA, proteins and lipids from oxidative damage (ID 294, 1758), maintenance of bone (ID 295), cognitive function (ID 296), fertility and reproduction (ID 297) and macronutrient metabolism (ID 299) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal, 7(9), 1113. https://doi.org/10.2903/j.efsa.2009.1113

National Institutes of Health, Office of Dietary Supplements. (2021, July 15). Zinc: Fact Sheet for Health Professionals. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/

[13] Iron

Pena-Rosas, J. P., De-Regil, L. M., Dowswell, T., & Viteri, F. E. (2012). Iron supplementation during pregnancy: A review of the evidence and possible mechanisms for risk reduction of adverse pregnancy outcomes. Nutrients, 4(7), 1045-1070. https://doi.org/10.3390/nu4071045

Name JJ, Vasconcelos AR, Valzachi Rocha Maluf MC. Iron Bisglycinate Chelate and Polymaltose Iron for the Treatment of Iron Deficiency Anemia: A Pilot Randomized Trial. Curr Pediatr Rev. 2018;14(4):261-268. doi: 10.2174/1573396314666181002170040. PMID: 30280670; PMCID: PMC6416187.

Teichman J, Nisenbaum R, Lausman A, Sholzberg M. Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting. Blood Adv. 2021; 5(22): 4666-4673.

Barton JC, Wiener HH, Acton RT, et al. Prevalence of iron deficiency in 62,685 women of seven race/ethnicity groups: the HEIRS study. PLoS One. 2020; 15(4):e0232125.

Lönnerdal, B. Calcium and Iron Absorption—Mechanisms and Public Health Relevance. Int. J. Vitam. Nutr. Res. 2010, 80, 293–299.

Shawki, A.; Mackenzie, B. Interaction of calcium with the human divalent metal-ion transporter-1. Biochem. Biophys. Res. Commun. 2010, 393, 471–475.

Hidalgo, C.; Nunez, M.T. Calcium, iron and neuronal function. IUBMB Life 2007, 59, 280–285

[14] Omega-3

Koletzko B, Cetin I, Brenna JT; Perinatal Lipid Intake Working Group; Child Health Foundation; Diabetic Pregnancy Study Group; European Association of Perinatal Medicine; European Association of Perinatal Medicine; European Society for Clinical Nutrition and Metabolism; European Society for Paediatric Gastroenterology, Hepatology and Nutrition, Committee on Nutrition; International Federation of Placenta Associations; International Society for the Study of Fatty Acids and Lipids. Dietary fat intakes for pregnant and lactating women. Br J Nutr. 2007 Nov;98(5):873-7. doi: 10.1017/S0007114507764747. Epub 2007 Aug 10. PMID: 17688705.

Zhang Z, Fulgoni VL, Kris-Etherton PM, Mitmesser SH. Dietary Intakes of EPA and DHA Omega-3 Fatty Acids among US Childbearing-Age and Pregnant Women: An Analysis of NHANES 2001-2014. Nutrients. 2018 Mar 28;10(4):416. doi: 10.3390/nu10040416. PMID: 29597261; PMCID: PMC5946201.

[15] Manganese

Ramakrishnan, U., Gonzalez-Casanova, I., Schnaas, L., DiGirolamo, A., Quezada, A. D., Pallo, B. C., Hao, W., Neufeld, L. M., & Rivera, J. A. (2016). Manganese intake and status during pregnancy and lactation: Progress and research gaps. Nutrients, 8(7), 1-15. https://doi.org/10.3390/nu8070409

Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient Supplements. Washington (DC): National Academies Press (US); 1990. 15, Trace Elements. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235243/

Institute of Medicine (US) Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington (DC): National Academies Press (US); 2001. 10, Manganese. Available from: https://www.ncbi.nlm.nih.gov/books/NBK222332/

[16] Copper

Ceko, M. J., Hummitzsch, K., & Hatzirodos, N. (2018). Copper and its role in embryo physiology during pregnancy. Cell and Tissue Research, 372(3), 399-414. https://doi.org/10.1007/s00441-017-2753-4

Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient Supplements. Washington (DC): National Academies Press (US); 1990. 15, Trace Elements. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235243/

Institute of Medicine (US) Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington (DC): National Academies Press (US); 2001. 10, Manganese. Available from: https://www.ncbi.nlm.nih.gov/books/NBK222332/

[17] Vitamin K

Greer, F. R., & Marshall, S. P. (2017). Vitamin K and its impact on maternal–fetal outcome: A review. Seminars in Perinatology, 41(1), 23-29. https://doi.org/10.1053/j.semperi.2016.09.011

Institute of Medicine (US) Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington (DC): National Academies Press (US); 2001. 10, Manganese. Available from: https://www.ncbi.nlm.nih.gov/books/NBK222332/

Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient Supplements. Washington (DC): National Academies Press (US); 1990. 17, Vitamins A, E, and K. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235251/

[18] Boron

Wells, E. M., Herdt-Losavio, M. L., Druschel, C. M., & Lin, S. (2015). Boron during pregnancy: Exposure assessment and epidemiological evidence of birth outcomes. Journal of Exposure Science & Environmental Epidemiology, 25(5), 523-530. https://doi.org/10.1038/jes.2015.25

Khayat S, Fanaei H, Ghanbarzehi A. Minerals in Pregnancy and Lactation: A Review Article. J Clin Diagn Res. 2017 Sep;11(9):QE01-QE05. doi: 10.7860/JCDR/2017/28485.10626. Epub 2017 Sep 1. PMID: 29207789; PMCID: PMC5713811.

Institute of Medicine (US) Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington (DC): National Academies Press (US); 2001. 13, Arsenic, Boron, Nickel, Silicon, and Vanadium. Available from: https://www.ncbi.nlm.nih.gov/books/NBK222322/

[19] Coenzyme Q10

Teran, E., Hernandez, I., Nieto, B., & Tavara, R. (2019). Role of Coenzyme Q10 in pregnancy and infant health. The Journal of Maternal-Fetal & Neonatal Medicine, 32(1), 172-178. https://doi.org/10.1080/14767058.2017.1418321

[20] Vitamin E

Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Panel on Dietary Antioxidants and Related Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of DRIs, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board 6 x 9, 529 pages, 2000.

Adams JB, Kirby JK, Sorensen JC, Pollard EL, Audhya T. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol. 2022 Jul 11;8(1):4.

Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient Supplements. Washington (DC): National Academies Press (US); 1990. 17, Vitamins A, E, and K. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235251/

[21] Selenium

Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Panel on Dietary Antioxidants and Related Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of DRIs, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board 6 x 9, 529 pages, 2000.

Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient Supplements. Washington (DC): National Academies Press (US); 1990. 17, Vitamins A, E, and K. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235251/

[22] Vitamin B1 / Thiamine Mononitrate

Mok, K. C., & Chen, C. T. (1979). B1-adenosine thiamine diphosphate, a fluorescent analogue of thiamine diphosphate: Binding studies with enzymes involved in thiamine metabolism. Journal of Biological Chemistry, 254(5), 1461-1467. https://www.jbc.org/article/S0021-9258(19)38963-5/fulltext

Adams JB, Kirby JK, Sorensen JC, Pollard EL, Audhya T. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol. 2022 Jul 11;8(1):4.

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients, Food and Nutrition Board, Institute of Medicine 6 x 9, 592 pages, 2000.

[23] Niacinamide / Vitamin B3

Adams JB, Kirby JK, Sorensen JC, Pollard EL, Audhya T. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol. 2022 Jul 11;8(1):4.

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients, Food and Nutrition Board, Institute of Medicine 6 x 9, 592 pages, 2000.

[24] Biotin / Vitamin B7

Adams JB, Kirby JK, Sorensen JC, Pollard EL, Audhya T. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol. 2022 Jul 11;8(1):4.

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients, Food and Nutrition Board, Institute of Medicine 6 x 9, 592 pages, 2000.

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