Lab Testing

Quest Diagnostics CBC with Differential and Platelets

Quest Diagnostics Glucose Tolerance Test

Quest Diagnostics OmegaCheck

Quest Diagnostics Vitamin D, 25-Hydroxy, Total, Immunoassay

Quest Diagnostics Micronutrient, Folate

Quest Diagnostics Iron, TIBC, and Ferritin Panel

Ingredients

Prenatal Multivitamin

Dosing: Dose per label instructions from preconception through lactation. A prenatal multivitamin should contain at least 400 mcg of folic acid and 30 mg of elemental iron. (Chanarin 1971)(Greenberg 2011)

Supporting evidence:

• Prenatal vitamins are formulated to meet the increased nutritional needs during pregnancy. Compared to iron and folic acid supplements alone, prenatal multivitamins are associated with a reduced risk of low birth weight. (Shah 2009)
• The American Association of Clinical Endocrinologists, the American College of Endocrinology, and The Obesity Society highlight the importance of specific nutrients during pregnancy, including: 
  • • • • Folic acid to prevent neural tube defects (NTDs): All women of childbearing age should consume 400 mcg per day and increase to 600 mcg per day during pregnancy.
        • Iodine for maternal and fetal thyroid function: 250 mcg per day
        • Iron to prevent preterm delivery and maternal anemia and support fetal red blood cell production: 27 mg per day
        • Calcium for fetal skeletal development: 1,000 mg per day
        • Vitamin D for fetal skeletal development: 15 mcg (600 IU) per day
        • Vitamin A for fetal eye development: Do not exceed 10,000 IU per day
        • Zinc to prevent pregnancy-induced hypertension, congenital malformations, slowed fetal growth, and premature birth: 11–13 g per day (Gonzalez-Campoy 2013)
• The US Preventive Services Task Force (USPSTF) recommends that all women planning pregnancy take a daily multivitamin containing folic acid at a dose of 400–800 mcg beginning at least one month before conception, based on evidence that demonstrates a significant reduction in the incidence of NTDs in women who take a folic acid-containing multivitamin. (USPSTF 2009)
• A double-blind RCT involving 1,729 women concluded that over 90% of participants had marginal or low vitamin concentrations during preconception and late pregnancy. However, taking a multivitamin (with beta-carotene, iron, calcium, iodine, B vitamins, myo-inositol, probiotics, and zinc) during preconception and continuing it throughout pregnancy significantly reduced the prevalence of vitamin deficiencies before and during pregnancy. (Godfrey 2023)
• The Camden Study examined the use of prenatal multivitamin supplements during the first and second trimesters among low-income, urban women. It found that supplement use starting in the first or second trimester was associated with a significant reduction in the risk of preterm delivery and low birth weight. Specifically, the risk of very preterm delivery (<33 weeks) was reduced more than fourfold for first-trimester users and approximately twofold when use started in the second trimester. (Scholl 1997)

Docosahexaenoic Acid (DHA)

Dosing: At least 200 mg per day starting no later than 20 weeks’ gestation; women with omega-3 deficiency may require 600–1,000 mg per day of omega-3 fatty acids (DHA+EPA) daily. (Koletzko 2007)(Best 2022)

Supporting evidence:

• DHA is a long-chain omega-3 fatty acid and a key structural component of brain and retinal tissues. Because fetuses cannot synthesize DHA, they rely on maternal dietary intake to support neurological, cognitive, and visual development. (Jiang 2023)
• Approximately 95% of pregnant women and women of childbearing age do not consume adequate amounts of omega-3 fatty acids, necessitating additional supplementation to meet fetal nutritional requirements. (Devarshi 2019)
• Pregnant women with low DHA intake and blood levels have an increased risk of preterm birth. (Cetin 2024) According to a Cochrane systematic review, omega-3 (particularly DHA) supplementation during pregnancy reduces the relative risk for early preterm birth (<34 weeks) by 42% and preterm birth (<37 weeks) by 11%. (Middleton 2018)
• A systematic review and meta-analysis including nine RCTs and a total of 5,710 individuals found that prenatal DHA supplementation (450–800 mg per day) during the latter half of pregnancy was associated with higher birth weights, fewer low birth weights, and fewer (but statistically insignificant) preterm births. (Bilgundi 2024)

Choline

Dosing: 550 mg per day during the second trimester of pregnancy (Jaiswal 2023)

Supporting evidence:

• Choline is an essential nutrient that plays a role in cell membrane structure, brain function, and lipid metabolism. Choline nutritional demands increase in pregnancy to support fetal neural tube formation and brain development, while also supporting maternal cardiometabolic health. (Jaiswal 2023)
• A 2025 systematic review and meta-analysis of 27 studies concluded that 88.76% of pregnant women do not achieve the optimal choline intake through diet. Insufficient intake can significantly increase the risk of adverse pregnancy outcomes, including maternal and fetal fatty liver, preterm birth, low birth weight, small for gestational age, and preeclampsia. (Obeid 2024)(Nguyen 2025)
• This systematic review and meta-analysis, which included over 5,000 mothers, demonstrated that low maternal choline intake during pregnancy was associated with a higher risk of NTDs, with the odds increasing by more than double in some populations. (Obeid 2022)

Iron

Dosing: 60–120 mg of elemental iron per day, in addition to the iron included in prenatal multivitamins, to treat maternal anemia until it resolves (Gonzalez-Campoy 2013)

Supporting evidence:

• According to data from the National Health and Nutrition Examination Survey (NHANES) from 1999–2006, the prevalence of iron deficiency in pregnant women in the second trimester is 14.3%. (Mei 2011)
• The results of a small RCT conducted in Vancouver, Canada, which included 60 pregnant women taking 27 mg of elemental iron daily, showed that 81% still developed probable iron deficiency (ferritin <30 μg/L) by the end of pregnancy. (Cochrane 2022)
• A Cochrane review of 57 studies involving 48,971 women found that daily iron supplementation during pregnancy reduces the rates of maternal anemia (7.4% to 4%) and iron deficiency (66% to 44%). (Finkelstein 2024)
• An RCT found that supplemental ferrous bisglycinate increases hematologic indices, including hemoglobin, red blood cell count, and ferritin levels, more effectively than ferrous fumarate. It was also associated with fewer reports of gastrointestinal side effects like nausea, abdominal pain, and constipation. (Bumrungpert 2022)

Lifestyle Recommendations

Nutrition

• • Continue eating a well-balanced, nutrient-rich diet emphasizing a diverse range of unprocessed fruits, vegetables, whole grains, legumes, nuts, seeds, and lean animal proteins to ensure a broad intake of essential vitamins and minerals. (Marshall 2021)
  • Continue eating foods that are rich in the pregnancy-essential nutrients highlighted by the American Association of Clinical Endocrinologists, the American College of Endocrinology, and The Obesity Society (referenced above):

• • • • • Folate: Green leafy vegetables, broccoli, Brussels sprouts, beans (Chan 2013)

• • • • • Iodine: Seafood, dairy products, eggs, iodized salt (Pehrsson 2022)

• • • • • Iron: Oysters, sardines, beef, spinach, lentils, soybeans (USDA 2024)

• • • • • Calcium: Dairy, tofu, dark leafy greens, sardines (USDA 2024)

• • • • • Vitamin D: Fatty fish, eggs, sun-exposed mushrooms, liver (Dominguez 2021)

• • • • • Zinc: Oysters, beef, crab, pumpkin seeds (NIH 2022)
• Continue eating 2–3 servings (8–12 oz) of low-mercury fish (e.g., sardines, anchovies, salmon, skipjack tuna) weekly to meet the adequate intake of omega-3 fatty acids. (Cetin 2024)
• Work with your healthcare provider to track pregnancy weight gain. Desired weight gain is based on preconception body mass index (BMI). In general, the Centers for Disease Control and Prevention (CDC) recommends that women eat an additional 340 calories daily during the second trimester. (ACOG 2013)(CDC 2024)
• Fluid requirements increase during pregnancy to support the growing fetus, maternal blood volume, amniotic fluid levels, and maternal changes in metabolism and kidney function. Continue drinking 8–10 glasses (64–80 oz) of water daily to stay well-hydrated. (Montgomery 2002)(Cheung 2013)
• Limit caffeine to 200 mg per day (equivalent to two small cups of coffee). (Qian 2019)
• Continue to avoid eating unpasteurized dairy, soft cheeses, deli meats, smoked fish, raw seafood, and raw or undercooked eggs due to the risk of foodborne illness. (Taylor 2010)
• Continue to abstain from drinking any alcohol due to the risk of fetal alcohol spectrum disorder. (Dejong 2019)

Exercise

• Women who exercise throughout pregnancy have reduced rates of excessive weight gain, gestational diabetes, gestational hypertension disorders, preterm births,  cesarean births, low birth weight infants, and postpartum mood disorders. (ACOG 2020)
• Continue moderate-intensity exercise, aiming for a total of at least 150 minutes per week. (​​Brown 2018)
• Shift focus to pregnancy-safe, low-impact activities, such as walking, swimming, and stationary bicycling, for comfort and reduced risk of injury.
• According to a systematic review and meta-analysis of 29 studies that included 2,217 pregnant women, yoga during pregnancy significantly reduces anxiety, depression, and perceived stress. It is also associated with reduced labor duration and increased normal vaginal birth rates. (Corrigan 2022)

Stress

• Women may experience lower degrees of anxiety and depression in the second trimester compared to the first trimester. (Viswasam 2020) However, given that the authors of one meta-analysis concluded that the global prevalence of depression and anxiety symptoms in the second trimester is still 30% and 28%, respectively, healthcare providers should incorporate routine screening into perinatal evaluations. (Aziz 2025)
• Promote a healthy lifestyle (e.g., balanced nutrition, regular exercise, and good-quality sleep) to support mental and emotional well-being. (Cai 2022)(Flor-Alemany 2022)(Philippe 2025)
• Stress-reduction techniques like yoga, progressive muscle relaxation, deep breathing, and mindfulness have been shown to reduce maternal stress, anxiety, and depressive symptoms and have positive effects on blood pressure and heart rate. (Abera 2024)
• Encourage patients to regularly carve out time for themselves, focusing on self-care, stress reduction, and professional support when needed. (ACOG 2023)

Sleep

• Sleep disturbance is common during pregnancy and tends to worsen as gestation progresses. (Garbazza 2020) 
• Advanced maternal age, fluid retention, physical discomfort and body pain, and mood disturbances are risk factors for sleep disturbance and poor sleep quality. (Yang 2020)
• Because poor sleep quality can lead to increased chances of preterm birth, prolonged labor, and perinatal/postpartum depression, healthcare providers should incorporate screening for sleep disturbances into their perinatal health evaluations. (Yang 2020)
• Incorporate good sleep hygiene practices into a nighttime routine. These include a consistent sleep schedule, a comfortable sleep environment, and the avoidance of stimulants before bed. (Paulino 2022)

Environment

• Continue avoiding Cannabis sativa (marijuana) use during pregnancy. (ACOG 2017)
• Continue minimizing exposure to tobacco smoke, heavy metals, and air pollution. (Gould 2020)(Rani 2023)(Zinia 2023)
• Create a safe home environment free from hazards to accommodate potential changes in mobility as pregnancy progresses. To prevent falls and injuries, clear walkways of obstacles, use non-slip floor mats, and install handrails on stairs. (Inanir 2014)(Wallberg 2021)

Patient Resources

• • Your Guide to a Healthy Pregnancy
  • Pregnancy Nutrition
  • Stress management