The Pregnant and Breast-Feeding Vegetarian: Meeting Nutritional Needs

Due to being vegetarian, pregnant vegetarians generally tend to eat less protein (and yet are not likely to be protein-deficient) and more carbohydrates than pregnant non-vegetarians.  As such, a vegetarian diet in pregnancy is not considered to be inadequate.

A Quick Overview of Nutrition in Pregnancy for Vegetarians

  • Choose a variety of foods, including wholegrains, vegetables, fruit, legumes, nuts, seeds and, if desired, dairy products and eggs.
  • Drinking plenty of water is important during pregnancy and breastfeeding.
  • Minimize intake of foods that are highly sweetened, high in sodium, and high in fat, especially saturated fat and trans-fatty acids.
  • Choose a variety of fruits and vegetables.
  • If animal foods such as dairy products and eggs are used, choose lower fat dairy products, and use both eggs and dairy products in moderation.
  • For women who are underweight, additional portions of all the food groups may contribute to healthy weight gain. (consult with a Registered Dietician for a balanced healthy weight-gain meal plan).
  • For women who are overweight or obese, limiting additional portions and avoiding energy-dense foods may limit excessive weight gain. Weight loss diets are not recommended during pregnancy unless strictly supervised by a Registered Dietician.

Regarding supplements:

  • Dietary supplementation with folic acid, from 12 weeks before conception and throughout the first 12 weeks of pregnancy, reduces the risk of having a baby with a neural tube defect. 500 micrograms per day is recommended.
  • Use one of the recommended pregnancy supplements on the market in SA pharmacies, and check with your Dietician or doctor if this is the appropriate one for you.
  • An iodine supplement of 150 micrograms per day is recommended. Women with pre-existing thyroid conditions should seek advice from their medical practitioner before taking an iodine supplement.
  • Iron supplementation in vegetarian women during pregnancy may be recommended due to low dietary iron intake. Intermittent supplementation is as effective as daily supplementation in preventing iron-deficiency anaemia, with fewer side effects.
  • Women at high risk of iron deficiency due to limited access to dietary iron may benefit from practical advice on increasing intake of iron-rich foods.

Vegetarian women and Dieticians often have the following questions:

  • How do nutritional intakes in pregnant vegetarians differ from that in pregnant non-vegetarians?
  • Are there differences in birth outcomes for babies born to vegetarian mothers vs those born to non-vegetarian mothers?
  • What are the patterns of micronutrient intakes among pregnant vegetarians?
  • What is the bioavailability of different micronutrients in pregnant vegetarians?

The research answers these questions for us as follows:

How do nutritional intakes in pregnant vegetarians differ from that in pregnant non-vegetarians?

Due to being vegetarian, pregnant vegetarians generally tend to eat less protein (and yet are not likely to be protein-deficient) and more carbohydrates than pregnant non-vegetarians.  As such, a vegetarian diet in pregnancy is not considered to be inadequate.

Are there differences in birth outcomes for babies born to vegetarian mothers versus those born to non-vegetarian mothers?

Research indicates that there are no significant health differences in babies born to vegetarian mothers versus non-vegetarians. In other words, the babies’ birth heights and weights are not significantly different when born to vegetarian mothers versus non-vegetarian mothers.

What are the patterns of micronutrient (i.e. vitamin and mineral) intakes among pregnant vegetarians?

Generally speaking only the following micronutrients (vitamins and minerals) have lower intakes among pregnant vegetarians than non-vegetarians:

  • Vitamin B12
  • Vitamin C
  • Calcium
  • Zinc
  • Iron
  • Folate

This indicates that during pregnancy and lactation, these micronutrients need to be supplemented – preferably in consultation with a Dietician who can suggest dietary sources as well as appropriate vitamin supplements dependent upon each individual.

What is the bioavailability of different micronutrients in pregnant vegetarians?

Interestingly, 6 studies that examined the bioavailability of different micronutrients in vegetarian vs non-vegetarian pregnant women show that only serum B-12 levels were significantly lower in vegetarians than non-vegetarians. On the other hand zinc levels are similar in vegetarian and non-vegetarian pregnant women.

What is most important to note is that balanced maternal vegetarian diets do not have detrimental outcomes for the health of the child at birth.

And, in summary, vegetarian diets can definitely be nutritionally adequate in pregnancy and can lead to positive birth outcomes.

Key nutrients in pregnancy include:

  • Vitamin B12
  • Vitamin D
  • Iron
  • Folate

Key nutrients in lactation include:

  • Vitamin B12
  • Vitamin D
  • Calcium
  • Zinc

Diets of pregnant and lactating vegetarians should contain reliable sources of Vitamin B12 daily.

In addition, if there is concern about vitamin D synthesis because of limited sunlight exposure, skin tone, season, or sunscreen use, pregnant and lactating women should use Vitamin D supplements or Vitamin D-fortified foods.

Iron supplements may be needed to prevent or treat iron-deficiency anaemia, which is common in pregnancy.

As mentioned earlier, 400-500mcg folate should be supplemented daily in women planning to fall pregnant.

Zinc and calcium needs can be met through foods or supplement sources.

DHA, an essential fatty acid, also plays an important role in pregnancy and lactation; Generally speaking infants of vegetarian mothers appear to have lower DHA levels than do infants of non-vegetarians.

Breast milk DHA is lower in vegans and lacto-ovo vegetarians than in non-vegetarians.

DHA is essential because of its beneficial effects on: the baby’s length at birth, eye function, and neurodevelopment. As such pregnant vegetarians and vegans should choose food sources of DHA (e.g. omega-rich eggs), or use a microalgae-derived DHA-supplement.

PRACTICALLY-SPEAKING:

Sources of:

MicronutrientTypical Food SourceVegetarian sources
Vitamin B12Organ meats, brewer’s yeast, oysters, sardines and other fish, eggs, meat and cheeseSupplement
Vitamin DEnriched breakfast cereals, fatty fish such as snoek, sardines and tunaSupplement
30 min sun per day (do not burn!)
IronLiver, beef, lamb.
Also found in clams, oysters and mussels.
Beans, peas, leafy greens, dried fruits (apricots, raisins0, seeds (pumpkin, squash, sunflower0 and fortified breakfast cereals.
Brewer’s yeast, kelp, blackstrap molasses, and wheat bran are exceptionally good sources.
Cooking tomatoes or other acidic foods in a cast-iron pot adds iron to meals as well. A good amount leaches out of the cookware into the food.
Beans, peas, leafy greens, dried fruits (apricots, raisins0, seeds (pumpkin, squash, sunflower0 and fortified breakfast cereals.
Brewer’s yeast, kelp, blackstrap molasses, and wheat bran are exceptionally good sources.
Cooking tomatoes or other acidic foods in a cast-iron pot adds iron to meals as well. A good amount leaches out of the cookware into the food.
FolateGreen vegetables, beans, wholegrains, orange juiceGreen vegetables, beans, wholegrains, orange juice
CalciumLow fat dairy products such as milk, yoghurt and cheese.
Salmon and sardines.
Kale, rocket, broccoli, almonds
Kale, rocket, broccoli, almonds
Zinc High protein foods:
Beef, pork, liver, poultry (especially dark meat), eggs, seafood (especially oysters).
Cheese, beans, nuts, wheat germ.
Eggs.
Cheese, beans, and nuts, wheat germ: however, the zinc in these foods is less easily absorbed than the zinc in meat.
Supplement

Breast Feeding

Without doubt breast feeding is the natural choice for the optimal care, nutrition and development of all babies.

The benefits to the infant are well known, endless and long-lasting in terms of the baby’s health, development and overall well-being.

The breast-feeding mother’s diet is vitally important. It must contain sufficient energy and other nutrients. The feeding mother needs to eat more per day than she did before and during the pregnancy, especially around the third month after birth, when the baby is drinking much more.

The mother’s diet also affects what is in the breast milk.

Vegetarian mothers must ensure an adequate intake of protein, and yet balance this out with sufficient wholegrain carbohydrates, fruits and vegetables.

Soy becomes and important protein source for breast-feeding vegetarians, and can be taken in in many ways (Soy Milk, Soy porridge e.g. Soya Life porridge, Soya patties and mince, soy beans and soy-based casseroles).

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