In recent years, plant-based diets have surged in popularity, driven by diverse motivations such as health benefits, sustainability concerns, and ethical considerations. These diets can be healthy and nutritionally adequate, even during the reproductive years. This article explores the benefits and risks of vegetarian diets during pregnancy, providing a comprehensive overview for expectant mothers considering or already following a plant-based lifestyle.
Understanding Plant-Based Diets
Plant-based diets encompass a spectrum of choices. Some individuals may opt for occasional meatless meals, while others embrace a fully vegetarian lifestyle, abstaining from all forms of meat. Within vegetarianism, further distinctions exist:
- Lacto-vegetarians: Exclude meat but consume dairy products.
- Ovo-vegetarians: Exclude meat but consume eggs.
- Lacto-ovo-vegetarians: Exclude meat but consume both dairy and eggs.
- Vegans: Adhere to the strictest form of vegetarianism, avoiding all animal products, including meat, dairy, eggs, gelatin, and honey.
Despite these restrictions, a wide array of food groups remains available to vegetarians and vegans, allowing for balanced and nutritious meal planning.
Nutritional Needs During Pregnancy: An Overview
Pregnancy significantly alters nutritional requirements to support the developing baby. While most women can meet these increased needs through a balanced diet and prenatal vitamins, vegetarians, and particularly vegans, must pay careful attention to specific nutrients.
The Importance of Prenatal Vitamins
Most women can easily meet the new nutritional requirements during pregnancy by taking a prenatal vitamin with 100% of the daily value (DV) to get all the important vitamins and minerals.
Read also: Is a Vegetarian Elimination Diet Right for You?
Key Nutrients for Vegetarian Pregnancies
Vitamin B12
Vitamin B12 plays a crucial role in the development and function of the central nervous system, red blood cell formation, and DNA synthesis. The recommended dietary allowance (RDA) for B12 during pregnancy is 2.6 mcg for everyone. However, vegetarians and vegans are at a higher risk of deficiency since this vitamin occurs naturally only in animal products. Therefore, plant-based expectant mothers should prioritize consuming foods fortified with B12, such as fortified cereals, fortified meat substitutes, vitamin B12-fortified plant milk, and nutritional yeast, or consider supplementation.
Iron
Iron requirements increase during pregnancy due to the expansion of plasma volume and red blood cell concentration. The RDA for iron is 27 mg for women who eat meat. However, vegetarians need 1.8 times higher, meaning 48.6 mg per day is needed because iron from plant foods is not absorbed as well as iron from meats. Good sources of iron for vegetarians are beans, dark leafy greens, prunes, tofu, and fortified cereals.
Choline
Choline is essential for fetal brain development and overall health. Around 90-95% of pregnant women don’t consume enough choline, regardless of what diet they follow. An RDA for choline of 450 mg is suggested for every pregnant woman. Soybeans, wheat germ, kidney beans, and eggs are some of the best plant-based forms of choline, but this vitamin can also be obtained from a dietary supplement.
Calcium
Calcium is vital for the development of the baby's bones and teeth, as well as for muscle and nerve function. The adequate intake of calcium is considered to be 1000 mg/day during pregnancy and lactation. Vegetarians who consume milk, cheese, and yogurt may not need to worry too much about this, but it’s known that certain plant foods contain large amounts of oxalates, a naturally occurring compound that can reduce the amount of calcium absorbed from food. For example, a cup of spinach contains about 30 mg of calcium, however because this food has a high oxalate content, the calcium is not well absorbed by the body. Another interesting point about calcium is that smaller doses are better absorbed. This means that spacing out a supplement and calcium rich foods throughout the day may be a better approach than taking it all at once. Lastly, it’s important to note that calcium should always be taken with vitamin D since the body needs vitamin D to absorb calcium. If you're a vegan, you also need to make sure you get enough calcium.
Vitamin D
Vitamin D is essential for calcium absorption and bone health. If you don't use milk or milk products, be sure to get enough vitamin D from other sources. Your body can produce vitamin D when exposed to sunlight on a regular basis. Although we get vitamin D from sunlight, vegetarian food sources include egg yolk, foods fortified with vitamin D, including some breakfast cereals and fat spreads, and dietary supplements. Because vitamin D is found only in a small number of foods, it is difficult to get enough from foods that naturally contain vitamin D and fortified foods alone. That's why the government recommends that all adults, including those who are pregnant and breastfeeding, should consider taking a daily supplement containing 10 micrograms of vitamin D during the winter months (October until the end of March). You may be at particular risk of not having enough vitamin D if you have brown or black skin (for example, if you're of African, African Caribbean or south Asian origin) or if you cover your skin when outside or spend lots of time indoors. You may need to consider taking a daily supplement of vitamin D all year.
Read also: Healthy Vegetarian Eating
Omega-3 Fatty Acids
The term “Omega 3s” commonly refers to alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). It is suggested that pregnant women get 1.4 grams/day of ALA, however, there is no official dose for DHA or EPA that has been established for pregnancy. ALA is present in plant oils, such as flaxseed, soybean, and canola oils. Walnuts and chia seeds are also good sources of ALA. The problem is that ALA does not easily convert to DHA in the body, so even when a woman who is plant-based consumes a good amount of ALA they can still have low DHA levels. Omega-3s (fatty acids) are needed for nerve, brain and visual development.
Folic Acid
Folic acid is crucial for preventing neural tube defects in the developing fetus. When folic acid is taken for at least one month prior to pregnancy, this important vitamin reduces the chance of neural tube defects (a type of birth defect affecting the baby’s brain and spinal cord) by as much as 50-70%!
Protein
Protein is an essential nutrient that helps build cells and make hormones for your growing baby. A general recommendation of 71 grams of protein/day is currently in place for everyone during pregnancy. Vegetarians can easily meet this requirement by consuming foods like yogurt, chia seeds, quinoa, beans, eggs, and certain vegetables. Vegans can focus on many of the above foods as well as tofu, lentils, soy milk, and nut butters.
Planning a Vegetarian Pregnancy
Pregnancy as a vegetarian or vegan doesn’t have to be stressful, but some additional planning may be needed. When possible, focus on getting nutrients from your diet. However, to meet RDAs during pregnancy, or if a deficiency is noted by blood work, supplementation can be beneficial.
Meeting Protein Requirements
The tricky part of eating vegetarian while you’re pregnant, explains Zumpano, is that your protein needs increase during those months. Zumpano says the average pregnant woman needs 71 to 75 grams of protein a day during pregnancy. That number can be even higher due to a number of factors, including if you’re carrying multiples. If you want to eat vegetarian during pregnancy, it’s best to see a dietitian for a personal assessment to know your specific protein needs. It’s definitely doable to eat vegetarian while pregnant - I did it myself - but you need to plan your meals around protein to ensure you’re getting enough, which may also include protein supplements.
Read also: Is a Chicken-Inclusive Vegetarian Diet Right for You?
Dietary Recommendations
The Physicians Committee for Responsible Medicine suggests that vegetarian pregnant women have to follow the recommendations for protein intake and should increase up to 25 g of protein each day to reach 1.1 g/kg/day as in pregnancy the demand of protein increases. The recommendations are to consume daily portions of dark green vegetables (1-2 servings), other vegetables and fruits (4-5 servings), bean and soy products (3-4 servings), whole grains (six or more servings), and nuts, seeds, and wheat germ (1-2 servings). Vegetarians should include sources of protein, iron, and vitamin B-12 intake, as well as calcium and vitamin D if avoiding milk products. Charts listed in these guidelines are useful for substituting beans, tofu, nuts, eggs, and seeds for meats, and include alternative food sources for calcium if milk and dairy products are rejected.
Tips for Successful Plant-Based Eating During Pregnancy
If you want to ensure complete nutrition during a vegetarian pregnancy, it’s best to plan ahead. Zumpano recommends making a list of the fruits, veggies, proteins and grains you’re willing to eat and then planning your meals around them. To avoid having soda crackers as your primary food source, Zumpano recommends:
- Juices: Juices have high concentrations of nutrients, so pregnancy is the perfect time to invest in a juicer.
- Smoothies: During my pregnancies, I made a smoothie almost every day. I would include a plant-based protein powder, hemp seeds or plain greek yogurt to help meet my protein needs. It’s also a way to sneak in the all-important dark leafy greens like kale or spinach.
- Snacks: It can be hard to eat large portions when you feel crummy. Instead, I recommend snacks every two to three hours. Zumpano recommends focusing on whole foods such as fruits, veggies, yogurt, cheeses, nuts, seeds and eggs.
- Trickery: Try sneaking veggies and protein in whenever you can, such as pureeing veggies or silken tofu in a sauce, and choosing a bean based pasta, making veggies patties with cheese, eggs, nutritional yeast, beans and veggies. If you’re craving rice, pair it with stir-fried veggies or try mixing in some riced cauliflower. This is good practice for parenthood because we often have to sneak the healthy stuff in our kids’ foods, too.
You’ll likely find it easier to meet all your nutritional needs in trimesters two and three (when you don’t feel like retching all day).
Benefits and Risks of Vegetarian Diets During Pregnancy
Potential Benefits
Vegetarian diets are nutritional powerhouses because they are high in fiber, loaded with vitamins and minerals, and low in saturated fat and cholesterol. Furthermore, cohort data have shown that low-fat diets enriched with fruit, vegetables, and fiber can lead to a reduction of risk factors for coronary heart diseases, a better lipid profile, lower body mass index (BMI), and lower blood pressure. In addition vegetarian diets appear to prevent cancer and type 2 diabetes.
Potential Risks
Althought plant-based diets are at risk of nutritional deficiencies such as proteins, iron, vitamin D, calcium, iodine, omega-3, and vitamin B12, the available evidence shows that well planned vegetarian and vegan diets may be considered safe during pregnancy and lactation, but they require a strong awareness for a balanced intake of key nutrients. Nevertheless, some data suggest that vegetarians and vegans may be at greater risk of increased plasma homocysteine levels, an arising risk factor for cardiovascular disease, and of low bone mineral density, which predisposes to osteoporosis.
Special Considerations
Food Safety
As pregnant women are at an increased risk for food poisoning, play it safe and avoid honey, raw or sprouted nuts and grains, unpasteurized milk or cheese and raw or undercooked eggs or soy products.
Artificial Sweeteners
The Food and Drug Administration (FDA) has approved some non-nutritive or artificial sweeteners during pregnancy. But avoid saccharin because it can pass through the placenta and remain in fetal tissue. Minimize intake of all other artificial sweeteners.
Cravings
Hormones can do crazy things to your body. They can even create food cravings, like for meat. It is perfectly OK to temporarily switch to eating meat. You can return to strictly plant foods after your baby arrives.