Plant-Based Pregnancy // Nutrition Considerations for Vegans and Vegetarians

This one is for all the vegetarian and vegan mothers-to-be out there. As plant-based diets have significantly increased in popularity in recent years, it’s not uncommon for individuals following a vegan or vegetarian diet to receive concerns from friends and family regarding their choices whilst pregnant. Iron, iodine, calcium, and vitamins D, B6 and B12 are the main nutrients that are often more difficult to get on a vegan and vegetarian diet, as their main sources are often animal products. However with the right information and guidance, it is entirely possible to have a health balanced diet whilst following a vegan or vegetarian lifestyle during pregnancy. This post will walk you through some of the best plant-based food sources for each nutrient, with a bit more information about why they are important during pregnancy. 


Iron

Iron is important for making red blood cells which carry oxygen around the body. A lack of iron can lead to iron deficiency anaemia, especially during pregnancy when women are more susceptible to it due to an increase in blood volume and the need to carry more oxygen throughout the body. During pregnancy a lack of iron can also put you and your baby at risk of premature delivery and low birth weight. The majority of people in the UK get their iron intake from meat and meat products, which are not suitable for those following a vegetarian/vegan lifestyle. However foods like, pulses, dark green vegetables, wholemeal bread, eggs (for vegetarians), fortified breakfast cereals (look for the ones with added iron) and dried fruit are great sources of iron. In addition to this, consuming vitamin C alongside iron will help increase its absorption. 

Iodine 

Iodine is important for thyroid function including the regulation of your metabolic rate, which increases significantly during pregnancy. Iodine is required from early on in pregnancy, so it is important that you ensure that you consume sufficient iodine even in the months prior to falling pregnant to build up iodine stores in your thyroid. During pregnancy, iodine is critical for healthy foetal brain development. Vegetarians can get iodine from cow’s milk and milk products, and vegans can look out for plant-based mylks fortified with iodine (although these still aren’t very common, there are a few brands on the market with iodine added). Plant foods containing iodine include wholegrains, green beans, courgettes, kale, strawberries, potatoes (with skin), breakfast cereals, nuts and seeds, however the amount of iodine in plant foods tends to be low and varies depending on how much iodine is present in the soil. Seaweed absorbs iodine from seawater, which makes it an excellent source of iodine. However due to very high concentrations of iodine, it is recommended that pregnant women limit its intake. Seaweed and kelp supplements are not recommended during pregnancy. 

Calcium 

Calcium is extremely important during pregnancy as it helps your baby grow a healthy heart, nerves and muscles, helps them develop a normal heart rhythm, and ensures normal blood clotting. If you’re a vegetarian who consumes dairy products, then calcium intake may not be an issue. For those following a vegan diet, foods such as, dark green leafy vegetables, pulses, fortified unsweetened plant mylks, brown and white bread, calcium-set tofu, sesame seeds and tahini, and dried fruit contain calcium.

Vitamin D 

Vitamin D is important for the regulation of calcium and phosphate in the body, which are needed to keep bones, teeth, and muscles healthy. It is also important for foetal skeletal development and growth, as well as lung development. Maternal vitamin D levels have been shown to positively correlate with birthweight centile, and in a study conducted in the Netherlands, women with vitamin D deficiency were shown to have a 2.5X greater risk of having a SGA (small for gestational age) baby. During late March/early April to the end of September, most individuals living in the Northern hemisphere should be able to get sufficient vitamin D from sunlight. However during October to early March we need to get vitamin D from other sources. Foods suitable for vegetarians that contain vitamin D include cow’s milk and egg yolks. For those following a vegan and vegetarian diet, food products fortified with vitamin D, such as orange juice and breakfast cereals, are good sources. In general, it is difficult for us to get sufficient vitamin D from food sources and thus it is recommended that all pregnant women take a 10 µg vitamin D supplement to ensure sufficient intake. Please make sure you speak to your healthcare professional before taking any supplements to make sure they are suitable. 

Vitamin B6 

Vitamin B6 (pyridoxine) is vital for the development of your baby’s nervous system and brain during pregnancy. Some research has shown vitamin B6 during pregnancy can help to alleviate nausea and vomiting. Plant-based sources of vitamin B6 include, beans, bananas, papayas, garlic, avocados, whole grains, sweet potatoes, and spinach.  

Vitamin B12 

Vitamin B12 is important during pregnancy as it helps with the formation of baby’s neural tube, brain, spinal cord, and nervous system. Together with vitamin B9 (folate), it facilitates DNA synthesis and the production of red blood cells. Insufficient vitamin B12 may result in the development of anaemia as blood cells become large and their nuclei aren’t formed properly. If this happens, you may notice that you become fatigued easily, feel tired and weak, and may experience dizziness, tingling in your hands and feet, and feel short of breath. Birth defects associated with inadequate vitamin B12 intake include, spina bifida, encephalocele (where part of the baby’s skull doesn’t form properly, and a portion of brain tissue pushes out), and anencephaly (where the spinal cord and brain do not form properly). Foods sources of vitamin B12 include, milk, cheese, eggs, and yogurt (for vegetarians), as well as yeast extract (marmite), and fortified products including breakfast cereals and unsweetened plant mylks. As plant-based sources of vitamin B12 can be limited, it may be worthwhile speaking to your healthcare provider about a suitable supplement.

Omega 3 fatty acids

There are limited plant-based sources of DHA (docosahexanoic acid) and EPA (eicosapentanoic acid), which are the forms of omega 3 fatty acids that are used by the body. Due to this fact, pregnant vegetarian and vegan women are often encouraged to consume an algae-based supplement and consume other plant foods that are rich in ALA (alpha-linolenic acid) including flaxseeds, hemp seeds, chia seeds, walnuts, and their oils. Nevertheless, our bodies have a limited ability to convert ALA into DHA and EPA, and is influenced by diet and other factors so it may be worth discussing a suitable supplement with your healthcare provider if this is of concern.

Supplements and Multivitamins 

During pregnancy you may need to take extra supplements on top of a well-balanced diet. The Department of Health in the UK recommends that all pregnant women take a supplement containing 10 µg of vitamin D and 400 µg folic acid (for the first 12 weeks of pregnancy). As already mentioned, there are some nutrients that are more difficult to get in a vegetarian and vegan diet. Therefore taking a multivitamin can be a safeguard against low stores or deficiencies. However, before taking a multivitamin it’s important you check with a health care professional because you may only require taking a single supplement, for example Vitamin B12, instead of a multivitamin. If you choose to take a multivitamin tablet, its important that it does not contain vitamin A, as this can be harmful to your baby.  This is why it is best to choose a pregnancy-specific multivitamin.

Take Home Message

Consuming a good balance and variety of foods each day is one of the most important things you can do whilst pregnant. When following a vegetarian or vegan lifestyle, there are certain nutrients that may require special consideration. By looking at your overall diet and working alongside a registered dietitian or nutritionist, you may be able to identify if there are any important improvements that can be made to best nourish yourself and your growing baby during pregnancy. Before taking any supplements and making drastic changes to your diet, its important to seek advice from a registered healthcare professional first, as they will be able to provide you with the correct and most practical advice for you as an individual. 


References

[1] Gordon J. Food Facts Sheet: Pregnancy [Internet]. The British Dietetic Association (BDA). 2016 - [cited 2019 Jun 30]. Available from: https://www.bda.uk.com/foodfacts/Pregnancy.pdf

[2] NHS. Vegetarian and vegan mums-to-be [Internet]. NHS. 2018 - [cited 2019 Jun 30]. Available from: https://www.nhs.uk/live-well/eat-well/vegetarian-and-vegan-mums-to-be/

[3] Bath S, Rayman M. Food Facts Sheet: Iodine [Internet]. The British Dietetic Association (BDA). 2016 - [cited 2019 Jun 30]. Available from: https://www.bda.uk.com/foodfacts/Iodine.pdf

[4] Robinson S, Nelson-Piercy C, Harvey NC, Selby P, Warner JO. Vitamin D in Pregnancy. Royal College of Obstetricians and Gynaecologists. 2014 - [cited 2019 Jun 30]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/vitamin_d_sip43_june14.pdf

[5] NHS. Vitamins, supplements and nutrition in pregnancy [Internet]. NHS. 2017 - [cited 2019 Jun 30]. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/vitamins-minerals-supplements-pregnant/

[6] Dietitians of Canada. Healthy Eating Guidelines for Vegans [Internet]. Dietitians of Canada. 2014 - [cited 2019 Jun 30]. Available from: https://www.dietitians.ca/Downloads/Factsheets/Guidlines-for-Vegans.aspx

[7] Sebastiani G, Barbero AH, Borrás-Novell C, Casanova MA, Aldecoa-Bilbao V, Andreu-Fernández V, Tutusaus MP, Martínez SF, Roig MDG, García-Alvar O. The effects of vegetarian and vegan diet during pregnancy on the health of mothers and offspring. Nutrients. 2019 Mar; 11(3): 557. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470702/


IMG_0478.JPG

Phoebe is a freelance Registered Associate Nutritionist, offering private 1-2-1 consultations, corporate wellness days and more. Phoebe believes in a simple approach to Nutrition meaning no fads or gimmicks. She has a passion for maternal and infant nutrition after learning about how the initial days of life has such a significant impact on a child's development. Phoebe is also a keen blogger, recipe and menu developer. You can keep in touch with her work on: