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Fertility Health
pre-pregnancy vitamins

As you start thinking about adding to your family, you’ll want to prepare your body as much as possible for pregnancy. One way to do that is to take pre-pregnancy vitamins.  While you likely know about the importance of folate (folic acid) before pregnancy, you may not know about several other critical nutrients. Along with folic acid, your pre-pregnancy vitamins should also contain the right amount of vitamin D, iodine, choline, and iron.

In this article, we share the five nutrients your pre-pregnancy vitamins should contain. Then we share how these nutrients can improve your fertility and help put your pregnancy on the right track.

At the very least, your pre-pregnancy vitamins should contain:

1. Folate (folic acid)

Folate (folic acid) is essential for many of the body’s normal processes and is necessary for proper formation of the neural tube in the earliest weeks of pregnancy. The Centers for Disease Control and Prevention, CDC, recommends that all women of childbearing age consume at least 400 mcg of folic acid each day. You want to be sure that this nutrient is in good supply during the earliest weeks of pregnancy. Your baby needs folic acid most during the first few weeks (around 4 to 6 weeks) after conception.

The term “folate” refers to naturally occurring food folates, as well as folic acid, the form found in many supplements and added to grains. Folate is naturally found in leafy green vegetables, fruit, dried beans, peas and nuts. These are healthy foods and you should definitely eat them often. However, it can be difficult to rely on what you eat to supply the steady intake of folate required for early pregnancy.

Folic acid needs during early pregnancy

You’ve probably heard that folic acid prevents birth defects known as NTDs or neural tube defects. The most common NTD is spina bifida.  Inside the embryo, the brain and spinal cord form from the neural tube, which starts out as a tube-like grouping of cells. It finishes forming 4 to 6 weeks after the first day of a woman’s last menstrual period. Studies show that taking a supplement with enough folic acid –  for at least one month before conception and continuing through pregnancy –  can significantly reduce the risk of NTDs.

How to get enough folic acid daily

Beginning in 1998, the United States Department of Agriculture (USDA) required food manufacturers to add folic acid to certain food products that do not naturally contain folate. These foods include enriched bread, flour, cornmeal, rice, pasta and other grain products. The Harvard T.H. Chan School of Public Health recommends relying on a daily multivitamin containing folic acid, however, instead of consuming a diet high in fortified foods.

One of the best ways to be confident you get enough is to take pre-pregnancy vitamins that contain, at the very minimum, 400 mcg of folic acid.

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2. Vitamin D

Higher vitamin D levels in the blood are associated with increased odds of getting pregnant and having a healthy pregnancy. Many women have a low vitamin D level. Here’s why. First, there are not many vitamin D-rich foods in our diet. The UV rays from sunlight on our skin trigger vitamin D synthesis. However, many women stay out of the sun or wear sunscreen to help reduce their risk for skin cancer. Also, women with darker skin have more melanin which reduces the ability of the skin to produce vitamin D from sunlight. So it’s easy to see how many women can have low levels of vitamin D when they start trying for a baby. It is worthwhile to get tested to determine your vitamin D level and to take a supplement if needed.

The goal is to reach and maintain a vitamin D blood level of 30 ng/mL or greater.  Women with vitamin D levels above 30 ng/mL during preconception have a better chance of getting pregnant and are at a lower risk for miscarriage than those who have low levels.

Vitamin D is also helpful for improvements in in vitro fertilization (IVF) outcomes. Moreover, higher vitamin D levels in the ovary may improve embryo implantation rate.

Vitamin D during pregnancy

Most reproductive health professionals believe that maintaining a healthy vitamin D level during pregnancy is critical. In many cases, it can improve pregnancy outcomes. Research shows that daily doses of 2,000 to 4,000 IU of vitamin D3 during pregnancy will usually produce normal blood levels. Women with normal vitamin D blood levels have a reduced risk for complications such as preterm birthgestational diabetes, and infant infection.

How to maintain vitamin D levels

Many people don’t know what their blood level of vitamin D is. Therefore, it is essential to ask your healthcare professional to test your level. If it is lower than 30 ng/mLpreconception vitamins with 2,000 to 4,000 IU of vitamin D each day can help restore you to a healthy level. The restoration process can take 60-90 days. Once your vitamin D level is healthy (greater than 30 ng/mL), you can take 2,000 IU of vitamin D each day to maintain this level.

3. Iodine

One nutrient that we don’t hear a lot about is iodine. Both you and your baby need enough iodine for your thyroid to do its job, and to regulate several important processes in the body. You also need enough iodine to ensure that your baby’s brain develops to its fullest potential.

Iodine deficiency may reduce pregnancy chances since women with moderate to severe deficiencies may take longer to get pregnant. A deficiency during pregnancy can lead to low birth weight and a decreased survival rate of the baby.

Iodine in foods

Elizabeth Ward, the author of Expect the Best, states: “Research suggests that women in their childbearing years in the US are probably at the greatest risk for insufficient iodine consumption. Adequate intake is important for baby’s brain development during pregnancy and breastfeeding, and even a mild iodine deficiency can limit baby’s physical and mental development. Certain foods are better sources of the mineral than others, but levels can vary. Seafood and sea vegetables, such as kelp and nori, are reliable iodine sources. Fruits and vegetables contain iodine, but the amount varies depending on the iodine content of the soil and other factors. Iodized salt is also a source, but it is not typically used in processed foods.”

How to get enough iodine daily

Elizabeth Ward recommends taking pre-pregnancy vitamins to get the iodine you need. She states: “It’s not always easy to fulfill your daily iodine quota with food, which is why the American Thyroid Association (ATA) recommends that pregnant and breastfeeding women, and those who are planning to become pregnant, consume at least 250 micrograms (mcg) of iodine daily. The ATA suggests that pregnant and breastfeeding women take 150 mcg of iodine as a dietary supplement every day to fill in possible iodine gaps. Choose a multivitamin with potassium iodide, as this form of iodine is well absorbed by the body.”

4. Iron

Another nutrient that you may not consider essential for preconception is iron. Iron is necessary to support the growing placenta and to support your plasma volume and red cell mass. Healthy iron levels during pregnancy help to reduce the risk of complications including abnormal kidney formation in the baby, which may lead to kidney disease in adulthood.

You actually need less iron during preconception than you need during pregnancy. Your pre-pregnancy vitamins should contain 18 mg of iron, and the dose should increase as your pregnancy goes on.

During the second and third trimester of pregnancy, your iron needs increase to 27 mg per day. You can find iron in fortified grain products, beans, lentils, and spinach. However, you will want to rely on pre-pregnancy vitamins to supply this increased need during pregnancy.

5. Choline

Choline is a vitamin-like compound that your body needs for cell membrane signaling, lipid transport, and many other functions in the body. Along with folate, choline is essential for neural tube formation.  You need choline during pregnancy because it is critical for fetal and infant brain development.

Despite choline’s importance, few women get enough in their diet. The American Medical Association recently recommended that all prenatal vitamins contain adequate choline.  Most prenatal vitamins do not contain any choline because it is difficult to put into a tablet or softgel.

It is very important to eat choline-rich foods (egg yolks, fish, chicken, broccoli, and brussels sprouts) while trying to conceive and during pregnancy, in addition to taking a prenatal containing at least 100 mg of choline.  The goal is to get at least 450 mg of choline from food and supplements each day.


When you’re thinking about getting pregnant, it’s essential to get enough of these nutrients. Many people are aware of the need for folic acid.  However, there is not much attention to iodine, iron, choline, or vitamin D as they relate to pregnancy. Consider taking pre-pregnancy vitamins to give you adequate levels of these critical nutrients.

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