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Women’s health · Preconception

Trying to conceive: the supplements guidelines agree on

Before pregnancy, one supplement has overwhelming evidence: folic acid, which lowers the chance of neural tube defects such as spina bifida. Omega-3 in pregnancy lowered preterm birth in trials. Beyond that, a preconception visit with your clinician matters more than any product. Nothing here is a fertility treatment.

By Kymata Health Editorial Sources cited inline Prices checked Oct 29, 2026

Quick answer

The quick answer

  • Folic acid around conception lowered neural tube defects by about two thirds in trials (high-quality evidence).
  • Omega-3 in pregnancy lowered preterm birth (risk ratio 0.89) and early preterm birth (0.58) across 70 trials.
  • Some people need a higher prescribed folic acid amount: a previous affected pregnancy, diabetes, seizure medicines or weight-loss surgery.
  • See a clinician before trying if you take prescription medicines, have a chronic condition, or have been trying for 12 months (6 months if 35 or older).

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Story

What a preconception visit covers

A preconception visit reviews your medicines (some need changing before pregnancy), vaccinations, chronic conditions such as thyroid disease and diabetes, and family history. It is also where folic acid and other supplements get tailored to you.

Many pregnancies are unplanned, which is why CDC recommends folic acid for everyone who could become pregnant, not only those actively trying.

The plan

The plan

  1. Step 1Book a preconception visit

    Review medicines, vaccines, chronic conditions and family history.

  2. Step 2Start folic acid now

    At least a month before trying, as a prenatal or on its own.

  3. Step 3Plan omega-3 for pregnancy

    From low-mercury fish or a DHA/EPA supplement.

  4. Step 4Basics

    Stop smoking, limit alcohol, keep caffeine moderate and check thyroid if you have symptoms.

The stack

The preconception basics

Folic acid for everyone who could become pregnant; omega-3 for pregnancy, especially if you eat little fish. Evidence grade: A strong · B moderate · C limited · D preliminary.

  1. 01

    Folic acid (in a prenatal or on its own)

    The one supplement every guideline agrees on before conception.

    What the research shows: In the Cochrane review, daily folic acid around conception lowered neural tube defects such as spina bifida by about two thirds (risk ratio 0.31; high-quality evidence). Women who have had a previous affected pregnancy need a higher prescribed amount. (PMID 26662928)

    • Ask your clinician about a higher amount if you have had a previous pregnancy with a neural tube defect, have diabetes, take seizure medicines or have had weight-loss surgery.
    • Adult upper limit for folic acid from supplements and fortified foods: 1,000 mcg a day unless prescribed.

    In the studies

    • Trials in the Cochrane review gave daily folic acid around conception; CDC and the US Preventive Services Task Force recommend 400–800 mcg a day for anyone who could become pregnant.

    A record of what researchers gave, in whom; not a dose for you.

    Evidencestrong (Grade A)

    What to look for on the label

    A prenatal vitamin or folic acid tablet with at least 400 mcg folic acid (labelled 680 mcg DFE). Folic acid is the form used in the trials and named by CDC.

    We only name brands we have vetted and work with; a specific pick will appear here once one is approved.

  2. 02

    Omega-3 (DHA and EPA)

    Lowered the chance of preterm birth in trials; most useful for women who eat little fish.

    What the research shows: Across 70 trials (19,927 women), omega-3 in pregnancy lowered preterm birth before 37 weeks (risk ratio 0.89) and early preterm birth before 34 weeks (0.58), both high-quality evidence. The effect on child development was unclear. (PMID 30480773)

    • Choose low-mercury sources. Two to three servings a week of low-mercury fish (salmon, sardines, trout) is another route.
    • Tell your clinician if you take blood thinners.

    In the studies

    • Trials in the 2018 Cochrane review gave omega-3 supplements or omega-3-rich foods during pregnancy; amounts varied between trials.

    A record of what researchers gave, in whom; not a dose for you.

    Evidencemoderate (Grade B)

    Quick pick · OceanBlue

    Brands that pay us are shown first in this list.

    OceanBlue Professional Omega-3 2100 (180 softgels)

    2 softgels: 2,100 mg omega-3 (1,350 mg EPA, 600 mg DHA, 150 mg DPA), ethyl ester form; 90 servings

    price checked Oct 29, 2026 on OceanBlue’s site

    Check price on Amazon (paid link, opens in new tab)

    We may earn a commission if you buy through these links. That never changes a rank. See how partner links work.

    Also from our partners

    Only brands that pay us are listed here.

Left out

What we left out, and why

"Fertility boosting" blends
No supplement has been shown to increase the chance of pregnancy in women without a deficiency. Many blends contain herbs that should not be taken in pregnancy.
High-dose vitamin A
High intakes of retinol (preformed vitamin A) in early pregnancy are linked to birth defects. Check prenatal and multivitamin labels; beta-carotene is safe.

Safety

Safety and interactions

  • Tell your clinician about every supplement before and during pregnancy; several popular herbs are unsafe in pregnancy.
  • Not medical advice. Check with your clinician or pharmacist before starting supplements if you take prescription medicines, are pregnant, trying to conceive or breastfeeding, or have kidney, liver or thyroid disease.
  • Supplements are not evaluated by the FDA to diagnose, treat, cure or prevent any disease.

Questions

Frequently asked questions

How much folic acid do guidelines recommend before pregnancy?

The recommended intake from CDC and the US Preventive Services Task Force is 400–800 mcg of folic acid a day, starting at least one month before conception. Some people need a higher prescribed amount.

Is methylfolate better than folic acid?

Folic acid is the form tested in the trials that showed fewer neural tube defects and the form CDC recommends, including for people with MTHFR variants.

Do I need omega-3 in pregnancy?

Across 70 trials, omega-3 in pregnancy lowered preterm birth. Two to three servings a week of low-mercury fish or a DHA/EPA supplement are the usual routes.

Sources

Sources

Studies were checked on PubMed on Oct 31, 2026. Product prices come from each brand's own site, read on Oct 29, 2026; each product shows the date its price was read.

  1. 1De-Regil LM et al. Effects and safety of periconceptional oral folate supplementation and birth defects (Cochrane review). Cochrane Database Syst Rev 2015 (opens in new tab)PMID 26662928
  2. 2Middleton P et al. Omega-3 fatty acid addition during pregnancy (Cochrane review). Cochrane Database Syst Rev 2018 (opens in new tab)PMID 30480773
  3. 3CDC. Folic acid: recommendations (opens in new tab)

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