What are the Best Prenatal Vitamins for Brain Development?
The Most Important Prenatal Nutrients for Brain Development
The neurodevelopmental benefits of choline are realized before the baby is born, and mother’s intake of choline influences the development of the fetal brain and has long-lasting impacts on the child’s memory, cognition, and behavior.
Adequate prenatal choline intake has been suggested to:
- Improve neurological function and lessen intellectual disability in children with Down Syndrome
- Improve cognitive deficits caused by prenatal exposure to alcohol
- Protect against neurologic and psychological disorders associated with fetal iron deficiency
- Reduce anxiety- related behavior in children who were impacted by maternal stress within the womb.
In childhood, choline is further responsible for neuron signaling, memory, and neurotransmitter production and metabolism.
Prenatal Daily Intake Goal: 500 mg
Food Source: eggs, liver, peanuts, fish, beef, chicken
Supplemental Source: Phosphatidyl Choline and lecithin (which contains phosphatidyl choline) are great sources. Additionally, some prenatals now contain choline!
DHA is present in the cell membrane of the brain and is necessary for the growth and maturation of an infant’s brain.
The accumulation of DHA in the child’s brain is primarily determined by maternal intake while in the women through dietary intake until 2 years of age.
Children of mother’s with higher levels of DHA have been shown to have better visual motor skills and improved cognitive abilities!
The benefits of maternal intake of DHA don’t stop in pregnancy. High DHA concentrations in breast milk have been associated with several brain-related positive health benefits in infants.
Prenatal Daily Intake Goal: The American Academy of Pediatrics recommends consuming 200-300 mg/day.
Food Source: Best source is through fish, though it is recommended that fish consumption is limited to 1x weekly during pregnancy due to mercury contamination. Therefore, I typically recommend supplementation.
Supplemental Source: Cod liver oil and algae based supplements are typically highest in DHA, but fish and krill sources also often provide the necessary amount.
Iodine is an essential mineral for thyroid production. Without sufficient iodine intake, thyroid hormone cannot be synthesized. This poses great risk in pregnancy, as thyroid hormone is essential for fetal growth and development, especially neurodevelopment. We’ve known for some time that low thyroid in pregnancy can increase risk of various neurodevelopmental disorders, including lower IQ. Likewise, prenatal iodine deficiency can results in deficits in intelligence, behavioral disorders, and language in offspring.
Iodine continues to be important during lactation, and the demands actually increase during this time, as the iodine content of breastmilk depends on maternal consumption. Iodine deficiency in early childhood can have harmful effects on the development of the child’s brain and nervous system.
After reading this, you may have the desire to take large amounts of iodine supplements. However, that is not recommended either- as too much iodine carries its own set of risk.
Daily Intake Goal: 250 mcg/day during pregnancy; 290 mcg/day during lactation.
Food Source: Seaweed is by far the best food source of naturally derived iodine, followed by seafood. As I typically don’t recommend sushi during pregnancy, one easy way to regularly consume seaweed is though seaweed snacks, which average about 50 mcg per pack. Fish needs to be consumed sparingly during pregnancy because of contamination with mercury, but shrimp and oysters have lower mercury content and can be consumed more regularly. Other sources of dietary iodine include dairy and eggs; however, attaining enough dietary iodine without the use of seaweed and seafood is difficult. This is why iodized salt and fortified foods became available. In those who eat mostly whole foods and use sea salt, I typically recommend a multi-vitamin supplement that contains iodine.
Supplemental Source: I recommend looking for a prenatal that contains at least 100 mcg from seaweed
Iron deficiency is the most common micronutrient deficiency around the world, and pregnant women are particularly vulnerable due to increased blood volume. In the prenatal period, iron plays a major role in neurodevelopment and a deficiency can result in long term neurobehavioral defects, including altered temperament, memory deficits, impaired fine motor skills and worse language ability.
Women should be screened for iron deficiency early on in pregnancy; however, screenings are often insufficient and only look at hemoglobin and hematocrit. I recommend a full iron panel, CBC, and ferritin. Ferritin levels are typically the most sensitive marker (as long as mom is not suffering from any inflammatory condition) and should be above 40 ng/mL.
Daily Intake Goal: 27 mg/day is recommended during pregnancy to maintain adequate levels; however, more will be needed if you have an iron deficiency.
Food Source: Lean beef, lamb, venison, elk, oysters, chicken, and turkey are all great sources of iron. Iron from vegetables is poorly assimilated. For this population, I recommend black strap molasses and regular use of cast iron pans.
Supplemental Source: Excess iron supplementation is not recommended, as too much iron can increase reactive oxygen species (leading to oxidative stress) and alter the gut microbiome towards a more dysbiotic profile that includes more pathogenic species.
B12, Folate, and Methylation
By far, this is the most confusing nutrient relationship to explain, yet potentially the most important. Folate is an essential nutrient in DNA synthesis and has an important role in methylation, and we have long known the importance of folate in preventing neural tube defects of the brain and spinal cord. However, recently, we’ve come to find that more may not always be better (especially in the case of folic acid). Let me explain…
In order to prevent neural tube defects, the US Public Health Service recommended in 1992 that women of reproductive age consume 400 mcg of folic acid before and during pregnancy. Folic acid is a synthetic form of folate that is used to fortify foods and within supplements. Around this same time, fortification of cereal products was increased. After this time period, average serum folate levels in the United States increased by 2.5 times! Evidence then began to emerge that too much unmetabolized folic acid could be increasing rates of autism.
An article published in 2017 in the Journal of Paediatric and Perinatal Epidemiology reports a “U” shaped relationship between maternal multivitamin supplementation and risk of autism. This study found that while deficiencies in B12 and folate can to increased risk of autism, so can extremely elevated maternal levels of folate and B12. So what is the right amount?
I believe it is less about the particular nutrients themselves, and more about how they influence methylation. In order to be utilized by the body, B12 and Folate must be methylated. For this reason, certain forms of these nutrients, such as folic acid and cyanocobalamin steal methyl groups, leading to undermethylation. On the other side, nutrients like methylfolate and methylb12 act as methyl donors, thereby, contributing to methylation.
Now, too little methylation or too much methylation BOTH have their own set of risk factors. We don’t want either. There is competition between the acetyl (unmethylated groups) and the methyl groups which often determines whether a gene is expressed or silenced. Methyl groups are powerful modifiers of DNA that can inhibit gene expression, while acetyl groups promote gene expression.
So what form is best? To date, there has been no research to support methylfolate contributing to increased rates of autism or any other adverse health outcome in offspring; therefore, methylfolate is my choice for folate supplementation in pregnancy. The only time I clinically recommend folic acid is when I am working with a woman who has a clinical history of depression and laboratory results that reveal overmethylation, as methylfolate has been shown to reduce serotonin activity. When it comes to B12, I usually prefer a combination of methylcobalamin and adenosylcobalamin within the general population, which promotes balanced methylation. That being said, in clinical practice, I often adjust this ratio for patients based on their genetic predisposition and markers of methylation status.
Daily Intake Goal:
- Methylfolate: minimum of 600 mcg of DFE
- Methylcobalamin/ adenosylcobalamin: this range is extremely variable, and I recommend consulting your physician for individualized recommendations based on your current levels of B12, MMA, Homocysteine, MCV, and Whole Blood Histamine. Those consuming a vegan or vegetarian diet are generally at increased risk for vitamin B12 deficiency.
- Folate: leafy green vegetables, lentils, broccoli, asparagus, nuts and seeds, avocados, oranges, and many more fruits and vegetables.
- B12: naturally found in animal products, including fish, meat, poultry, eggs, and milk products.
Supplemental Source: Most individuals should meet their daily requirements through their prenatal, though your physician may add additional folate and/or B12 if you are at risk for deficiency.