Prenatal Supplements: Are They a Waste of Time and Money?

A recent ABC News investigation, “Unnecessary prenatal supplements marketed at expectant parents” (8 August 2026), raised something I talk to my patients about often. Today, the prenatal supplement market is full of products with bold claims and premium price tags. In many cases, those claims outpace what the evidence actually supports.

I think that’s a fair call. It’s one of the reasons I take an evidence-informed approach rather than an “everyone needs everything” one. Understandably, pregnancy is a time when it’s natural to want to do everything right for your baby. That’s exactly the instinct that a lot of supplement marketing leans on. Megadoses, proprietary blends, and “just in case” ingredient lists aren’t the same thing as good clinical care.

But there’s a second half to this story that matters just as much: unnecessary supplementation isn’t the same problem as no supplementation. In fact, there’s a solid body of research showing that specific, targeted nutrients genuinely improve outcomes for mother and baby. A good deal of it comes from Cochrane, which is about as gold-standard as evidence synthesis gets. The skill isn’t avoiding supplements altogether — it’s knowing which ones matter for you, at what dose, and for how long. That’s a clinical question, not a marketing one.

Here’s what the peer-reviewed research on PubMed actually shows, nutrient by nutrient.

Omega-3 fatty acids: one of the best-supported nutrients in pregnancy

Of everything I reviewed for this article, omega-3 long-chain fatty acids have some of the strongest trial evidence behind them. These are the DHA and EPA found in fish oil.

A 2018 Cochrane review pooled 70 randomised controlled trials involving almost 20,000 women. It found that omega-3 supplementation during pregnancy reduced the risk of preterm birth before 37 weeks (13.4% vs 11.9%), and reduced early preterm birth before 34 weeks by 42% — high-quality evidence (Middleton et al., 2018, Cochrane Database of Systematic Reviews, DOI: 10.1002/14651858.CD003402.pub3).

That’s not a fringe finding. A 2022 consensus statement from the International Society for the Study of Fatty Acids and Lipids built directly on that Cochrane evidence. It concluded that women with low baseline omega-3 intake benefit most, recommending around 1,000 mg combined DHA+EPA daily, ideally started before 20 weeks (Best et al., 2022, DOI: 10.1016/j.plefa.2022.102495).

This is a good example of why I’d rather look at your actual diet than hand you a generic recommendation. If you’re already eating oily fish two or three times a week, your needs look quite different to someone who isn’t. That’s the kind of thing worth talking through together, rather than guessing at.

Folate: still the clearest “yes” in prenatal nutrition

Indeed, folate is about as close to a universal recommendation as this field gets. A Cochrane review found that periconceptional folate supplementation reduced the risk of neural tube defects by 69%, based on data from more than 6,700 births — high-quality evidence (De-Regil et al., 2015, DOI: 10.1002/14651858.CD007950.pub3). This is why I recommend folate supplementation start before conception wherever possible, and continue through the first trimester.

Genetics matter too: why I check MTHFR status before deciding on folate form

Folate metabolism itself isn’t one-size-fits-all, and this is exactly the sort of thing a label can’t tell you. The MTHFR gene codes for the enzyme that converts folate into its active form, L-5-methyltetrahydrofolate (5-MTHF). Common variants — particularly C677T and A1298C — reduce that enzyme’s efficiency. As a result, people who carry two copies convert folate less efficiently than most.

A 2026 review described MTHFR genetics and vitamin B12 status as “critical modifiers” of folate metabolism. It made the case for a precision approach based on someone’s actual folate levels, genotype and B12 status, rather than a blanket recommendation (Yang & Li, 2026, DOI: 10.3389/fnut.2026.1785263).

Choosing between standard folic acid and active folate forms

Practically, this affects which folate form makes sense. A 2025 comparative analysis found that active folate forms — 5-MTHF and folinic acid — have real advantages for people with reduced MTHFR activity. Specifically, they avoid a build-up of unmetabolised folic acid and lower the risk of masking an underlying B12 deficiency (Skavinska et al., 2025, DOI: 10.1093/nutrit/nuaf216). Real-world data backs this up for higher-risk groups: in women with a history of pregnancy complications, high homocysteine and higher-risk MTHFR genotypes, methylfolate lowered homocysteine more effectively than standard folic acid. It was also linked to fewer adverse pregnancies (Song et al., 2025, DOI: 10.3233/THC-241034).

That said, I want to be upfront about the nuance here, because I think it matters. This isn’t a case for skipping folic acid, or for assuming every MTHFR carrier needs something different. Standard folic acid is still the only folate form proven in large trials to prevent neural tube defects at a population level, and it remains central to public health fortification programs worldwide (Skavinska et al., 2025). People who are homozygous for the MTHFR polymorphism generally just need more folate overall. Often, this can be tracked with a simple homocysteine and red cell folate check, rather than an entirely different product (Bjørke-Monsen & Ueland, 2023, DOI: 10.29219/fnr.v67.10258).

In practice, the right folate form for you depends on your genotype, your homocysteine level, your red cell folate status, and your own history — including recurrent pregnancy loss or a previous pregnancy affected by a neural tube defect. That’s a conversation I have with patients directly, informed by testing, not a decision made at the pharmacy shelf.

Vitamin D: meaningful benefits, but dose and status matter

A Cochrane review of vitamin D supplementation in pregnancy found it probably reduces the risk of pre-eclampsia, gestational diabetes and low birthweight — moderate-certainty evidence across 30 trials (Palacios et al., 2019, DOI: 10.1002/14651858.CD008873.pub4). A follow-up Cochrane review on dosing found higher doses may further reduce gestational diabetes risk, without an apparent increase in adverse events, though the evidence there is less certain (Palacios et al., 2019, DOI: 10.1002/14651858.CD013446). Vitamin D is a good example of “it depends” — benefit tracks with your baseline status, and that’s simple enough to test.

Iron: helpful for the right person, not automatically for everyone

Generally, iron supplementation is standard care for anyone who is, or is at risk of becoming, iron-deficient during pregnancy. It’s a major contributor to poor birth outcomes globally. However, a 2025 systematic review comparing iron-folic acid regimens against multiple-micronutrient formulations found outcomes varied meaningfully by formulation and dose. Some combinations even showed a higher relative risk of low birthweight and stillbirth (Srivastava et al., 2025, DOI: 10.1186/s12884-025-08292-7). That’s precisely the kind of nuance a generic label glosses over, and it’s why I check iron studies rather than assume more is automatically better.

Iodine: a good example of “unnecessary for some”

This is where the ABC article’s core caution is best illustrated by the evidence itself. In countries with mandatory iodine fortification, including Australia, Cochrane reviews have found no clear evidence that routine iodine supplementation improves child cognitive development in women with only mild-to-moderate deficiency (Ley & Turck, 2021, DOI: 10.1097/MCO.0000000000000737). Similarly, a separate meta-analysis spanning three decades of trials found iodine supplementation improved maternal iodine status. However, it didn’t translate into better growth or neurodevelopmental outcomes in infants (Nazeri et al., 2021, DOI: 10.1530/EJE-20-0927). Iodine matters enormously where deficiency is real, and is far less clear-cut as a blanket addition for everyone else.

The nutrients nobody tests for: common undiagnosed gaps, especially choline

Notably, here’s a gap I see often in practice that rarely makes headlines. It’s arguably more clinically relevant than most of what gets marketed on the front of a prenatal bottle. Several genuinely important nutrients in pregnancy are neither routinely tested nor reliably included in standard prenatal formulations. As a result, a deficiency can go completely unnoticed in someone who’s diligently taking “a good prenatal.”

Choline: essential, and easy to miss

Choline is the clearest example. It’s essential for fetal brain development. Specifically, it’s a building block for the neurotransmitter acetylcholine, a structural component of every cell membrane, and a key methyl-group donor involved in fetal DNA regulation (Derbyshire, 2025, DOI: 10.3390/nu17091558). Yet US national nutrition survey data found only 7.9% of pregnant women met the recommended intake for choline, even counting supplement use — roughly 9 in 10 fall short (Bailey et al., 2019, DOI: 10.1001/jamanetworkopen.2019.5967). A separate multi-cohort NIH study found almost the same pattern (Sauder et al., 2021, DOI: 10.1093/jn/nxab273).

Why does it slip through? Choline isn’t part of routine antenatal bloodwork, and unlike folic acid or iron, it isn’t reliably included in standard prenatal multivitamins. So a genuine shortfall can persist for an entire pregnancy without anyone noticing. Several recent reviews suggest low maternal choline may be an independent risk factor for neural tube defects, separate from folate status. This is worth knowing, given how common plant-based diets — which are naturally lower in choline — have become (Deng et al., 2026, DOI: 10.1002/bdr2.70019; Obeid, Holzgreve & Pietrzik, 2022, DOI: 10.1024/0040-5930/a001398; Krupa & Skrzypulec-Plinta, 2025, DOI: 10.5603/gpl.105802).

As with omega-3, the nuance matters. A randomised controlled trial that supplemented women already eating moderate-choline diets found no added benefit to infant cognition at 10–12 months (Cheatham et al., 2012, DOI: 10.3945/ajcn.112.037184). In other words, supplementation looks most valuable for genuinely low intake. That’s something worth actually checking, not assuming.

Vitamin B12 and magnesium: the other overlooked shortfalls

Vitamin B12 follows a similar pattern. Suboptimal status is common — an estimated 30–60% of some populations — and it’s linked to neural tube defect risk and impaired infant brain development. Yet it’s easy to miss without a specific blood test (Smith, Warren & Refsum, 2018, DOI: 10.1016/bs.afnr.2017.11.005).

Finally, magnesium rounds out the picture. US nutrition data found 47.5% of pregnant women had usual intakes below the requirement, the largest shortfall of any nutrient assessed (Bailey et al., 2019). Interestingly, that doesn’t mean magnesium supplements fix everything they’re marketed for. For example, a meta-analysis found oral magnesium wasn’t significantly effective for pregnancy leg cramps specifically, despite that being one of its most common marketed uses (Liu et al., 2021, DOI: 10.1016/j.tjog.2021.05.006). In short, a nutrient can be genuinely under-consumed at a population level, and still not be the right fix for every symptom it’s sold against.

There’s a broader quality concern here too. A 2026 review proposing a precision-nutrition framework for prenatal supplements flagged that as many as 18–40% of commercially available prenatal supplements tested contained undeclared pharmaceuticals, heavy metals, or incorrect dosages (Chen et al., 2026, DOI: 10.3390/antiox15010057). That’s a genuinely good reason for caution about generic, unverified products. It’s also part of why I think sourcing supplementation through a practitioner who can advise on quality-assured products matters — not just for dosage, but for what’s actually in the bottle.

The real takeaway: evidence-based, not marketing-based

Put these findings side by side, and the pattern lines up closely with what the ABC investigation was warning about, with one important addition:

• Folate: strong, near-universal evidence of benefit — though the form (standard folic acid vs. an active form like 5-MTHF) is a genetics-and-biomarker question, not a marketing one.
• Omega-3 (DHA/EPA): strong evidence of benefit, especially for those with low baseline intake.
• Vitamin D and iron: clear benefit for those who are actually deficient or at risk — much less clear as a blanket “everyone needs extra” approach.
• Iodine: benefit is population- and context-dependent, and in well-fortified countries like Australia, more isn’t automatically better.
• Choline, vitamin B12 and magnesium: genuinely common shortfalls that usually go undiagnosed simply because they’re not routinely tested or reliably included in standard prenatal formulations.

This isn’t an argument against supplementation. Rather, it’s an argument against undifferentiated supplementation — the idea that one premium product, marketed the same way to every expectant parent, is the right answer regardless of individual diet, health history, and test results.

Why I think a practitioner consultation is the missing piece

Ultimately, the honest answer to “which prenatal supplements do I actually need?” is: it depends on you. Your diet, your bloodwork, your health history, your genetics, and your stage of pregnancy all play a part. That’s not something a product label or a social media post can tell you. It’s something I can help you work through, properly.

This is really what naturopathic care is about for me: treating the whole person rather than a symptom or a single nutrient in isolation, and looking for the actual cause of a deficiency rather than just papering over it. I also work collaboratively with your GP or obstetrician, rather than instead of them. Rather than guessing which of the dozens of prenatal products on the shelf is right for you, I can assess your individual nutrient status — including the gaps that don’t make it onto a standard label, like choline, B12 and magnesium. From there, I can build a plan that’s grounded in the evidence above: the right nutrients, the right doses, and nothing you don’t actually need.

If you’re pregnant or planning a pregnancy, I’d genuinely encourage you to have this conversation before you buy another bundle. Importantly, it’s a low-pressure, obligation-free first step. It can also save you money on products you don’t need, while making sure you’re actually covering what the research shows matters most.

This article is for general educational purposes and isn’t a substitute for individualised medical or naturopathic advice. Please talk to a qualified healthcare practitioner before starting, changing or stopping any supplement during pregnancy.

Frequently Asked Questions

Is it true that many prenatal supplements are unnecessary?

Some marketed prenatal products contain ingredients, mega-doses or proprietary blends that go beyond what the evidence supports. That doesn’t mean all prenatal supplementation is unnecessary. Instead, it means the right supplements, at the right doses, should be based on your individual needs rather than generic marketing.

What does the research say about omega-3 supplements in pregnancy?

A 2018 Cochrane review of 70 randomised controlled trials found omega-3 (DHA/EPA) supplementation reduced preterm birth before 37 weeks, and cut early preterm birth before 34 weeks by 42%, particularly for women with low baseline omega-3 intake.

Which prenatal supplements have the strongest evidence?

Folic acid (for neural tube defect prevention) and omega-3 fatty acids (for reducing preterm birth risk) currently have the strongest, most consistent trial evidence. Vitamin D and iron help those who are deficient. Iodine’s benefit, meanwhile, depends heavily on your background dietary intake.

What is the most commonly undiagnosed nutrient deficiency in pregnancy?

Overall, choline is one of the most overlooked. National nutrition data shows roughly 9 in 10 pregnant women don’t meet the recommended intake, yet it isn’t part of routine antenatal blood testing and is often missing from standard prenatal multivitamins. B12 and magnesium shortfalls are also common, and easily missed without specific testing.

Should I get tested for MTHFR before choosing a folate supplement?

It’s worth discussing, especially if you have a personal or family history of neural tube defects, recurrent pregnancy loss, or elevated homocysteine. Your MTHFR genotype affects how efficiently you convert folate into its active form. This, in turn, helps determine whether standard folic acid is enough for you, or whether an active form (5-MTHF or folinic acid) is more appropriate.

Should I choose my own prenatal supplements or see a practitioner first?

I’d always recommend a practitioner consultation. Nutrient needs vary by diet, health history, genetics and test results. Because of this, a qualified practitioner can identify what you actually need, rather than relying on generic product marketing.

Madeline Sheppard BHSc (Naturopathy)

Member of NHAA

Naturopath at Living Holistic Health Geelong & Bellarine

Sources (PubMed / Cochrane)

Core evidence: Cochrane reviews and major trials

1. Middleton P, et al. “Omega-3 fatty acid addition during pregnancy.” Cochrane Database Syst Rev, 2018. DOI: 10.1002/14651858.CD003402.pub3
2. Best KP, Gibson RA, Makrides M. “ISSFAL statement number 7.” Prostaglandins Leukot Essent Fatty Acids, 2022. DOI: 10.1016/j.plefa.2022.102495
3. Saccone G, Berghella V. Meta-analysis, omega-3 and preterm birth. Obstet Gynecol, 2015. DOI: 10.1097/AOG.0000000000000668
4. De-Regil LM, et al. “Effects and safety of periconceptional oral folate supplementation.” Cochrane Database Syst Rev, 2015. DOI: 10.1002/14651858.CD007950.pub3
5. Palacios C, et al. “Vitamin D supplementation for women during pregnancy.” Cochrane Database Syst Rev, 2019. DOI: 10.1002/14651858.CD008873.pub4
6. Palacios C, et al. “Regimens of vitamin D supplementation.” Cochrane Database Syst Rev, 2019. DOI: 10.1002/14651858.CD013446
7. Srivastava M, et al. Iron-folic acid formulations comparison. BMC Pregnancy Childbirth, 2025. DOI: 10.1186/s12884-025-08292-7
8. Ley D, Turck D. “Iodine supplementation: is there a need?” Curr Opin Clin Nutr Metab Care, 2021. DOI: 10.1097/MCO.0000000000000737
9. Nazeri P, et al. Iodine supplementation in pregnancy. Eur J Endocrinol, 2021. DOI: 10.1530/EJE-20-0927
10. ABC News. “Unnecessary prenatal supplements marketed at expectant parents.” 8 August 2026. abc.net.au

Additional supporting research: choline, folate genetics and nutrient status

11. Derbyshire EJ. “Choline in Pregnancy and Lactation.” Nutrients, 2025. DOI: 10.3390/nu17091558
12. Bailey RL, et al. “Estimation of Total Usual Dietary Intakes of Pregnant Women in the US.” JAMA Netw Open, 2019. DOI: 10.1001/jamanetworkopen.2019.5967
13. Sauder KA, et al. Disparities in micronutrient intake risk in pregnancy. J Nutr, 2021. DOI: 10.1093/jn/nxab273
14. Deng S, et al. Choline in neural tube defect pathogenesis. Birth Defects Res, 2026. DOI: 10.1002/bdr2.70019
15. Obeid R, Holzgreve W, Pietrzik K. Folate, choline, B12 supplementation. Ther Umsch, 2022. DOI: 10.1024/0040-5930/a001398
16. Krupa A, Skrzypulec-Plinta V. Active folates and choline in prenatal development. Ginekol Pol, 2025. DOI: 10.5603/gpl.105802
17. Cheatham CL, et al. Phosphatidylcholine supplementation RCT. Am J Clin Nutr, 2012. DOI: 10.3945/ajcn.112.037184
18. Smith AD, Warren MJ, Refsum H. “Vitamin B12.” Adv Food Nutr Res, 2018. DOI: 10.1016/bs.afnr.2017.11.005
19. Liu J, et al. Oral magnesium for pregnancy leg cramps meta-analysis. Taiwan J Obstet Gynecol, 2021. DOI: 10.1016/j.tjog.2021.05.006
20. Chen J, et al. Precision Nutrition Framework (GAPSS). Antioxidants, 2026. DOI: 10.3390/antiox15010057
21. Yang R, Li G. Folate, MTHFR genetics, B12 in pregnancy outcomes. Front Nutr, 2026. DOI: 10.3389/fnut.2026.1785263
22. Skavinska O, et al. Comparative analysis of folate forms. Nutr Rev, 2025. DOI: 10.1093/nutrit/nuaf216
23. Song J, et al. Folic acid forms and pregnancy outcomes. Technol Health Care, 2025. DOI: 10.3233/THC-241034
24. Bjørke-Monsen AL, Ueland PM. Folate scoping review, Nordic Nutrition Recommendations 2023. Food Nutr Res, 2023. DOI: 10.29219/fnr.v67.10258

Research sourced from PubMed (National Library of Medicine) and the Cochrane Database of Systematic Reviews.

Madeline Sheppard

Madeline is passionate about supporting holistic well-being, offering personalized care to address everything from hormonal imbalances and fertility to anxiety, stress, and emotional health.