Prenatal Supplements or Iron and Folic Acid Only?

Why a nutritious diet is vital prior to pregnancy

A good, nutritious diet is important for optimum health throughout life, but it’s perhaps most important before a baby is born. Most expectant mothers are urged to take full-spectrum prenatal supplements as soon as a pregnancy is apparent but a recent study looks at the value of the full-spectrum approach compared with that of iron and folic acid supplements exclusively.

What has research shown us about iron and folic acid supplementing?

Dr. Keith P. West, Jr., turned to mothers in Bangladesh to determine which degree of supplementation is best for a baby born there. Babies in the Bangladesh area are prone to complications that jeopardize their lives and the lives of their mothers during pregnancy and childbirth. Poor nutrition is thought to contribute to these complications, which include:

West and his team of researchers headquartered at Baltimore’s Johns Hopkins Bloomberg School of Public Health, enlisted 44,567 Bangladeshi mothers for their study of prenatal dietary supplementation. All the expectant mothers in the study were receiving prenatal care at The JiVitA Project in Gaibandha, Bangladesh. Most women were in the 9th week of pregnancy when supplementation began. Each woman was randomly assigned to one of two groups:

  • Supplementation with 15 micronutrients (22,405 women)
  • Supplementation with only iron and folic acid (22,162 women)

Outcomes from supplementing daily in early pregnancy 

Live births:

  • 14,373 in the multi-supplement group
  • 14,142 in the iron/folic acid group

Infant mortality at 6 months:

  • 764 (54.0 per 1,000 live births) in the multi-supplement group
  • 741 (51.6 per 1,000) in the iron/folic acid group


  • 43.1 per 1,000 live births in the multi-supplement group
  • 48.2 in the iron/folic acid group

Preterm births:

  • 18.6 per 100 live births in the multi-supplement group
  • 21.8 in the iron/folic acid group

Low birth weight:

  • 40.2 per 100 live births in the multi-supplement group
  • 45.7 in the iron/folic acid group

The research team considers the differences between the two groups to be statistically insignificant except for the clear advantage for preterm births and low birth weight in the group taking the multi-supplement.

The American Congress of Obstetricians and Gynecologists (ACOG) Recommendations

The ACOG recommendation for folic acid varies according to the stage of pregnancy:

  • 400 micrograms (mcg) daily for at least 1 month before conception
  • 600 mcg during pregnancy

It recommends 27 milligrams daily of iron throughout pregnancy.

The Congress also recommends getting adequate supplies of these and all nutrients through a nutritionally sound diet but does recommend supplementation when dietary intake may be inadequate.

Read More:
Prenatal Pregnancy Tests
Prenatal Care in the Age of COVID
Why Do Doctors Measure Your Stomach at Prenatal Visits?


  1. West, Jr., Keith P., et al. "Effect of Maternal Multiple Micronutrient vs Iron–Folic Acid Supplementation on Infant Mortality and Adverse Birth Outcomes in Rural Bangladesh: The JiVitA-3 Randomized Trial." JAMA - The Journal of the American Medical Association. American Medical Association, 24 Dec. 2014. The JAMA Network. Web. 3 Jan. 2015.
  2. "Nutrition During Pregnancy." ACOG / The American Congress of Obstetricians and Gynecologists. American Congress of Obstetricians and Gynecologists, Sep. 2013. Web. 3 Jan. 2015.