Calcium and Milk | The Nutrition Source | Harvard T.H. Chan School of Public HealthPregnancy and the Vegan Diet
by Reed Mangels, PhD, RD
5th Edition
"My doctor says I have to drink a quart of cow’ my parents
are convinced I’m doi and I’m even starting
to wonder if my diet is all right." Even the most committed and
knowledgeable vegan may face doubts when pregnant. After all, the
so-called experts are all questioning her dietary choices.
it is reasonably simple to follow a vegan diet throughout pregnancy
while eating foods that meet your needs and the needs of your baby. A
series of studies
at The Farm, a community where vegan diets
are a part of a socially responsible lifestyle, have shown that
vegans can have healthy pregnancies and healthy children. Here are
some things to consider.
Weight Gain
How much weight you gain during your pregnancy has a marked impact on the
baby’s size and health at birth.
will help you
to calculate how much weight you should gain. If you were underweight
prior to your pregnancy, you should try to gain 28-40 pounds. Average
weight women should aim for a 25-35 pound weight gain, and overweight
women should strive to gain 15-25 pounds. Adolescents may need to
gain 30-45 pounds. A general trend is to have little weight gain for
the first 12 weeks. Then, in the second and third trimesters, a
WEIGHT GAin of a pound a week is common .
vegans begin pregnancy on the slim side and may gain weight very
slowly. If this sounds like you, you will need to eat more food.
Perhaps eating more often or eating foods higher in fat and lower in
bulk will help. I found it easiest to drink extra calories and
treated myself to a soy milk shake (soy milk blended with fruit and
tofu or soy yogurt) in the evening for a few weeks when weight gain
was low. Other concentrated sources of calories include nuts and nut
butters, dried fruits, soy products, and bean dips.
shows some ways of getting some extra calories & you need
about 340 extra calories per day in the second and 450 calories per
day in the third trimester. If, on the other hand, your weight gain
seems too high to you and your health care provider, look at the
types of food you are eating. Simply replacing sweets and fatty foods
with fruits, vegetables, grains, and legumes can lead to more
moderate weight gain. Daily exercise, as approved by your health care
provider, can also help.
Table 14: Body Mass Index
Step 1. Take your prepregnant weight (in pounds) and divide it by your height (in inches) then multiply by 700. BMI = lb/in2 x 700. For example, if I weigh 110 pounds and am 60 inches tall, my BMI is 110/3600 x 700 = 21.4.
Step 2. Use your BMI to find your pre-pregnancy weight-for-height status and the amount of weight you should try to gain in pregnancy.
Pre-pregnancy BMI
Weight-for-height status
Recommended weight gain
Underweight
Normal weight
25-35 pounds
Overweight
15-25 pounds
Adapted from reference .
You will probably get lots of questions about whether or not you are getting
enough protein. Current recommendations for protein in pregnancy call
for 25 grams more of protein per day in the second and third
tri-mesters for a total of 71 grams of protein . One study showed
that the average non-pregnant vegan woman was eating 65 grams of
protein daily , almost enough to meet the needs during pregnancy.
If your diet is varied and contains good protein sources such as soy
products, beans, and grains, and you are gaining weight, you can
relax and not worry about getting enough protein. Many women simply
get the extra protein they need by eating more of the foods they
usually eat. As an example, you can add 25 grams of protein to your
usual diet by adding 1-1/2 cups of lentils or tofu, 3-1/2 cups of soy
milk, or 2 large bagels.
and Vitamin D
Vegans also get lots of questions about calcium. Both calcium and vitamin D
are needed for the development of the baby’s bones and teeth. There
is some evidence that pregnant women adapt to low calcium intakes and
increased needs by increasing calcium absorption and reducing calcium
losses . This certainly is worthy of additional study and may be
pertinent to vegans whose diets may be low in calcium. However, for
the time being, calcium intakes of 1300 milligrams daily are
recommended for women 18 and younger and of 1000 milligrams daily for
women 19 through 50 . Pregnant vegans should make a special effort
to have 8 or more servings of calcium-rich foods daily. (See the
Vegan Meal Plan on page 198 for more details.)
women who have regular sunlight exposure do not need any extra
vitamin D . However, if there is any question as to whether or
not your sun exposure is adequate, 15 micrograms (600 IU) of dietary
and/or supplemental vitamin D . Supplements of vitamin D should
only be used with the approval of your health care provider since
high doses of vitamin D can be toxic. Fortified foods like some
brands of soy or other plant milks are another way to meet vitamin D
deficiency anemia is not uncommon during pregnancy, whether vegan or
non-vegetarian. Iron needs are much higher than usual in pregnancy
because of the increase in the amount of the mother’s blood
because of blood formed for the baby. Iron supplements during the
second and third trimester are commonly recommended along with
iron-rich foods. Additional iron may be needed in case of iron
deficiency. Iron supplements should not be taken with calcium
supplements and should be taken between meals in order to maximize
absorption. Even when iron supplements are used, pregnant vegans
should choose high iron foods like whole grains, dried beans, tofu,
and green leafy vegetables daily.
regular use of vitamin B12 supplements or fortified foods is
recommended for all pregnant vegans. Vitamin B12 plays an important
role in the developing fetus. Fortified foods include some breakfast
cereals, some soy milks, and Red Star Vegetarian Support Formula
nutritional yeast.
Folate has
been in the news because of its connection with a type of birth
defect called neural tube defect. Studies have shown that women who
have infants with neural tube defects have lower intakes of folate
and lower blood folate levels than other women. Folate is needed
early in pregnancy (before many women know they are pregnant) for
normal neural tube development. Many vegan foods including enriched
bread, pasta, gr
and orange juice are good sources of folate. Vegan diets tend to be
high in folate, however, to be on the safe side, women capable of
becoming pregnant should take a supplement or use fortified foods
that provide 400 micrograms of folate daily.
Docosahexaenoic
Acid (DHA)
type of fat that is mainly found in fatty fish. It seems to be
important in the development of the brain and the retina, a part of
the eye. Some DHA can be made from another fat called linolenic acid
that is found in flaxseed, flaxseed oil, canola oil, walnuts, and
soybeans. Choosing these foods regularly and avoiding foods
containing trans fats that can interfere with DHA production,
can help to enhance DHA production. Some women may opt to use a vegan
DHA supplement produced from microalgae.
vegans who use salt should use iodized salt at the table or in
cooking. The American Thyroid Association recommends that pregnant
women living in the United States and Canada take a prenatal vitamin
containing 150 micrograms of iodine daily .
this advice to eat a plant-based whole foods diet sounds wonderful to
many pregnant women. What are the barriers to eating a healthful
vegan diet?
Nausea and
Nausea and
vomiting, also called morning sickness, is a concern of many pregnant
women, vegans included. Many women are repulsed by foods that used to
make up the bulk of their diet such as salads, dried beans, and soy
milk. These aversions are extremely common in early pregnancy and are
believed to be due to a heightened sense of smell, possibly due to
hormonal changes . While every woman and every pregnancy will
vary in terms of coping with nausea and vomiting, some things to try
appear on page 182.
300 Calorie Snacks
snacks can help to provide some of the extra calories that are needed
in pregnancy. During the second trimester you need about 340 calories
more per day and during the third trimester you need about 450
calories daily (compared to your pre-pregnant needs).
Fruit Whiz (p. 17)1 serving
Pita Chips (p. 36)
Raisin Spice Muffins (p. 20)1/2 cup
Hummus Spread (p. 27) on
Whole Wheat Bread
Cheesy Pita Toast (p. 37)1 cup
Apple Juice
serving Tofu Dip (p. 99) withFresh
Vegetables
Cookies (p. 109)1 cup Soy
Karen’s Creamy Rice Pudding (p. 115)1 large
Yogurt with2 Tbsp
Nuts and Dried Fruit
with1 Tbsp
Almond Butter
Thick Shake (p. 18)
Easy Pasta Salad (p. 44)1 Banana
serving Split Pea Dip (p. 36) withDouble
serving Pita Chips (p. 36)
Pizza (p. 34)
with nausea and vomiting:
tastes good, eat it! I can remember wanting nothing but saltines and
ginger ale for days at a time. Then, one day when my husband was
warming up some left-over pasta, it smelled wonderful. I ate 3 bowls
full and never regretted it.
eating low fat, high carbohydrate foods. These are digested more
quickly and stay in the stomach for less time giving less time for
queasiness.
often. Sometimes nausea is really due to hunger.
foods that have strong smells. Sometimes cold foods are better
tolerated because they don’t smell as much. Have someone else do
the cooking if possible and go away from the house while cooking is
being done.
sure to drink juice, water, soy milk, or miso broth if you can’t
eat solid food. Keep trying to eat whatever you can.
Contact your health care provider if you are unable to eat or drink
adequate amounts of fluids for 24 hours.
you’re working full time outside the home or at home full time (or
some variation), the thought of preparing elaborate meals and snacks
will probably seem daunting. Meals do not have to be elaborate. A
meal can be as simple as a bowl of cereal and fruit with soy milk,
peanut butter and crackers, or a baked potato and a salad. Use
convenience foods like canned beans, frozen vegetables, mixes,
pre-chopped vegetables, and frozen entrées to reduce preparation
time. Use time-saving appliances like crockpots, pressure cookers,
and microwave ovens. Plan to have leftovers. Check out some quick and
easy vegan cookbooks for ideas.
Health Care Provider
While many
family practice physicians, obstetricians, and nurse-midwives may be
quite knowledgeable about nutrition, many are not familiar with
vegetarian and especially vegan diets. Your health care provider may
have lots of questions about what you are eating and whether or not
you will be able to meet your needs. Look on this as an opportunity
to educate someone about vegan nutrition. Try sharing this chapter
and other materials from the resource list with your health care
provider. Keeping a record of what you eat for several days may help
convince your health care provider that what you’re doing is fine
or may highlight areas needing improvement. If you have specific
concerns and questions, you may choose to consult a registered
dietitian (RD) with expertise in vegetarian nutrition. Remember, a
varied vegan diet can meet your needs and the needs of your baby
during this exciting time.
It is also
important to think about alcohol and smoking. Moderate to large
amounts of alcohol during pregnancy can cause fetal alcohol syndrome,
which impairs mental and physical development. Even one or two drinks
of alcohol daily are associated with greater risk of health and
development problems for the baby. Based on what we know, women
should avoid alcohol during pregnancy. Cigarette smoking has been
clearly linked to low birth weight, which increases the infant’s
chance of having a variety of health problems. Smoking should also be
avoided during pregnancy.
Food Guide on page 198 can be used in pregnancy. Note the
modifications to meet increased needs for protein and other
nutrients.
Menu Plan for Pregnant Vegans:
1/2 cup oatmeal with maple syrup
1 slice whole wheat toast with fruit spread with margarine
1 cup EdenSoy Extra soy milk
1/2 cup calcium and vitamin D fortified orange juice
1/2 whole wheat bagel Banana
Veggie burger on whole wheat bun with 3/4 cup ready-to-eat mustard and catsup
1 cup steamed collard greens
Medium apple
1 cup EdenSoy Extra soy milk
cereal with 1/2 cup blueberries 1 cup EdenSoy Extra soy milk
3/4 cup tofu stir-fried with 1 cup vegetables 1 cup brown rice Medium
Whole grain crackers
with 2 Tbsp peanut butter 4 ounces apple juice
Nutritional analysis of sample menu
2240 calories
100 grams protein (18% of calories)
55 grams fat (22% of calories)
336 grams carbohydrate (60% of calories)
1688 mg calcium
32.5 mg iron
11.2 mg zinc
2.1 mg thiamin
1.4 mg riboflavin
23.1 mg niacin
9 mcg vitamin B12
4.2 mcg vitamin D
15 mcg (supplement/sun exposure indicated)
850 mcg folate
References
JP, Furman T, Hutcheson HR. Preeclampsia and reproductive performance
in a community of vegans. Southern Med J -697.
O’Connell JM, Dibley MJ, Sierra J, et al. Growth of vegetarian
children: The Farm study. Pediatrics -481.
Rasumssen KM, Yaktine AL. Weight Gain During Pregnancy: Reexamining
the Guidelines. Washington, DC: Institute of Medicine, National
Research Council, 2009.
and Nutrition Board, Institute of Medicine. Dietary Reference Intakes
for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol,
Protein, and Amino Acids. Washington, DC: National Academy Press,
Carlson E, et al. A comparative evaluation of vegan, vegetarian, and
omnivore diets. J Plant Foods -100.
Prentice A. Maternal calcium metabolism and bone mineral status. Am J
Clin Nutr 2000;71(suppl):1312S-16S.
(Institute of Medicine). Dietary Reference Intakes for Calcium and
Vitamin D. Washington, DC: The National Academies P 2011.
Specker BL. Do North American women need supplemental vitamin D
during pregnancy or lactation? Am J Clin Nutr
1994;59(suppl):484S-91S.
DV, Braverman LE, Delange F, et al. Iodine supplements for pregnancy
and lactation & United States and Canada: recommendations of the
American Thyroid Association. Thyroid -51.
M. Hyperolfaction as a factor in hyperemesis gravidarum.
Considerations for nutritional management. Perspectives in Applied
Nutrition -9.
Thanks to VRG volunteer Alan Polster for converting this document into HTML.}