Balanced Plant-Based Diet During Pregnancy

  • Kutal Mete Tekin MRes, Bioengineering, Imperial College London, UK
  • Zahraa Al-Lami Alevel Biology, Chemistry, Psychology and Arabic, The UCL Academy

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Introduction

Vegetarian diets contain many health benefits that are widely publicized such as a reduction in the amount of fat and an increase in the number of vitamins from plant-based sources. There is also a great emphasis on the ethical considerations of a plant-based diet. During pregnancy, a balanced diet is essential for the healthy growth of your baby, and to make sure that the birthing parent remains healthy themselves.

Always consult with a healthcare professional if you have any concerns about diet and pregnancy. Vegetarian diets go as far back as 3200 BC, with Egyptian people believing that not eating meat would mean that they would be more likely to be reincarnated.1 In India, vegetarianism is very popular which is probably partly because cows are sacred, and violence against animals is frowned upon.2

Read on to find out the specific nutrients that are required during pregnancy, and also some useful recipes to try during your pregnancy. 

The nutritional needs of pregnant people

As you can guess, pregnant people require an increased amount of calories in order to facilitate the healthy development of their baby. If you are pregnant with one baby, then you need an extra 340 calories during the 2nd and 3rd trimesters. If you are pregnant with twins, then you need an extra 600 calories. Triplet-birthing parents-to-be would require 900 extra calories a day.3

You need:

  • Vitamin D, vitamin B-1 (thiamine), vitamin B-12 (cyanocobalamin), vitamin B-2 (riboflavin), vitamin B-5 (pantothenic acid), vitamin B-3 (niacin) and vitamin B-9, vitamin B-7 (biotin) and vitamin C
  • 400 micrograms of Folic Acid (In some cases this may need to be increased to 5mg)
  • Good sources of calcium, such as almonds and fortified cereals
  • Starchy foods such as bread and potatoes
  • Fiber sources such as wholemeal bread
  • Protein sources such as beans, tofu, lentils, chia seeds, and nuts4
  • Omega 3 and 6 are polyunsaturated fats that are essential in our diets10

Planning a well-balanced vegetarian diet 

Incorporating a variety of plant-based foods 

A variety of plant-based foods such as whole grains, legumes and pulses, nuts and seeds, leafy greens and vegetables and fruits can provide optimal protein intake and enhance iron absorption. You may be worried that adopting a plant-based diet may cause you to develop certain deficiencies but it is possible to meet most of your needs without dairy products. An example is calcium, as a lot of breakfast cereals are now fortified with this mineral. Ensuring sufficient vitamin B12 intake is also a common concern for people who have a vegetarian diet. If needed, your doctor can offer you B12 injections to prevent deficiency in B12.11

Plant-based sources of omega-3 fatty acids

Folic acid in pregnancy is essential to prevent neural tube defects. Whilst you can get folate from foods, it is hard to know how much folate you are consuming, which is why tablet supplements for folic acid are available to prevent any deficiencies. You can also buy liquid vitamin and mineral supplements, if you find it hard to take tablets. 

Symptoms of folate deficiency can include:12

  • Mouth ulcers 
  • Tiredness 
  • Depression
  • Pins and needles in your limbs

If you notice any of these symptoms, it is important to talk to your healthcare professional for guidance on whether a blood test is needed. People who take certain medications can be at an increased risk of folate deficiency. For example, if you take anticonvulsants or proton pump inhibitors, your body may struggle to absorb folate from your food.12

The philosopher Pythagoras was an avid believer in the health benefits of a balanced vegetarian diet.5 In any diet it is important to manage the different levels of each nutrient and this is especially important if pregnant. 

Omega 3 and 6

  • Omega 3 can be found in: rapeseed/canola oil, hempseed oil, walnut oil, algal oil, soya bean oil and flax seeds
  • Omega 6 can be found in walnuts, soya beans, corn oil, grapeseed oil, sunflower oil, soya bean oil, walnut oil and wheatgerm oil10

Why do we need Omega 3 and Omega 6? 

Omega-3 and Omega-6 are essential for brain function and brain growth. During pregnancy, your baby's brain is developing and as such it is important to maintain the correct levels of Omega 3 and Omega 6 to prevent any abnormalities occurring. Omega-3 and Omega-6 are also important in bone and skin health.15

Managing morning sickness and common pregnancy concerns

Coping with morning sickness on a vegetarian diet

Morning sickness is a common side effect of pregnancy. The guidance that is given for morning sickness is to eat little meals often. Eating regularly and reducing the time that you feel hungry can reduce nausea and vomiting. It’s also a good idea to eat foods that you find don’t upset your stomach, for example plain foods may reduce irritation to your stomach. Foods that are very rich, for example with lots of spices or heavy creamy sauces may upset the stomach. You may also find that certain textures may cause you to gag, which is completely normal. It is also important to note that morning sickness can occur at any time of the day, and not just in the mornings. 

For information on hyperemesis gravidarum, click the link here. Hyperemesis gravidarum, is morning sickness that is severe and prevents you from doing day to day tasks due to excessive vomiting. If you are struggling with morning sickness, you can sign up for help with Start for Life, which is part of the Better Health initiative. 

Supplements and prenatal vitamins

Vitamins and minerals can be found in a variety of plant-based foods, for example, Vitamin K can be found in leafy green vegetables. It is important to note that Vitamin K is a fat-soluble vitamin. This means that you need a small amount of fat in your diet in order to be able to absorb vitamin K efficiently. Carotenoids are changed into Vitamin A in our bodies which is also another fat-soluble vitamin. Carotenoids can be found in carrots. Healthy plant-based fats include avocados.16

During pregnancy, iron deficiency is a common problem. Iron deficiency can lead to neural tube defects. Vegetarian foods that have high amounts of iron, including beans, lentils, tofu, cashew nuts, quinoa, chickpeas, seeds, and green leafy vegetables such as kale and spinach.

Multivitamins can provide additional nutrients, when there is a deficiency in your diet. Whether this is due to the preferences that you have in your diet, or because your body isn’t very effective at absorbing the nutrients that you put into it. You can buy vitamins that are specific to one type of nutrient, eg: Vitamin A, or you can buy a multivitamin that has a balanced blend of the vitamins and minerals that your body requires.

These multivitamins will have the recommended daily dose of each vitamin or mineral. A point to make is that different brands should all adhere to the same standards, however, there may be differences in the size, shape and texture of the tablets which make it easier to swallow. A second point to make is that water soluble vitamins such as Vitamin B will reach a maximum level in your body and then will be excreted (removed) in your urine.9

During pregnancy, the minerals calcium, iron, magnesium, selenium, zinc, and possibly chromium and iodine start to deplete. This is why supplements are usually recommended by your healthcare practitioner.13 Vitamin D and Folic acid supplements are also recommended for all pregnant people. Additionally, your healthcare professional will also monitor your B12 levels. If there is a deficiency, they may offer B12 injections. 

Overcoming social and cultural challenges

Handling concerns and criticisms from family and friends can be a hard part of a vegetarian diet during pregnancy. It is also hard to deal with misconceptions about vegetarianism. When communicating with healthcare providers about dietary choices, it is important to remember that a healthy, balanced vegetarian diet will in most cases provide all the nutrients that you need. The only exception to this rule is folic acid and vitamin D supplements which are recommended to all pregnant people. 

Faith, culture and diet

In many religions there are traditions of fasting at certain times of the year, one such example comes from Islamic culture; including a month-long period of fasting, however pregnant people are exempt from this rule. Fidyah is the practice of giving food to someone else who is living in poverty, if you don’t fast for any reason. Providing an accessible way to not fast whilst still maintaining the values behind it.

The main risk of fasting whilst pregnant is dehydration. This can lead to a smaller amount of amniotic fluid around the baby. Many pregnant people may struggle between choosing what is right for their baby and for their religion, so it is important to note that research has been carried out and results show that there is no difference in the health of babies born to mothers who fasted, than mothers who didn’t fast.14

Sample meal plans for vegetarian pregnant people 

Here you can find a link to a couple of different recipes to try. Remember that variety is important when picking what to eat, to ensure the most varied macronutrients for you and your baby.

Special considerations in vegan and vegetarian pregnancy 

A vegetarian diet is simply one where you do not eat meat. A vegan diet is where you do not eat meat or meat derived products. One of the main differences between a vegan and vegetarian diet is that vegans do not eat dairy products so calcium deficiency can be an issue if suitable alternatives to dairy are not introduced. However, there are plant-based sources of calcium that can be used instead of dairy products to prevent a calcium deficiency. You can also use calcium supplements. 

Exercise and self-care during pregnancy

Exercise allows us to burn off calories that we take in during the day. In order to maintain healthy muscles and bodies, exercise is needed to maintain muscle strength and also to reduce the likelihood of cardiovascular disorders. You can also use exercise as a means of stress management and relaxation during your pregnancy. However, taking part in contact sports or taking part in workouts which require you to lie on your back for a prolonged amount of time is not recommended for pregnant people. Instead, opt for pelvic floor and stomach-strengthening exercises.17

FAQ’s

Which plant-based foods are high in iron for vegetarians? 

Plant-based foods that are high in iron include legumes such as beans, lentils and chickpeas, tofu, pumpkin seeds, quinoa, fortified cereals and dried fruits like apricots and raisins , spinach and kale.

Which vegetarian foods are high in vitamin C? 

Vitamin C-rich vegetarian foods include citrus fruits such as oranges, grapefruits, lemons, mango, papaya, bell peppers, broccoli, and tomatoes, strawberries, kiwi and guava.

Can I have a healthy pregnancy, whilst maintaining a vegan diet? 

Yes, as long as you balance your diet and take appropriate supplements (when required) you can have a healthy pregnancy. 

Summary 

The number of people embracing the vegetarian diet has increased by 600% from 2014 to 2018.6 Trials have also shown that a switch to vegetarian diets aids weight loss. In cases of gestational diabetes, a vegetarian diet may help to reduce excess weight gain and maintain steady blood sugar levels. This is because the vegetarian diet improved the insulin resistance markers of the people contributing to the study. Insulin resistance markers show how well your body is managing to deal with sudden spikes in your blood sugar.7

References

  1. Hargreaves SM, Raposo A, Saraiva A, Zandonadi RP. Vegetarian Diet: An Overview through the Perspective of Quality of Life Domains. IJERPH [Internet]. 2021 [cited 2024 Mar 11]; 18(8):4067. Available from: https://www.mdpi.com/1660-4601/18/8/4067
  2. Alsdorf L. In: The History of Vegetarianism and Cow-Veneration in India. Asdorf L., Bollée W., editors. Routledge; Weisbaden, Germany: 2010.
  3. Nutrition During Pregnancy [Internet]. [cited 2024 Mar 11]. Available from: https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy
  4. Mewada P. List Of Protein Rich Food For Vegetarians. PharmEasy Blog [Internet]. 2022 [cited 2024 Mar 11]. Available from: https://pharmeasy.in/blog/list-of-protein-rich-food-for-vegetarians/.
  5. Clem, J., & Barthel, B. (2021). A Look at Plant-Based Diets. Missouri medicine, 118(3), 233–238.
  6. Forgrieve J. The Growing Acceptance Of Veganism. Forbes [Internet]. [cited 2024 Mar 11]. Available from: https://www.forbes.com/sites/janetforgrieve/2018/11/02/picturing-a-kindler-gentler-world-vegan-month/.
  7. Kahleova, H., Fleeman, R., Hlozkova, A., Holubkov, R., & Barnard, N. D. (2018). A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein. Nutrition & diabetes, 8(1), 58. https://doi.org/10.1038/s41387-018-0067-4
  8. Trust) N (National C. Is a vegan diet healthy during pregnancy and breastfeeding? | Pregnancy articles & support | NCT. NCT (National Childbirth Trust) [Internet]. 2020 [cited 2024 Mar 11]. Available from: https://www.nct.org.uk/pregnancy/food-and-nutrition/vegan-diet-healthy-during-pregnancy-and-breastfeeding?gclid=Cj0KCQjw2qKmBhCfARIsAFy8buIRl5oqvNi6X8p5_2sdzxJ09D9ewyYz3E_EqgT6Gy63fKN9GmfCUycaAlShEALw_wcB
  9. [Internet]. 2022. Multivitamins vs Individual Vitamins: Which Is Better for Your Body?; [cited 2024 Mar 11]. Available from: https://my.klarity.health/multivitamins-vs-individual-vitamins/.
  10. Nutritional advice. Vegetarian Society [Internet]. [cited 2024 Mar 11]. Available from: https://vegsoc.org/eating-veggie/nutritional-advice/.
  11. Vitamin B12 or folate deficiency anaemia - Treatment. nhs.uk [Internet]. 2017 [cited 2024 Mar 11]. Available from: https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/treatment/.
  12. NHS inform [Internet]. Vitamin B12 or folate deficiency anaemia symptoms and treatments; [cited 2024 Mar 11]. Available from: https://www.nhsinform.scot/illnesses-and-conditions/nutritional/vitamin-b12-or-folate-deficiency-anaemia/.
  13. Adams, J. B., Sorenson, J. C., Pollard, E. L., Kirby, J. K., & Audhya, T. (2021). Evidence-Based Recommendations for an Optimal Prenatal Supplement for Women in the U.S., Part Two: Minerals. Nutrients, 13(6), 1849. https://doi.org/10.3390/nu13061849
  14. Ramadan and pregnancy - British Nutrition Foundation [Internet]. [cited 2024 Mar 11]. Available from: https://www.nutrition.org.uk/life-stages/pregnancy/healthy-eating-during-pregnancy/ramadan-and-pregnancy/#:~:text=Do%20I%20have%20to%20fast,the%20health%20of%20her%20baby
  15. Brown TJ, Brainard J, Song F, Wang X, Abdelhamid A, Hooper L. Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019 Aug 21;l4697.
  16. Vitamins and minerals - Others. nhs.uk [Internet]. 2017 [cited 2024 Mar 10]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/others/. 17) Exercise in pregnancy. nhs.uk [Internet]. 2020 [cited 2024 Mar 10]. Available from: https://www.nhs.uk/pregnancy/keeping-well/exercise/.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Rachel Siobhan Smith

MSc Biomedical Science, University of Greenwich

Rachel is a Post Graduate student reading Biomedical Science at the University of Greenwich. They have years of experience working in Biomedical laboratories, but also a keen interest in medical communications. Rachel previously worked in a Covid Testing laboratory to help enable the UK, to increase testing capacity during the Covid-19 pandemic.

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