NIH Research Suggests Few Prenatal Supplements Meet All Nutrition Recommendations for Pregnancy

Posted on April 4, 2023August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Approximately 90 percent of pregnant women do not meet nutrition recommendations for pregnancy from diet alone and will need to supplement their diet with prenatal vitamins. At the same time, a majority of affordable prenatal supplements are missing the necessary amounts of at least one key nutrient, according to a new study funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Researchers analyzed the diets of 2,450 pregnant participants from six ECHO cohorts across the United States to determine the amount of key nutrients participants got from their diets and what additional amount they would need from a supplement.

After analyzing over 20,000 dietary supplements, researchers found only one that meets the nutritional recommendations for pregnancy for vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids when used to supplement the participants’ diets. The monthly cost was too high for some people and it required pregnant women to take seven pills a day. The researchers also identified other lower-cost supplements that provided the right amounts of at least five of the needed key nutrients.

“This research can inform pregnant women and their doctors about key nutrients they may be missing in their diet and help them choose prenatal vitamins that can provide the nutrients they need,” said Katherine Sauder, PhD, an ECHO Program investigator at the University of Colorado, Anschutz Medical Campus.

Dr. Sauder led this collaborative research published in The American Journal of Clinical Nutrition.

Sauder, C. et al. “Selecting a Dietary Supplement with Appropriate Dosing for Six Key Nutrients in Pregnancy.” American Journal of Clinical Nutrition. DOI: 10.1016/j.ajcnut.2022.12.018

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov

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ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

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ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

Authors: Katherine Sauder, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

Out of all the prenatal supplements analyzed, the study found one that may potentially give pregnant patients the optimal amounts of the most important nutrients. But, the monthly cost of this supplement can be too high for some people, and it requires pregnant women to take seven pills a day. To ensure that pregnant women have accessible options for prenatal vitamins, the researchers looked for dietary supplements containing close to the needed amounts of nutrients that cost less and required only one to two pills a day.

See the full publication (Appendix A) for a list of the prenatal supplements analyzed during this study and their nutritional contents.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study can inform pregnant women and their doctors about key nutrients they may be missing in their diet and what prenatal vitamins they can take to get those nutrients. Companies that manufacture prenatal vitamins can also use the results of this study to understand how much of these nutrients should be in the products they make. Importantly, this study highlights the ongoing need for more prenatal vitamin options that are low cost and convenient, while still containing the optimal amounts of key nutrients.

Why was the study needed?

It is important that pregnant women get the right amounts of the nutrients they need for a healthy pregnancy. There are thousands of options for prenatal dietary supplements in the United States, so ECHO researchers conducted this study to help pregnant women and doctors pick the ones that contain optimal doses of key micronutrients to support a healthy pregnancy.

Who was involved?

This study included 2,450 pregnant participants from six ECHO cohorts located across the United States.

What happened during the study?

ECHO researchers first analyzed data about what the participants ate and drank during their pregnancies. Then, they calculated how much vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids the pregnant participants were getting from their diet. The researchers compared the participants’ diets to nutrition recommendations for pregnancy to determine the amount of nutrients the participants would need from a prenatal vitamin to make up what they were missing in their diet.

The researchers compared over 20,000 prenatal vitamins available in the US, focusing on the nutrients that are most important for maternal and infant health: vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids.

What happens next?

In addition to the use of prenatal dietary supplements, pregnant women can adjust their diet to include more of the nutrients they need for a healthy pregnancy. Going forward, more research is needed to identify foods that pregnant women could eat to get enough of these nutrients.

Where can I learn more?

Access the full journal article, titled “Selecting a dietary supplement with appropriate dosing for six key nutrients in pregnancy" in The American Journal of Clinical Nutrition.

Read more information about healthy eating during pregnancy on the American College of Obstetricians and Gynecologists website.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published April 2023

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ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

ECHO Researchers Compare Thousands of Prenatal Vitamins to Help Pregnant Patients Get the Nutrients They Need

Posted on April 4, 2023April 3, 2025 by Jodi Snare

Collaborative ECHO research led by Katherine Sauder, PhD of the University of Colorado, Anschutz Medical Campus highlights six key nutrients essential for healthy pregnancies and identifies the best prenatal dietary supplements available in the United States to help pregnant women get the right amounts of these nutrients. Out of over 20,000 choices, the researchers found one prenatal dietary supplement that may potentially provide the right amounts of the most important nutrients needed during pregnancy: vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids. However, the supplement costs $200 per month and requires the patient to take seven pills a day, so the researchers identified other, more accessible vitamin supplement options that provide as close a match to the needed of amounts of nutrients as possible. This research, titled “Selecting a dietary supplement with appropriate dosing for six key nutrients in pregnancy," is published in The American Journal of Clinical Nutrition.

It is important for pregnant women to get optimal amounts of the right nutrients. There are thousands of options for prenatal vitamins in the United States, so ECHO researchers designed this study to help pregnant women and doctors select the ones that contain optimal doses of key micronutrients to support a healthy pregnancy.

This study included 2,450 pregnant participants from six ECHO cohorts located across the United States. ECHO researchers first analyzed data about what participants ate and drank during their pregnancies. Then, they calculated how much of the six key nutrients (vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids) mothers were getting in their regular diet. The researchers compared the participants’ diets to nutrition recommendations for pregnancy to determine the amount of nutrients the participants would need from prenatal vitamins to supplement their diet.

“This research will inform pregnant patients and their doctors about key nutrients they may be missing in their diet and help them choose prenatal vitamins that can provide the nutrients they need,” said Dr. Sauder. “Dietary supplement manufacturers can also use these results to inform better dosing in their products.”

The results of this study highlight the ongoing need for prenatal vitamin options that are low cost and convenient, while still containing the optimal amounts of key nutrients. More research on nutrients in foods will also be needed to help pregnant patients get more of these key nutrients in their daily diets.

Read the research summary.

March is National Nutrition Month

Posted on March 16, 2022June 7, 2023 by Jodi Snare

March is National Nutrition Month. With information from a diverse population of more than 50,000 children followed from birth through adolescence, ECHO researchers are well positioned to investigate how nutrition influences child health across our five outcome areas, including obesity.

This month’s Connector features ECHO research that explores the extent to which treating pregnant women, who cannot quit smoking, with vitamin C can protect lung function for their children. In addition, this issue of the Connector includes ECHO research on the relationship between growth in early childhood and the onset of puberty, as well as facilitators and barriers to clinical trial recruitment in rural settings.

As a reminder, the ECHO Program is back on Twitter. We encourage you to follow the ECHO Twitter account (@ECHOChildHealth) to stay up-to-date on ECHO news and events, including information on recent publications and research.

ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

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ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

Author(s): Emily Zimmerman, Andréa Aguiar, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, and the National Institutes of Health.

Footnote: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

What were the study results?

The researchers found that higher maternal stress during late pregnancy was associated with fewer but longer sucking bursts when the infants sucked on the special pacifier. It is important to note that the maternal stress levels and infants’ sucking behaviors between the two cohorts were different. This could be due to differences between the two cohorts’ cultures, geographical locations, ethnicities, incomes, and education levels.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This is the first study investigating the link between maternal stress and infants’ sucking patterns. The results of this study may help promote awareness and earlier detection of stress exposure during pregnancy and, as a result, improve the treatment of stress-exposed infants. This study also researched these outcomes in two groups of participants with different demographics and stress levels, which may allow for earlier detection of high maternal stress exposure in lower SES populations.

Why was this study needed?

Previous studies show that a mother’s stress during pregnancy can affect her baby’s development. But less is known about how a mother’s stress during pregnancy relates to their infant’s brain function early in life. Infants’ sucking patterns have been used to measure brain function soon after birth. This study investigated whether there was any relationship between mothers’ stress in pregnancy and their young infants’ sucking patterns.

Who was involved?

The study included participants from two ECHO cohorts—one from Urbana-Champaign, Illinois and the other from Manati, Puerto Rico.

What happened during the study?

The researchers surveyed mothers regarding their stress during late pregnancy using the Perceived Stress Scale, which has 10 questions. Next, between one and eight weeks after the mothers gave birth, the researchers measured the infants’ sucking behaviors by having them suck on a pacifier connected to a pressure detector for approximately five minutes.

What happens next?

Future studies will look at the question of how early sucking behaviors relate to a child’s growth and development, in particular their brain function and cognitive development.

Where can I learn more?

Access the full journal article, titled “Examining the Association Between Prenatal Maternal Stress and Infant Non-Nutritive Suck” in Pediatric Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 16, 2021

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ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

Too Much or Too Little: Exploring Micronutrient Intake in Pregnant Women

Posted on September 14, 2021April 8, 2025 by Jodi Snare

Good nutrition during pregnancy is important for a baby’s health. Too few vitamins and minerals, such as folic acid and vitamin A, can result in neural tube defects and alterations in heart structure. On the other hand, excessive intake of certain micronutrients may increase chronic disease risk. Although previously associated with lower income countries, meta-analyses and nationally representative samples have shown that at least one in every three pregnant women in the US aged 20-40 were at risk for inadequate intake of various vitamins while nearly one third of pregnant women exceeded the upper intake level of certain micronutrients by up to 5-10 times their required amount.

To explore the disparities in nutrient intake among pregnant women, Katherine Sauder of CU Anschutz and her writing team collected data from nearly 10,000 women in 15 ECHO cohorts across 14 states. Participants in all of these cohorts reported sociodemographic data, weight, age, race/ethnicity, education status, and pre-pregnancy body mass index. Participants were women aged 14-50 who provided either 24-hour dietary recalls or food frequency questionnaires during their pregnancy between 1999-2019.

The team compared the intake of 19 micronutrients from food alone versus food plus dietary supplements to estimate the proportion of the micronutrients consumed above and below their recommended amounts among the different sociodemographic and physical subgroups.

The study found that more than one in five pregnant women did not eat enough of the vitamins D, E, K, and choline and the minerals magnesium and potassium, even when taking dietary supplements. The women most likely to not get enough of these vitamins and minerals were those aged 14-18 years, those who were Hispanic or Black, those who had less than a high school education, and those with obesity. Also, non-Hispanic women were most likely to eat too much folic acid, potentially putting their child at an increased risk for chronic illness.

“This study shows that the dietary supplements women use today do not help them get all the nutrients they need in the right amounts. Personalized approaches for dietary counseling and dietary supplement recommendations are needed. Reformulation of supplements would likely benefit pregnant women as well,” said Sauder. “Choosing a prenatal vitamin can be hard because there are so many products at the store. Ask your doctor to help you choose the best one for you.”

In the future, the team will study how much vitamins and minerals women are getting from foods and compare this value to the recommended amounts for pregnant women. This will help doctors identify which dietary supplements on the market will give women the vitamins and minerals they need.

Read the research summary.

ECHO Study Identifies Demographics of Pregnant Women Least Likely to Get the Nutrients They Need

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ECHO Study Identifies Demographics of Pregnant Women Least Likely to Get the Nutrients They Need

Author(s): Katherine Sauder, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

More than one in every five pregnant women did not eat enough of the vitamins D, E, K, and choline and the minerals magnesium and potassium, even when taking dietary supplements. The women most likely to not get enough vitamins and minerals were those aged 14-18 years, those who were Hispanic or Black, those who had less than a high school education, and those with obesity. Non-Hispanic women were the most likely to eat too much folic acid.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The study showed that many pregnant women are at a high risk of not getting enough nutrients from food alone, so it is important for pregnant women to improve their diet quality and take dietary supplements when needed. The risk of not getting enough vitamins or minerals for women of various ages, races/ethnicities, education levels, or weights is often a problem, even when using dietary supplements.

This study shows that the dietary supplements women use today do not help them get all the nutrients they need in the right amounts. Pregnant women need guidance specific to their bodies to manage the vitamins and supplements they need. Different combinations and formulas of dietary supplements taken before getting pregnant may also help this problem and make sure women do not receive too much folic acid, iron, and zinc.

Why was this study needed?

One in three pregnant women in the United States eats too little or too many key vitamins and minerals. Prior studies do not tell us what groups are at the most risk for poor nutrition during pregnancy. Knowing who is at risk for poor nutrition can make it easier for doctors and public health workers to help pregnant women manage their nutrition.

Who was involved?

The researchers studied 9,801 women aged 14-50 years living across the United States who were pregnant between 1999 and 2019.

What happened during the study?

Pregnant women reported their daily food and dietary supplement intake during pregnancy. Researchers compared their daily intake of 19 vitamins and minerals to the Institute of Medicine recommendations for pregnant women.

What happens next?

The researchers will study how much vitamins and minerals women are getting from foods and compare this amount to the amount pregnant women should get. They will identify dietary supplements that can give women the right amounts of the vitamins and minerals they need.

Where can I learn more?

Access the full journal article, titled “Disparities in risks of inadequate and excessive intake of micronutrients during pregnancy” in Journal of Nutrition.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published September 7, 2021

Access the associated article.

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ECHO Study Identifies Demographics of Pregnant Women Least Likely to Get the Nutrients They Need

ECHO Study Suggests Specific Form of Vitamin E Prevents, Treats Bronchopulmonary Dysplasia

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ECHO Study Suggests Specific Form of Vitamin E Prevents, Treats Bronchopulmonary Dysplasia

Author(s): Cosby Stone, Cynthia McEvoy, Judy Aschner, et al

Who sponsored this research?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

The researchers learned:

There was not enough information in existing studies to recommend using vitamin E to prevent BPD.
A specific type of vitamin E called α-tocopherol isoform may be helpful in preventing or treating BPD.

*Results reported here are for a single research review. Other or future reviews or studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The researchers think that studying the vitamin E α-tocopherol isoform would help provide more information on the benefits and risks of using it to prevent and treat BPD. This type of vitamin E is already associated with better health outcomes for conditions such as asthma, allergic airway swelling, and improved lung growth than other forms of vitamin E. However, without further studies, there is not enough information to recommend it now.

Why was this study needed?

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that mostly affects newborns and infants. It occurs when a newborn or infants’ lungs are damaged from being on a ventilator (a machine that provides oxygen). We already know that there is a connection between low levels of vitamin E and the risk of BPD. Some doctors use vitamin E to help prevent BPD in newborns and infants. However, the last time researchers studied how vitamin E may affect BPD was 1991. Since then, we have learned more about how to reduce the risk of oxygen and ventilator-related lung injuries in newborns. We also know more about how vitamin E affects overall lung health. People only get vitamin E through their diet or supplements, like vitamins, so it’s important to understand if people need more of it.

What was the purpose of the study?

To update our knowledge and understanding of vitamin E and BPD.

Who was involved?

No study participants were involved in this research. The researchers involved are experts in neonatology (the study of newborns), epidemiology (understanding health in certain populations of people), pulmonary medicine (medicine related to the lungs) and environmental interventions (how changing something in a person’s environment affects health.

What happened during the study?

Researchers gathered and analyzed existing research on vitamin E. From this analysis, they suggest ideas for future research that could help us learn more about vitamin E and its role in preventing or treating BPD.

What happens next?

Researchers are interested in studying individual types of vitamin E as dietary supplements to improve lung health and as a potential way to treat or prevent BPD. We will need more and better data from research studies to understand if taking certain vitamin E isoforms can help reduce the risk of:

BPD for newborns when taken by a pregnant women at risk of preterm birth.
BPD for premature newborn when given to the newborn right after birth.
Having long-term lung problems that may continue later into life.

Where can I learn more?

Access the full journal article titled, “Update on Vitamin E and Its Potential Role in Preventing or Treating Bronchopulmonary Dysplasia.”

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

ePublished: March 7, 2018

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ECHO Study Suggests Specific Form of Vitamin E Prevents, Treats Bronchopulmonary Dysplasia

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ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

Who sponsored this study?

What were the study results?

What was the study's impact?

Why was the study needed?

Who was involved?

What happened during the study?

What happens next?

Where can I learn more?

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ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

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