Supplements During Pregnancy: What's Safe And What's Not

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Evidence BasedSupplements During Pregnancy: What’s Safe and What’s Not

Medically reviewed by Carla Prophete, MPAS, PA-C — Written by Jillian Kubala, MS, RD — Updated on May 13, 2024

Supplements during pregnancy
Safe supplements
Supplements to avoid
Bottom line

Key takeaways

Pregnancy increases your need for key nutrients, and experts recommend prenatal vitamins plus folic acid to help prevent birth defects.
Supplements considered safe with doctor guidance include folate, iron, vitamin D, magnesium, ginger, fish oil, probiotics, and choline, depending on your needs.
Some supplements should be avoided in pregnancy, including vitamin A and vitamin E, plus herbs like black cohosh, goldenseal, dong quai, and yohimbe.

If you did your extra credit work, we bet you already know that high mercury seafood, alcohol, and cigarettes are off-limits during pregnancy. What may surprise you is that some vitamins, minerals, and herbal supplements should be avoided as well.

Information on which supplements are safe and which aren’t varies and can make things feel even more complicated. We’ve got you, though.

This article breaks down which supplements are believed to be safe to take during pregnancy and why some supplements should be avoided.

Why take supplements during pregnancy?

Woman taking supplements During Pregnancy

Getting the right nutrients is important at every stage of life, but it’s especially critical during pregnancy, as you’ll need to nourish both yourself and your growing babe.

Pregnancy increases the need for nutrients

During pregnancy, macronutrient intake needs grow significantly. Macronutrients include carbohydrates, proteins, and fats.

For example, protein intake needs to increase from the recommended 0.36 grams per pound (0.8 grams per kg) of body weight for non-pregnant women to 0.5 grams per pound (1.1 grams per kg) of body weight for pregnant women.

You’ll want to be including protein in every meal and snack to meet your needs.

The requirement for micronutrients, which include vitamins, minerals, and trace elements, increases even more than the need for macronutrients.

While some people are able to meet this growing demand through a well-planned, nutrient-dense eating plan, it can be a challenge for others.

You may need to take vitamin and mineral supplements for various reasons, including:

Nutrient deficiencies: Some people may need a supplement after a blood test reveals a deficiency in a vitamin or mineral. Correcting deficiencies is critical, as a shortage of nutrients like folate has been linked to birth defects.
Hyperemesis gravidarum: This pregnancy complication is characterized by severe nausea and vomiting. It can lead to weight loss and nutrient deficiencies.
Dietary restrictions: Women who follow specific diets, including vegans and those with food intolerances and allergies, may need to supplement with vitamins and minerals to prevent micronutrient deficiencies
Smoking: Although it’s critical for mothers to avoid cigarettes during pregnancy, those who continue to smoke have an increased need for specific nutrients like vitamin C and folate.
Multiple pregnancies: Women carrying more than one baby have higher micronutrient needs than women carrying one baby. Supplementing is often necessary to ensure optimal nutrition for both the mother and her babies.
Genetic mutations like MTHFR: Methylenetetrahydrofolate reductase (MTHFR) is a gene that converts folate into a form that the body can use. Pregnant women with this gene mutation may need to supplement with a specific form of folate to avoid complications.
Poor nutrition: Women who under eat or choose foods that are low in nutrients may need to supplement with vitamins and minerals to avoid deficiencies.

In addition, experts like those at the American College of Obstetricians andGynecologists (ACOG) recommend that all pregnant people take a prenatal vitamin and folic acid supplement. This is advised to fill nutritional gaps and prevent developmental abnormalities at birth like spina bifida.

Depending on your personal circumstances, be prepared to take on the task of adding supplements to your daily routine if directed by your healthcare provider.

Herbal supplements can help with ailments — with caution

In addition to micronutrients, herbal supplements are popular.

One 2019 study found that 15.4 percent of pregnant women in the United States use herbal supplements. However not all disclose to their physicians they’re taking them. (A 2017 study found about 25 percent of herbal supplement users in the United States don’t tell their docs.)

While some herbal supplements may be safe to take during pregnancy, there are far more that might not be.

Although some herbs can help with common pregnancy ailments like nausea and upset stomach, some may be harmful to both you and baby.

Unfortunately, there isn’t much research regarding the use of herbal supplements by pregnant people, and much is unknown about how the supplements can affect you.

The safest bet? Keep your doctor in the know about any and all changes to your eating plan and supplements.

Supplements considered safe during pregnancy

Just as with medications, your doctor should approve and supervise all micronutrient and herbal supplements to ensure that they’re necessary and taken in safe amounts.

Always purchase vitamins from a reputable brand that has their products evaluated by third-party organizations like the United States Pharmacopeia (USP).

This ensures that the vitamins adhere to specific standards and are generally safe to take. Not sure which brands are reputable? Your local pharmacist can be a lot of help.

1. Prenatal vitamins

Prenatal vitamins are multivitamins that are specially formulated to meet the increased demand for micronutrients during pregnancy.

They’re intended to be taken before conception and during pregnancy and breastfeeding.

Observational studies have shown that supplementing with prenatal vitamins reduces the risk of preterm birth and preeclampsia. Preeclampsia is a potentially dangerous complication characterized by high blood pressure and possibly protein in the urine.

While prenatal vitamins aren’t meant to replace your healthy eating plan, they may help prevent nutritional gaps by providing extra micronutrients that are in high demand during pregnancy.

Since prenatal vitamins contain the vitamins and minerals that you’ll need, taking additional vitamin or mineral supplements may not be necessary unless suggested by your doctor.

Prenatal vitamins are often prescribed by doctors and available over-the-counter.

2. Folate

Folate is a B vitamin that plays an integral role in DNA synthesis, red blood cell production, and fetal growth and development.

Folic acid is the synthetic form of folate found in many supplements. It gets converted into the active form of folate — L-methylfolate — in the body.

It’s recommended to take at least 600 micrograms (mcg) of folate or folic acid per day to reduce the risk of neural tube defects and congenital abnormalities like cleft palate and heart defects.

In a review of five randomized studies including 6,105 women, supplementing with folic acid daily was associated with a reduced risk of neural tube defects. No negative side effects were noted.

Although adequate folate can be obtained through diet, many women don’t eat enough folate-rich foods, making supplementation necessary.

Additionally, the Centers for Disease Control and Prevention (CDC) recommends that all women of childbearing age consume at least 400 mcg of folate or folic acid per day.

This is because many pregnancies are unplanned, and birth abnormalities due to a folate deficiency can occur very early in pregnancy, even before most women know they’re pregnant.

It may be wise for pregnant women, especially those with an MTHFR genetic mutation, to choose a supplement that contains L-methylfolate to ensure maximum uptake.

3. Iron

The need for iron increases significantly during pregnancy, as maternal blood volume increases by about 45 percent.

Iron is critical for oxygen transport and healthy growth and development of your baby and the placenta.

In the United States, the prevalence of iron deficiency in pregnant women is around 18 percent, and 5 percent of these women have anemia.

Anemia during pregnancy has been associated with preterm delivery, maternal depression, and infant anemia.

The recommended intake of 27 milligrams (mg) iron per day can be met through most prenatal vitamins. However, if you have iron deficiency or anemia, you’ll need higher doses of iron, managed by your doctor.

If you aren’t iron deficient, you shouldn’t take more than the recommended intake of iron to avoid adverse side effects. These may include constipation, vomiting, and abnormally high hemoglobin levels.

4. Vitamin D

This fat-soluble vitamin is important for immune function, bone health, and cell division.

Vitamin D deficiency during pregnancy has been linked to an increased risk of cesarean section, preeclampsia, preterm birth, and gestational diabetes.

The current recommended intake of vitamin D during pregnancy is 600 IU or 15 mcg per day. However, some experts suggest that vitamin D needs during pregnancy are much higher.

Check in with your doctor regarding screening for vitamin D deficiency and proper supplementation.

5. Magnesium

Magnesium is a mineral involved in hundreds of chemical reactions in your body. It plays critical roles in immune, muscle, and nerve function.

Deficiency in this mineral during pregnancy may increase the risk of chronic hypertension and premature labor.

Some studies suggest that supplementing with magnesium may reduce the risk of complications like fetal growth restriction and preterm birth.

6. Ginger

Ginger root is commonly used as a spice and herbal supplement.

In supplement form, you may have heard of it used to treat nausea caused by motion sickness, pregnancy, or chemotherapy.

A review of four studies suggested that ginger is both safe and effective for treating pregnancy-induced nausea and vomiting.

Nausea and vomiting are common during pregnancy, with up to 80 percent of women experiencing them in the first trimester of pregnancy.

Though ginger may help reduce this unpleasant pregnancy complication, more research is needed to identify the maximum safe dosage. Double check with your doctor to see if you need it.

7. Fish oil

Fish oil contains docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), two essential fatty acids that are important for baby’s brain development.

Supplementing with DHA and EPA in pregnancy might boost post-pregnancy brain development in your baby and decrease maternal depression, though research on this topic isn’t conclusive.

Although observational studies have shown improved cognitive function in the children of women who supplemented with fish oil during pregnancy, several controlled studies have failed to show a consistent benefit.

For example, one 2010 study involving 2,399 women found no difference in the cognitive function of infants whose mothers had supplemented with fish oil capsules containing 800 mg of DHA per day during pregnancy, compared with infants whose mothers did not.

This study also found that supplementing with fish oil did not affect maternal depression.

However, the study did find that supplementing with fish oil protected against preterm delivery, and some evidence suggests that fish oil may benefit fetal eye development.

Maternal DHA levels are important for proper fetal development and supplementing is considered safe. The jury is still out on whether taking fish oil during pregnancy is necessary.

To get DHA and EPA through food, it’s encouraged to consume two to three servings of low-mercury fish like salmon, sardines, or pollock per week.

8. Probiotics

Given increased general awareness of gut health, many parents-to-be turn to probiotics.

Probiotics are living microorganisms that are thought to benefit digestive health.

Many studies have shown that probiotics are safe to take during pregnancy, and no harmful side effects have been identified, aside from an extremely low risk of probiotic-induced infection.

Additionally, several studies have shown that supplementing with probiotics may reduce the risk of gestational diabetes, postpartum depression, and infant eczema and dermatitis.

Research on probiotic use in pregnancy is ongoing, and more about the role of probiotics in maternal and fetal health is sure to be discovered.

9. Choline

Choline plays a vital role in baby’s brain development and helps to prevent abnormalities of the brain and spine.

The current recommended daily allowance of choline during pregnancy (450 mg per day) has been thought to be inadequate and that an intake closer to 930 mg per day is optimal instead.

Note that prenatal vitamins often don’t contain choline. A separate choline supplement may be recommended by your doctor.

Supplements to avoid during pregnancy

While supplementing with some micronutrients and herbs is safe for pregnant women, many of them should be avoided, or avoided in high amounts.

Always check with your doctor before adding any additional supplements outside of any prenatal vitamins you may be taking.

1. Vitamin A

You’ll often find vitamin A in your prenatal vitamins since it’s so important. Although this vitamin is extremely important for fetal vision development and immune function, too much vitamin A can be harmful.

Given that vitamin A is fat soluble vitamin, your body stores excess amounts in the liver.

This accumulation can have toxic effects on the body and lead to liver damage. It can even cause birth defects.

For example, excessive amounts of vitamin A during pregnancy has been shown to cause congenital birth abnormalities.

Between prenatal vitamins and foods, you should be able to get enough vitamin A, and additional supplementation outside of your prenatal vitamins is not advised.

2. Vitamin E

This fat-soluble vitamin plays many important roles in the body and is involved in gene expression and immune function.

While vitamin E is very important for health, it’s recommended that you don’t supplement with it.

Extra supplementation with vitamin E has not been shown to improve outcomes for either mothers or babies and may instead increase the risk of abdominal pain and premature rupture of the amniotic sack.

3. Black cohosh

A member of the buttercup family, black cohosh is a plant used for a variety of purposes, including controlling hot flashes and menstrual cramps.

It’s unsafe to take this herb during pregnancy, as it can cause uterine contractions, which could induce preterm labor.

Black cohosh has also been found to cause liver damage in some people.

4. Goldenseal

Goldenseal is a plant that’s used as a dietary supplement to treat respiratory infections and diarrhea, although there’s very little research on its effects and safety.

Goldenseal contains a substance called berberine, which has been shown to worsen jaundice in infants. It can lead to a condition called kernicterus, a rare type of brain damage that can be fatal.

For these reasons, definitely avoid goldenseal.

5. Dong quai

Dong quai is a root that has been used for over 1,000 years and is popular in traditional Chinese medicine.

Though it’s used to treat everything from menstrual cramps to high blood pressure, evidence regarding its efficacy and safety is lacking.

You should avoid dong quai, as it may stimulate uterine contractions, raising the risk of miscarriage.

6. Yohimbe

Yohimbe is a supplement made from the bark of a tree native to Africa.

It’s used as an herbal remedy to treat a range of conditions from erectile dysfunction to obesity.

This herb should never be used during pregnancy, as it has been associated with dangerous side effects like high blood pressure, heart attacks, and seizures.

7. Other herbal supplements considered unsafe during pregnancy

It’s best to avoid the following:

saw palmetto
tansy
red clover
angelica
yarrow
wormwood
blue cohosh
pennyroyal
ephedra
mugwort

The bottom line

Pregnancy is a time of growth and development, making health and nutrition a top priority. Taking the best care of that little one is the goal.

While some supplements can be helpful during pregnancy, many can cause dangerous side effects in both you and your baby.

Importantly, while supplementing with certain vitamins and minerals may help fill nutritional gaps, supplements are not meant to replace a healthy eating plan and lifestyle.

Nourishing your body with nutrient-dense foods, as well as getting enough exercise and sleep and minimizing stress, is the best way to ensure a healthy pregnancy for you and your baby.

Although supplements can be necessary and helpful in certain circumstances, always check with your doctor regarding doses, safety, and potential risks and benefits.

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How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Medically reviewed by Carla Prophete, MPAS, PA-C — Written by Jillian Kubala, MS, RD — Updated on May 13, 2024

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