Are Prescription Prenatal Vitamins Better than Over the Counter Ones?

Prescription prenatal vs OTC prenatal vitamins. Which one is right for you? Read our guide.

By Dr. Mare Mbaye, Natalist

Most people can agree that prenatal vitamins are considered an important addition to a nutritious diet around the time of pregnancy. In fact, both the Centers for Disease Control & Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend prenatal vitamins both before conception and throughout pregnancy.

Put simply, prenatal vitamins are vitamins that contain more folic acid and iron than your standard multivitamin since these nutrients are especially important to the growth of the developing fetus. What might be news to some women, however, is that there are both over the counter prenatals as well as prescription ones.

So, on top of the sheer number of prenatal vitamin options on store shelves to choose from, women have to also decide if they want a prescription or over the counter prenatal? Way to make a hard decision even harder…but never fear, we’ve got you covered with this explanation of the main differences (or lack thereof) between over the counter and prescription prenatals.

Let’s start with what these prenatals have in common. First and foremost, no matter what type of prenatal you end up taking or how you end up obtaining it, it is always recommended that you take it daily and that you start it prior to getting pregnant. This is dealt with in greater detail here,but briefly, there are certain nutrients in prenatal vitamins that are important in the first month after conception. Many women don’t realize they’re pregnant in those first four weeks so it’s recommended to be on a prenatal if you may be getting pregnant soon.

What makes a prenatal vitamin “prenatal?”

As mentioned before, what makes a prenatal vitamin “prenatal” is that it typically has higher amounts of certain nutrients per dose (folic acid and iron, most notably) than a regular old multivitamin. Why these particular nutrients?

In the case of folic acid, research has shown that low levels of folic acid can lead to a higher chance of neural tube defects, which are defects of the brain and spine. Neural tube defects are the second most common major congenital anomaly (after cardiac anomalies) and can have varying short and long-term outcomes.

Iron supports fetal growth and development by preventing anemia, where mom’s blood has a low number of healthy red blood cells. In addition, some research suggests that prenatal vitamins decrease the risk of having a baby who is small for his or her gestational age.

Another important nutrient is omega-3 fatty acid, which is thought to help promote brain development in the baby. Unfortunately, due to (valid) concerns of mercury and other contaminants in fish, most women in the US and other countries — both pregnant and nonpregnant — are not getting enough of the right fatty acids from their diet. If you don’t eat enough fish or other foods high in omega-3 fatty acids, you may want to consider a prenatal that contains those or a separate fatty acid supplement in addition to a regular prenatal vitamin. Most omega-3 fatty acid supplementation comes in the form of Docosahexaenoic acid (DHA).

Calcium and vitamin D are two more very important players in this game. They become especially critical during the third trimester, when a fetus’s bones are growing quickly. One study looked at vitamin D and calcium supplementation in pregnant teens and found that optimal intake of both nutrients was needed to maximize fetal bone growth. Another study looked at maternal vitamin D levels and found that low vitamin D can lead to changes in the fetus’ bone development as early as 19 weeks! And there’s plenty more studies out there that support these findings. Of note, vitamin D deficiency is incredibly common due to women staying indoors more and the increased use of sunscreen for cancer prevention. It is even more prevalent in women of color so don’t be surprised if your provider suggests additional supplementation on top of what may be in your prenatal vitamin to get your vitamin D level back in the normal range.

Regardless of prescription or over the counter, any vitamin that claims to be a prenatal should have folic acid, iron, calcium, and vitamin D supplementation. The omega-3 fatty acids are not always included, but are easy to supplement if the recommended amount can’t be met through diet alone.

What sets over the counter and prescription prenatals apart?

I will preface this by saying I am happy to leave it up to my patients whether they want a prescription or not. What matters most to me is that they are taking a prenatal vitamin consistently and without side effects. Many times when I’m prescribing a prenatal vitamin, I’m not choosing a specific brand over another. I look at the specific quantity of each nutrient and choose a prenatal that has all the doses we know are effective for pregnancy.

The only time this changes is if I have a patient who has had a neural tube defect in a prior pregnancy because then the recommended dose of folic acid is much higher and therefore easier to reach with most prescription prenatals.

One thing to remember is that the Food and Drug Administration (FDA) doesn’t regulate the safety or effectiveness of any over the counter supplements before they become available on the market. As a result, not all over the counter prenatal vitamins are created equal. This technically goes for prescription prenatal vitamins as well, though it’s not quite as drastic a difference from brand to brand. Despite this, most providers are pretty quick to suggest prenatal vitamins to anyone who’s trying to get pregnant (and even to those who aren’t).

This lack of regulation brings us to a significant difference between an over the counter and prescription prenatal: over the counter options vary more widely in terms of the exact doses they use for nutrients. This can make it a bit difficult to say exactly how much or what type of folic acid, iron, etc. is in each prenatal vitamin that is available on the market without knowing the exact brand and/or product. One plus to the prescription options is that they always have a high amount of folic acid (usually around 1000 mcg per dose, which is the maximum daily recommended dose). However, because of the well-established guidelines, it’s important to note that any over the counter supplement worth its salt that contains folic acid will have the recommended 400 mcg dose (and sometimes up to 800 mcg) per the CDC.

Prescription prenatals also tend to have iron in the chelated form. This form of iron is more readily absorbed into the bloodstream while being gentler on the stomach. Many over the counter prenatals don’t list what type of iron they contain. Furthermore, the omega-3 fatty acids — or DHA — found in prescription prenatals are generally pure and molecularly distilled to remove heavy metals. Over the counter prenatals do not necessarily undergo any such process so the purity of their DHA is difficult to assess.

The only other big difference is actually a pretty important one to consider — cost and convenience. Over the counter prenatals range widely based on ingredient quality, so make sure to read the label carefully. (Read our post Prenatal Vitamins: Why They Matter & How to Find the Best One For You).

Last but not least, is one option more convenient? Possibly. Both options can be sent to your home or easily called in and picked up from your local pharmacy. Where they may be a difference is in how often you need to take the prenatal vitamin each day. A prescription prenatal with higher doses per pill may allow you to take it fewer times per day.

I’ll leave you with what I always tell my patients in the office: the best prenatal is the prenatal that you can take every day! So once you’ve found your prenatal vitamin, just stay consistent with it, and you’ll be one step closer to a healthier, safer pregnancy.

Learn more at Natalist.

Originally published at https://natalist.com.