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Pregnancy and the Vegan Diet
by Reed Mangels, Ph.D., R.D.
From the Vegetarian Resource Group
Topics in this
"My doctor says I have to drink
a quart of cow's milk a day; my parents are convinced I'm doing
something harmful; 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
Actually, it is reasonably
simple to follow a vegan diet throughout pregnancy while eating foods
that meet your needs and the needs of your baby. I know; I've done it
twice. In addition, a series of studies 1,2 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.
How much weight you gain during your pregnancy has a marked impact on
the baby's size and health at birth. Table 1 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 3. Figure 1 shows recommended patterns of
weight gain based on your pre-pregnancy body mass index (BMI). Select
the graph corresponding to your pre-pregnant BMI. Your weight gain will
not necessarily fall on the dashed line but should be approximately
parallel to the line 3.
Many 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. Table 2 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 1: Body Mass
Step 1. Take
your pre-pregnant weight (in pounds) and divide it by
your height (in inches) squared; then multiply by 700.
BMI = lb/in 2 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
19.8 to 26
26 to 29
no less than 15 pounds
Young adolescents and black women should attempt to gain at the upper
end of the given ranges since these groups tend to have higher rates of
low birth weight infants. Higher weight gains seem to reduce the risk of
having an infant whose weight at birth is very low and who is at risk
for complications. Short women (under 62 inches) should attempt to gain
at the lower end of the given ranges.
Figure 1: Weight Gain
Source: Adapted from Reference 3.
Select the graph corresponding to pre-pregnancy BMI. Weight gain will
not necessarily fall on the dashed line but should approximately
parallel the line. The vertical line at the right of each graph shows
the range of recommended weight gain.
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
trimesters for a total of 71 grams of protein 4. One study
showed that the average non-pregnant vegan woman was eating 65 grams of
protein daily 5, 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, 2-1/2 cups of soy milk, or 2
Calcium 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 6. 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 7. Pregnant vegans should make a
special effort to have 8 or more servings of calcium-rich foods daily.
Pregnant women who have regular sunlight exposure do not need any
extra vitamin D 7,8. However, if there is any question as to
whether or not your sun exposure is adequate, 5 micrograms (200 IU) of
dietary and/or supplemental vitamin D is recommended 7.
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 milk and orange juice and some
cereals are another way to meet vitamin D needs.
Iron 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 and because
of blood formed for the baby. Iron supplements of 30 milligrams daily
during the second and third trimester are commonly recommended along
with iron-rich foods 3. 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.
The 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
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, and cold cereal; dried beans; green leafy vegetables; 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)
DHA is a 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
Pregnant vegans should use iodized salt at the table or in cooking to
insure adequate iodine intake. Slightly more than half a teaspoon of
iodized salt meets iodine needs in pregnancy while the iodine needs of
breast-feeding women can be met by ¾ teaspoon of iodized salt. Other
options are a low-dose iodine supplement (check - iodine may already be
in your prenatal supplement at 100% of the Daily Value, and, if it is,
additional iodine is not needed) or limited use of sea vegetables.
All of 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 Vomiting
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 9.
Coping with nausea and
If it 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.
Try eating low fat, high carbohydrate foods. These are digested more
quickly and stay in the stomach for less time giving less time for
Eat often. Sometimes nausea is really due to hunger.
Avoid 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
Be 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.
Lack of Time
Whether 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.
Your 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 10. Based on what we know,
women should avoid alcohol during pregnancy 10. 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.
Table 2: Sample Menu Plan for Pregnant Vegans
|1/2 cup oatmeal with maple syrup
1 slice whole wheat toast with fruit spread
1 cup EdenSoy Extra soy milk
1/2 cup calcium and vitamin D fortified orange
|1/2 whole wheat bagel with
|Veggie burger on whole wheat bun
with mustard and catsup
1 cup steamed collard greens
1 cup EdenSoy Extra soy milk
|3/4 cup ready-to-eat cereal with
1/2 cup blueberries
1 cup EdenSoy Extra soy milk
|3/4 cup tofu stir-fried with 1
1 cup brown rice
|Whole grain crackers with 2 Tbsp
4 ounces apple juice
analysis of sample menu
| 100 grams protein (18% of
|| 71 grams
| 55 grams fat (22% of
| 336 grams carbohydrate (60%
|1688 mg calcium
| 32.5 mg iron
|| 49 mg (supplemental iron may
be needed to meet the iron RDA for vegetarians)
| 11.2 mg zinc
|| 11 mg
| 2.1 mg thiamin
|| 1.4 mg
| 1.4 mg riboflavin
|| 1.4 mg
| 23.1 mg niacin
|| 18 mg
| 9 mcg vitamin B12
|| 2.6 mcg
| 4.2 mcg vitamin D
|| 5 mcg (supplement/sun
| 850 mcg folate
|| 600 mcg
- Carter JP, Furman T, Hutcheson HR. Preeclampsia and
reproductive performance in a community of vegans. Southern Med
- O'Connell JM, Dibley MJ, Sierra J, et al. Growth of
vegetarian children: The Farm study. Pediatrics
- Institute of Medicine Subcommittee on Nutritional
Status and Weight Gain During Pregnancy. Nutrition During
Pregnancy. Washington, DC: National Academy Press, 1990.
- Food 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, 2002.
- Carlson E, et al. A comparative evaluation of vegan,
vegetarian, and omnivore diets. J Plant Foods 1985;
- Prentice A. Maternal calcium metabolism and bone
mineral status. Am J Clin Nutr
- Standing Committee on the Scientific Evaluation of
Dietary Reference Intakes, Food and Nutrition Board, Institute
of Medicine. Dietary Reference Intakes for Calcium,
Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington,
DC: National Academy Press, 1997.
- Specker BL. Do North American women need
supplemental vitamin D during pregnancy or lactation? Am J
Clin Nutr 1994;59(suppl):484S-91S.
- Erick M. Hyperolfaction as a factor in hyperemesis
gravidarum. Considerations for nutritional management.
Perspectives in Applied Nutrition 1994;2:3-9.
- USDA/DHHS: Dietary Guidelines for Americans,
2005. Washington, DC: Government Printing Office, 2005.
Lactation and the Vegan Diet
The best diet for breast-feeding is very similar to the diet
recommended for pregnancy. Protein recommendations are the same,
vitamin B12 recommendations are higher, and the recommendations for
iron and calories are lower than during pregnancy.
If you eat too little while breast-feeding, you may not produce
as much milk. Although the recommended calorie intake is 330
calories above your usual intake for the first six months 1, you
still may lose weight because of a loss of calories in breast milk.
It is safe to lose about 1/2 to 1 pound a week while breast-feeding
but more rigorous dieting is not recommended. As in pregnancy, small
frequent meals are the best way to be sure that you are getting
enough calories. Since you do need extra fluid while breast-feeding,
use nutritious beverages like juices, soy milk, soups, and vegan
smoothies to provide calories.
The recommendation for protein is the same as in pregnancy 1
and can be obtained easily from the extra food you are eating. You
should still eat good quality food because you are providing all
nutrients to your infant. You will need to be careful to get enough
vitamin B12, vitamin D, iodine, and DHA in order to be sure that
these nutrients are present in your milk in adequate amounts.
Requirements for most other nutrients are similar to those in
pregnancy and should be obtained from a varied, healthy vegan diet.
- Food 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
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