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Prenatal Label Red Flags: A pharmacist’s POV on what to look for, and what to avoid, on a supplement label.
Navigating pregnancy can be overwhelming. There can be much confusion about what to eat, what activities you can or can’t to do and what vitamins to take!
Not all multivitamins are created equal. Here is what you need to look for and avoid.
Why do pregnant women even need to even supplement?
One of the first things a woman planning pregnancy or just found out is pregnant, are advised is to start taking a prenatal (pregnancy) supplement. This is because pregnancy is a time of vital growth, development and increased nutrient requirements. Evidence indicates that the first 1,000 days of life are critical for optimal growth and brain development1.
Eating a nourishing diet should be prioritised where possible. Women will get most of their key vitamins and minerals from a varied, wholefood diet including meat, fish, poultry, eggs, dairy, vegetables, fruit and legumes2.
Even if you are eating a well-rounded diet, recommended dietary intake is higher for some nutrients when pregnant. A prenatal multivitamin is recommended to bridge any gaps and reduce risk of nutrient deficiency. This is especially important during early pregnancy when baby is developing rapidly and when many pregnant women struggle to eat well due to morning sickness.
What should a pregnancy multivitamin include?
Look for these two essentials – iodine and folate
A pregnancy multivitamin should always include supplementation of iodine and folate (as recommended by national pregnancy guidelines)2.
Iodine is essential for a baby’s brain and central nervous system development. To produce enough thyroid hormone to meet foetal demands, a women’s daily intake needs need to increase by approximately 100 mcg per day1. This is further increased during breastfeeding. Changing dietary habits in Australia based on food trends (iodised salt replaced with Himalayan salt, reduced bread consumption and use of plant based milk alternatives) pre-dispose women to an increased risk of iodine deficiency1. National pregnancy guidelines recommend to take 150 mcg per day to prevent iodine deficiency2. This is lower than the recommended dietary intake for pregnancy and lactation which is higher at 220 mcg/day for pregnant women and 270 mcg/day for lactating women1.
Folate is very important in early pregnancy to prevent congenital neural tube defects such as spinal bifida. It is recommended for 400–600 mcg per day from 4 weeks pre-conception and through the first 12 weeks2. Continuing folic acid supplementation throughout the rest of pregnancy has been reported to reduce risk of pre-eclampsia and lower risk of preterm birth3. If you haven’t taken folic acid before you found out you were pregnant – don’t worry, just be sure to start as soon as you can once you know that you are pregnant2.
What about the extras?
Other vitamins and minerals that may be included in a prenatal multivitamin
There are other common key vitamins and minerals that a prenatal multivitamin may include to help bridge nutritional gaps and optimise mother and baby’s health.
These may include vitamin D, choline, B vitamin cofactors, omega-3 fatty acids and vitamin C. Always check if your prenatal multivitamin is designed for pregnancy to ensure the right vitamins and right levels are appropriate for pregnant women.
Other supplementation your doctor or midwife may recommend
For some women, there will be a clinical need to take extra supplementation outside of a prenatal vitamin for known risk factors or deficiencies. Iron is commonly added on as a supplement during pregnancy. Research shows that up to two-thirds of women may become iron deficient during their pregnancy due to the high cost of iron during gestation4. Once a woman becomes iron deficient in pregnancy, diet alone is unlikely to replete iron stores and supplementation is recommended4. Another example of additional supplementation that a health provider may recommend for pregnant women is calcium if at risk of high blood pressure2.
Red flag – why more is not always better
A pregnancy multivitamin is designed to provide peace of mind and bridge any dietary gaps. However, it is important that pregnant women are aware of the risk of taking too much. This can be the case if taking multiple products such as fortified food or beverages containing vitamin C or B complexes like energy drinks; or morning sickness tablets such as pyridoxine (B6)5.
Some supplements are unnecessary and not completely without harm6. High dose supplements of vitamin A, C and E can be harmful in pregnancy and should not be taken by pregnant women with no identified deficiency.
Even unnecessary doses of some recommended vitamins can present health risks. The Therapeutic Goods Administration has reported high doses of vitamin B6 can lead to adverse pregnancy outcomes5. Another example is a recent link between maternal folate excess and gestational diabetes7. This is why it is important for pregnant women to only take extra supplementation outside of their prenatal multivitamin if recommended by their healthcare provider.
The takeaway message is that women should always check that their multivitamin is designed for use in pregnancy. Insufficient supplementation can lead to issues and too much supplementation can also lead to issues. If you are unsure if a multivitamin is suitable, check with your healthcare provider.
Red flag – always check before starting complementary or alternative medicines
Complementary medicines require caution from pregnant women as few have been established as being safe or effective during pregnancy.
Some commonly used and accepted supplements in pregnancy include ginger and probiotics (always check for pregnancy safety data for that proprietary product). Ginger and peppermint tea can be helpful for relieving nausea during periods of morning sickness or for traditional indigestion relief8.
Particular care should always be taken with other herbal products (this includes Chinese medicines, Ayurvedic medicines and powders/teas which include medicinal mushrooms). This is because of sub-optimal evidence on safety and unclear dosing or timing on which trimester a herbal preparation can be safely taken8.
It is important to check with your healthcare provider on the safety of any new medicine, supplement or herbal preparation during pregnancy.
Red flag – Check your prenatal multivitamin is TGA listed
An important tip is to check that your prenatal vitamin has been reviewed by the Therapeutic Goods Administration (TGA) and includes an AUST-L number on their medicine label. This ensures safety and quality standards are met10.
It is worth going one step further and checking if your prenatal vitamin has had independent ingredient testing by a third party or efficacy testing with research institutions.
Top Tips
- A multivitamin is not a substitute for a balanced diet – aim to eat a wide variety of wholefoods
- A prenatal multivitamin does have an important and legitimate place for pregnant women who require higher levels of specific nutrients
- Folic acid and iodine are recommended for routine supplementation
- Supplementation helps bridge gaps if dietary intake is insufficient
- More is not always better – only supplement based on medical advice
- Always check with your healthcare provider before starting supplements
- Ensure prenatal vitamins are TGA listed
Addendum to flag Aus Pregnancy Guidelines Dec 2025 updates (more conservative recommendations).
Additional Prenatal Supplementation
When it comes to extra supplementation outside of iodine and folate, the NRMC guidelines currently recommend:
Calcium – Advised for women at risk of high blood pressure
Iron – Advised for all pregnant women to reduce risk of iron-deficiency anaemia
Appropriate dose should be taken in context of dietary intake and RDI
Vitamin B6 – Additional supplementation not routinely recommended
Vitamin B12 – Additional supplementation not routinely recommended
Vitamin D – Additional supplementation not routinely recommended
Magnesium – Additional supplementation not routinely recommended
Omega-3 fatty acids – Additional supplementation not routinely recommended
Vitamin A and E – High-dose supplementation not recommended
Vitamin C – High-dose supplementation not recommended if intake adequate
Choline – Insufficient evidence for routine recommendation
Zinc – Additional supplementation not routinely recommended
Probiotics – Insufficient evidence to provide recommendation
