What prenatal vitamins and supplements are recommended for a pregnant woman who runs three to five times per week?

Prenatal Vitamins for Pregnant Runners

All pregnant women who run 3-5 times per week should take a comprehensive daily prenatal multivitamin containing folic acid (400-1000 mcg), iron (45-60 mg elemental), calcium (1200-1500 mg in divided doses), vitamin D (≥1000 IU), and DHA (300 mg), with no additional supplementation needed specifically for exercise beyond standard prenatal recommendations. 1

Core Prenatal Supplementation Requirements

The American College of Obstetricians and Gynecologists recommends that all pregnant women take a daily multivitamin and mineral supplement throughout pregnancy to support maternal health and optimal fetal development, regardless of exercise level 1. Running 3-5 times per week does not change these fundamental requirements.

Essential Daily Nutrients

• Folic Acid: 400-1000 mcg daily starting at least 2-3 months before conception and continuing through the first trimester 1, 2

  • Women with BMI >30 kg/m² or diabetes require higher doses of 4-5 mg daily during periconception and first trimester 1
  • After 12 weeks gestation, continue 400-1000 mcg through delivery and 4-6 weeks postpartum or throughout breastfeeding 2

• Iron: 45-60 mg elemental iron daily 1

  • This prevents iron deficiency anemia, which is common during pregnancy 1
  • Low-dose iron (30 mg/day) is often recommended during second and third trimesters 1
  • Iron supplementation should be separated by 2 hours from calcium supplements to avoid absorption interference 1

• Calcium: 1200-1500 mg daily in divided doses (includes dietary intake) 1

  • Single doses should not exceed 600 mg 3
  • Particularly important for preventing preeclampsia in populations with low dietary calcium intake 1

• Vitamin D: ≥1000 IU (40 mcg) daily 1

  • Should maintain serum 25-hydroxyvitamin D levels above 50 nmol/L 1

• DHA (Docosahexaenoic Acid): 300 mg daily from algal oil 4

  • Select sources free of mercury, dioxins, and PCBs 5

Additional Micronutrients

• Vitamin B12: 1 mg every 3 months intramuscularly or 1 mg daily orally 1
• Thiamine: >12 mg daily 1
• Copper: 2 mg daily 1
• Zinc: 8-15 mg per 1 mg copper 1
• Vitamin K: 90-120 mcg daily 1
• Vitamin E: 15 mg daily 1
• Vitamin A: 5000 IU daily in beta-carotene form only (never retinol during pregnancy) 1
• Selenium: 50 mcg daily 1

Critical Pitfalls to Avoid

Vitamin A Form: The retinol form of vitamin A must be avoided during pregnancy due to teratogenicity risk; only beta-carotene form should be used 1, 6. This is a critical safety consideration that many over-the-counter prenatal vitamins may not address properly.

Calcium-Iron Timing: Calcium inhibits iron absorption, so these supplements should be taken at different times of day 1. For example, take iron in the morning and calcium in the evening.

Over-the-Counter Product Inadequacy: A 2024 study found that none of the commercially available over-the-counter prenatal vitamins in the United States met ACOG recommendations for all five key nutrients (folic acid, iron, DHA, vitamin D, and calcium), with no products meeting daily calcium requirements 7. This means most pregnant women will need to supplement beyond a single prenatal vitamin.

Cost Does Not Equal Quality: Higher-priced prenatal vitamins are not more likely to meet ACOG recommendations compared to lower-cost options 7. Evaluate products based on nutrient content, not price.

Monitoring During Pregnancy

Regular monitoring is essential to ensure adequate supplementation:

• Each Trimester: Check serum folate or red blood cell folate, serum vitamin B12, serum ferritin with iron studies and full blood count, serum vitamin D with calcium/phosphate/magnesium/parathyroid hormone, and serum vitamin A 1

Exercise-Specific Considerations

Running 3-5 times per week during pregnancy does not require additional vitamin or mineral supplementation beyond standard prenatal recommendations 1. The focus should be on:

• Maintaining adequate caloric intake to avoid hypocaloric diets (<1,200 calories/day), which can result in ketonemia and ketonuria that may affect fetal development 1
• Ensuring proper hydration and electrolyte balance through diet rather than supplements
• Consuming a folate-rich diet alongside supplementation 2

Practical Implementation

Most pregnant runners will need multiple products to meet requirements: A standard prenatal multivitamin plus separate calcium supplements (since no prenatal contains adequate calcium) and potentially additional iron if the prenatal contains less than 45-60 mg elemental iron 7. A DHA supplement from algal oil (300 mg) should also be added if not included in the prenatal vitamin 4.