The prenatal vitamin aisle can be overwhelming. Gummies vs. pills vs. capsules. Synthetic folate vs. methylfolate. $10 vs. $60. What actually matters?
Here's what you need to know to choose wisely.
The Non-Negotiable Nutrients
| Nutrient | What to Look For | Why It Matters |
|---|---|---|
| Folate | 400-800mcg (Critical!) | Prevents neural tube defects. Start before conception. |
| Iron | 18-27mg | Supports increased blood volume; prevents anemia. |
| Iodine | 150-220mcg | Critical for baby's brain development. Often missing! |
| Vitamin D | 600-4000 IU | Supports bone health, immune function, fertility. |
| Choline | 450mg (often lacking) | Brain development; as important as folate for neural tube. |
| DHA (Omega-3) | 200-300mg | Brain and eye development. Separate supplement if not included. |
| B12 | 2.6-6mcg | Works with folate; especially important for vegetarians. |
Choline and Iodine are often low or absent in prenatal vitamins. Choline is as important as folate for preventing neural tube defects, yet most prenatals contain little or none. Check your label—you may need to supplement separately or choose a prenatal that includes both.
Folate vs. Folic Acid: Does It Matter?
Folic acid is the synthetic form of folate. Most people convert it to the active form just fine. It's well-studied, inexpensive, and effective for the vast majority of women.
Methylfolate (5-MTHF, L-methylfolate) is the already-active form. It bypasses the conversion step. About 30-40% of people have MTHFR gene variants that reduce conversion efficiency, though most can still get enough folate from folic acid.
Bottom line: Methylfolate is a reasonable choice, especially if you know you have MTHFR variants or want extra assurance. But folic acid works well for most women and is found in effective prenatals at all price points.
Our Top Prenatal Picks
What About Adding DHA and Choline?
If your prenatal is low in these crucial nutrients, consider adding:
Nordic Naturals Prenatal DHA
Gold standard for fish oil
Needed Choline
Full recommended amount
Seeking Health Choline
Budget choline option
When to Start Taking a Prenatal
Ideally: 1-3 months before you start trying to conceive. This ensures folate levels are optimal when the neural tube is forming (very early in pregnancy).
At minimum: As soon as you stop birth control or start trying.
Already pregnant? Start immediately. It's never too late to benefit, though earlier is better for neural tube development.
For most women: Thorne Basic Prenatal + separate DHA (Nordic Naturals) + separate Choline (Seeking Health) gives you complete coverage with high-quality, well-absorbed ingredients for about $50-60/month total. For a simpler option at a higher price point, Theralogix TheraNatal Complete includes everything in one system.
Signs You May Need to Switch Prenatals
- Severe nausea: Try a prenatal without iron temporarily, or switch to gummies during first trimester
- Constipation: Iron can cause this; look for gentle iron forms (iron bisglycinate) or lower-iron formulas
- Difficulty swallowing pills: Gummies or smaller capsules may work better
- Anemia despite prenatal: You may need additional iron or a higher-iron formula
- Stomach upset: Take with food or try a different brand; some fillers cause sensitivity
Not Sure What You Need?
Our quiz can help you understand your fertility journey and recommend next steps.
Take the Fertility Quiz →The Bottom Line
The "best" prenatal is one you'll actually take consistently. That said, make sure it covers the essentials:
- Folate: 400-800mcg minimum (methylfolate or folic acid both work for most)
- Iron: 18-27mg (unless your doctor says otherwise)
- Iodine: 150mcg (often missing—check your label!)
- Vitamin D: 600+ IU (many people need more)
- Choline: As close to 450mg as possible (usually requires separate supplement)
- DHA: 200-300mg (often separate)
Start at least one month before trying, take it daily, and continue through pregnancy and breastfeeding. This simple step is one of the most impactful things you can do for your future baby's health.