It seems that each time we reach a new stage in life, there are more questions than answers! This is no exception when you begin the journey of trying to conceive for a baby. In Australia it is estimated that 2.5 million people (12.1% of the population) in Australia are fully or almost all vegetarian. In 2021 there were 309,996 registered births. Based on this, we can assume that 37,000 women (~12%) who gave birth in 2021, followed a vegetarian diet.
Is it okay to be vegetarian during pregnancy?
A very common question that comes up in conversation between clients and dietitians. The answer is a little more complex than you think! There are different types of vegetarianism, and many people ‘beat to their own drum’ in terms of how they practice vegetarianism.
Some of these vegetarian diet types include:
- Lacto-vegetarian: excludes meat, fish, poultry and eggs, as well as foods that contain them. Dairy products, such as milk, cheese, yogurt and butter, are included.
- Ovo-vegetarian: excludes meat, poultry, seafood and dairy products, but allows eggs.
- Lacto-ovo vegetarian: excludes meat, fish and poultry, but allows dairy products and eggs.
- Pescatarian diets might exclude meat and poultry, but allow fish. Some might also include dairy, and eggs.
- Vegan diets exclude meat, poultry, fish, eggs and dairy products and foods that contain these products.
Some people follow a semi-vegetarian diet, colloquially referred to as ‘flexitarian’ — which is primarily a plant-based diet but includes meat, dairy, eggs, poultry and fish on occasion or in small quantities.
There are many benefits to following a vegetarian diet for the general population.
These include a reduced risk of:
- Cardiovascular disease
- Hypertension
- Diabetes
- Some types of cancer
So why does following a vegetarian diet in pregnancy cause controversy?
Following a vegetarian diet, that is not well planned means that you might be at risk of developing nutrient deficiencies. This can impact your health and the health of your baby. The main nutrients of concern in a vegetarian diet are iron, B12, calcium, zinc, vitamin D, iodine, and omega 3 fatty acids.
It is common for food aversions, nausea and vomiting to arise in pregnancy. This is frequently around meat, and meat products. In the case of those who follow a vegan or vegetarian diet, the options for adequate nutrient and protein intake become very limited if the aversions extend to vegetarian protein sources.
Read more about the impact of nutrition in pregnancy here
Vegetarian in pregnancy risks, are there any?
In pregnancy, nutrient needs increase significantly to account for the changes in physiology to mum, and the growth of the baby. Women who follow a regular omnivorous diet are often low in key nutrients like iron, and vitamin D. Those following a vegan or vegetarian diet are at a much higher risk of deficiency in these. Of course, all of the key nutrients needed in pregnancy are able to also be found in plant sources. Unfortunately the amount, absorption and form of each are often lesser than those that come from animal origin, which is why deficiency or inadequate intake becomes a concern.
How to get the right nutrients during pregnancy
Iodine
Iodine is involved in the production of the thyroid hormone. Thyroid hormone is involved in regulating your metabolism and has a key role in both your brain and body growth and development. During pregnancy, your iodine requirement increases, as your thyroid activity increases. It is recommended that you work on increasing your iodine intake 6 months before you begin trying to conceive, as it can take some time for your levels to increase.
In Australia it is recommended that women who are considering pregnancy, currently pregnant or breastfeeding should have a minimum of 150 micrograms per day through supplementation as well as including it in their diet.
Iodine is naturally found in seaweed, dairy products, eggs and seafood. Most of these products are often not included in a vegetarian or vegan diet. In Australia all commercially sold bread has iodised salt added to it as a way to reduce the risk of iodine deficiency.
Iron rich vegetarian foods for pregnancy
Iron deficiency in the general population, and the pregnant population is around 20%. Iron is needed in your body to produce red blood cells, which carry oxygen around the body. Iron is a key nutrient of concern in vegan and vegetarian diets, and this need is increased in pregnancy.
Low iron levels can contribute to increased levels of fatigue, poorer concentration and in some cases an inability to fight off infection. During pregnancy, a person’s blood volume increases by up to 50% to support both mother and baby.
The recommendation for iron during pregnancy is 27mg, which is nearly 10mg more than the requirement for an adult woman.
Anaemia during pregnancy can continue after the baby is born, and in some cases can affect the baby’s iron stores. The last 10 weeks of pregnancy is most important as it sets up your baby’s iron stores for the first 6 months of life, until they begin solids.
Iron is found in abundance in meat (beef, chicken, pork, lamb), and fish. Key plant-based sources of iron include tofu, kidney beans, legumes, wholegrains (brown rice, wholemeal pasta, quinoa, oats, popcorn), nuts and dried fruits.
Vitamin B12
Cyanocobalamin (or vitamin B12) plays a role in mental alertness, DNA synthesis, red blood cell formation and the conversion of energy.
Vitamin B12 also relies on folate to work correctly, as each depends on the other. This is important during pregnancy as it can help to prevent spina bifida, and other central nervous system birth defects.
Vitamin B12 is mostly found in animal products, so those who are vegan or vegetarian can be at risk of B12 deficiency (pregnant or non-pregnant) and may need to take a supplement. B12 is found in abundance in milk, eggs, seafood, and meat/poultry. Key plant based sources of B12 are often fortified with B12, rather than being high in naturally occurring B12. These include fortified nutritional yeast, fortified breakfast cereals, and fortified plant based milks.
Calcium
Calcium plays a vital role in strengthening bones and teeth, regulating muscle & heart function, blood clotting and more! As the body doesn’t make calcium, it is important you get it from your diet.
During pregnancy it is recommended women consume 1000-1200mg of calcium a day. During pregnancy, your body takes calcium from your own bones and/or teeth to give to your growing baby. It is essential that mummas take care of themselves by meeting those all-important calcium requirements. Some key plant based sources of calcium are fortified plant based milks, almonds, dark leafy greens (spinach and kale), edamame & tofu.
Vitamin D
There are no strong dietary sources of vitamin D, especially plant-based sources. Vitamin D is absorbed from sunlight on the skin and is then used by the body to assist with calcium absorption.
The research has shown that women who are vitamin D deficient in pregnancy are more likely to have pregnancy complications such as pre-eclampsia and preterm birth. The research has also shown that vitamin D deficiency could be linked with the development of childhood allergy.
We can find plant based sources of vitamin D in fortified margarines, fortified milks and vitamin D mushrooms.
Zinc
Zinc isn’t generally one of the main nutrients that come to mind to include during pregnancy, however it can still play an important role. Zinc is needed for optimal immune function, and is involved in tissue and cellular growth. Low levels of zinc in women during pregnancy have been shown to cause preterm birth, and in some cases prolong labour. The highest concentrations of zinc are found in meat, fish, and seafood. In a vegetarian diet, plant based sources of zinc include wholegrains, tofu, nuts such as cashews, and walnuts, seeds such as hemp, chia and pumpkin seeds, lentils, and legumes (chickpeas and beans).
Omega 3 rich vegetarian foods for pregnancy
There are 3 omega-3 fatty acids. These are docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and alpha linoleic acid (ALA).
DHA plays a vital role in adult brain function and maintenance. For growing babies, DHA in pregnancy supports development of the brain, eyes, and nervous system. Adequate DHA in pregnancy and postpartum can prevent preterm birth, support a healthy birthweight baby, and improve the mother’s mood and mental health in the postpartum period. It is estimated that only 10% of women of childbearing age are meeting the recommended DHA intake.
DHA recommendations can be met through dietary sources or supplementation during pregnancy. There is no solid recommendation for DHA in pregnancy, despite it being a KEY preconception nutrient. The RACGP (Royal Australian College of General Practitioners) suggests a 500mg supplement daily in pregnancy. This is somewhat backed up by the Heart Foundation Australia which recommends 250 – 500mg of marine sourced omega 3’s (DHA & EPA) daily for adults, for general health.
Where do we get DHA?
Unfortunately, the best quality sources of DHA come from salmon, sardines, anchovies, salmon, mackerel, and rainbow trout. ALA is the type of omega 3 found in plant sources. ALA can be converted to EPA and DHA in the body however this is not efficient and can vary in the amount that is actually converted. Plant based omega 3 (such as ALA) are found in flaxseeds, walnuts, chia seeds, seaweed, algae, edamame and hemp seeds. Often women who follow a vegan or vegetarian diet in pregnancy, will need supplementation of omega 3’s under guidance of a dietitian or doctor.
Conclusions
In summary, following a vegetarian diet in pregnancy can put you at risk of nutrient deficiency. By including a prenatal dietitian as part of your pregnancy team, you can meet your nutrient needs for a healthy and happy pregnancy for you and your baby.
