Some vegetarian diets include eggs and dairy. A vegan diet has no meat, dairy or eggs. A pescatarian diet is plant-based but includes fish. Is one type better during pregnancy? All pregnant women, whether or not they eat meat, need to take a quality prenatal vitamin.
It can be almost impossible to eat a complete diet in this situation. It was first reported in one prospective study, which obtained an adjusted OR of 4. However, this work failed to demonstrate a relationship between the incidence of hypospadias and the intake of soya products, which were supposed to be the first source of phytoestrogens in this lifestyle [ ]. Another Scandinavian prospective case—control study reported an increased risk of hypospadias in women with diets excluding meat and fish diet.
The study was based in the hypothesis that the lack of some essential amino acids may produce a deficiency during organogenesis [ ]. However, these large and well-designed studies had the limitation that their conclusions were based on indirect correlations derived from retrospectively self-administered questionnaires. On the contrary, more recent works, which have focused on the relationship of nutrients to estrogen metabolism and the quantity of phytoestrogens in the diet to hypospadias, have not found positive correlation [ , ].
Furthermore, one Italian study found a positive correlation between hypospadias and a frequent consumption of fish during pregnancy [ ]. This contradictory data, together with other studies, suggest that the imbalance of some nutrients or the intake of food contaminants may play roles in the genesis of hypospadias; however, at this point in time, there is not enough information to conclude that vegetarian or vegan diets increase the risk of disruption during the genital organogenesis [ , ].
Plant-based and vegetarian diets, characterized by a high consumption of fruits and vegetables and low or no intakes of cured meat and smoked fish, which represent the principal exogenous dietary sources of nitrate, nitrite, and N-nitroso compounds, associated with a higher risk of developing NTD, would be protective to the risk of congenital malformations [ 92 ]. However, it has been described that pickled vegetables are also a source of nitrite and NOCs. A study showed the association between maternal periconceptional consumption of pickled vegetables and NTD in four Chinese countries [ ].
Vegetarian diets differ between individuals: without good information and well planned diets, vegetarians may be at risk for some deficiencies during pregnancy and consequently during breastfeeding period. In the Table S1 we recollected the daily nutrient requirements during pregnancy and lactation. Although vegetarian diets are usually rich in carbohydrates, the need to develop energy reserves during lactation increases demand for more calories.
Both vegetarian and nonvegetarian mothers need caloric reserves to reach sufficient energy average for breastfeeding during the postpartum period [ ]. The composition of human milk changes dynamically and can vary according to many maternal factors, such as diet and nutritional status.
A recent study analyzed the association of maternal nutrition and body composition with human milk composition. For women in the third month postpartum, they observed moderate to strong correlations between total protein content in milk and the body composition measures such as percentage of fat mass, fat-free mass, and muscle mass.
The variance in milk fat content was related to body mass index BMI , with a significant positive correlation in the first month postpartum. These findings suggest that maternal body composition may be associated with the nutritional value of human milk, with independence of type of diet [ ].
Nutritional supplements do not change milk composition in observational studies maybe due to compensatory physiological mechanisms that conserve stable milk macronutrient composition related to the nutritional modifications of maternal diet [ ]. Also protein concentration in human milk does not vary in relation to maternal intake of vegetal or animal proteins [ ]. Nevertheless, Agostoni et al. Vegetarian mothers might have low pre-pregnancy nutritional status that can lead to low maternal fat stores for lactation.
Fikawati et al. They followed 42 pairs of vegetarian and 43 pairs of nonvegetarian. Sociodemographic characteristics did not differ between the two dietary groups except in maternal parity. Vegetarian mothers had lower pre-pregnancy BMI but higher pregnancy weight gain compared to nonvegetarian. The mothers in the nonvegetarian group in this study had a significantly greater energy intake compared with the vegetarians. Without adequate intake of energy during lactation the postpartum nutritional profile of vegetarian mothers decreased, so the maternal nutritional stores are sacrificed to support infant normal growth.
Low maternal vitamin B intake during lactation can lead to low vitamin B12 content in breast milk which can cause permanent neurological disabilities in infants with low vitamin B12 levels. Maternal vitamin B12 status is the major factor affecting the severity of cobalamin deficiency in breast-fed infants and vegetarian and vegan population are at increasing risk [ ].
Breastfed infants of mother who adhere to vegan diets are at increased risk of vitamin B12 deficiency [ ]. Pawlak et al. Specific fatty acids that form the total lipid fraction are influenced by maternal nutrition. Fatty acids intake derives from the maternal plasma, or they synthesized endogenously by the mammary glands. Both of these sources are influenced by maternal diet composition [ ]. The breast milk of vegetarians and particularly vegans in the United Kingdom showed lower DHA levels if compared to omnivores, but in the United States, vegetarians do not have lower levels of DHA in breast milk lipids, probably due to higher ingestion of ALA from soybean oil or preformed DHA [ 63 ].
Compared to nonvegetarians, the breast milk of vegetarians was found to have more than twice the amount of LA and ALA, but less than half the amount of DHA [ 84 ]. Supplementation with DHA during lactation is more useful to raise DHA content in breast milk than supplementing only during pregnancy [ ].
A recent review analyzed 13 low- and middle-income countries and showed that the content of DHA in breast milk was very low in populations living mainly on plant-based diets but higher in fish-eating countries [ ].
They found that breast milk from vegans had significantly higher unsaturated fat and total omega-3 fats, and lower saturated fats, trans fats, and omega-6 to omega-3 ratios than vegetarian and omnivore. DHA concentrations in breast milk were low regardless of maternal diet pattern, and were reflective of low seafood intake and supplement use.
Supplement use was relatated to high DHA levels. The study was limited to small sample. The vegan diet contains essentially no ARA and DHA, as plants thought to have fatty acids such as hempseed, rapeseed, flaxseeds, soy beans, and walnuts are poorly converted into DHA by the body [ ]. In addition, in the developed world, vitamin D deficiency is most frequently diagnosed exclusively in breastfed infants of vegetarian or vegan mothers [ ].
More data are needed to evaluate the milk composition of mother following vegetarian or vegan diets. Specific dietary interventions before, during, and after gestation that are aimed in improving diet quality and setting appropriate intakes of macro- and micronutrients are important to avoid maternal health impairment with consequent physical and neurological fetal abnormalities.
The intake of pulses, green leafy vegetables, cereals, and fruit that is associated with best adherence to the Mediterranean diet provides a relatively high intake of folate, which is particularly important in the preconception period.
Following a Mediterranean diet also increases the likelihood of achieving adequate intakes of zinc, B vitamins, vitamin A, vitamin E, magnesium, and vitamin C [ 40 ].
A strict plant-based diet is suitable during pregnancy but it must be well planned in order to provide all the energy requirements and meet critical nutrients, such as protein, fiber, omega-3, fatty acids, zinc, iodine, calcium, vitamin D, and vitamin B The vegetarian-type pattern is not associated to any outcome as preterm birth, BW or SGA if requirements are met [ , ].
Educational resources and food recommendations help vegetarians to consume adequate and complete diets. Some tools could be used for educating vegetarian patients as recording dietary intake by food diaries, providing charts that list of different sources of nutrients or sample menus [ 63 ].
Guidelines on what to eat during pregnancy and lactation are essentially the same for vegetarians as for meateaters, but women who choose restricted diets may need to consume supplements or fortified food in order to reach the recommended requirements [ 9 ].
Protein needs are particularly high during pregnancy and lactation. Adding 1. Essential amino acids can be full obtained from both grains and legumes. An increase in all sources of protein can compensate for low lysine intake [ 63 ]. Lysine is an amino acid that can be more readily obtained from beans and soy and less readily obtained from cereals.
Some plant foods, such as soy, lupines, spinach, pseudocereals buckwheat, quinoa, and amaranth , and hemp seeds, have all the essential amino acids in similar proportions to animal foods. But some other foods, such as antinutritional factors or fiber, interfere in the absorption of plant proteins.
If protein consumption in a vegan diet is well planned, no differences in infant birth weight in vegan mothers in comparison with omnivorous mothers have been observed [ 16 ].
Balanced energy and protein supplementation reduce the risk of stillbirth and SGA, but high-protein supplementation is not recommended [ ]. Plasma quantization of amino acids could be performed in a laboratory to detect deficiencies [ ].
Fiber intake is recommended in pregnancy because it improves the richness of microbiota and avoids constipation but an excessive consume can difficult the meeting of appropriate nutrient and energy absorption. Therefore, during second and third trimester, alternative foods are preferred fruits and vegetables, refined grains, peeled beans, and high-protein, high-energy, fiber-free foods such as soy milk, tofu, and soy yoghurt [ ]. Due to the limited vegetable sources of DHA, pregnant vegetarian women are encouraged to consume an algae-based supplement.
High dietary LA intake, excessive intakes of trans fatty acids, inadequate intakes of energy, protein, pyridoxine, biotin, calcium, copper, magnesium, or zinc can impair EPA and DHA synthesis [ 16 ]. Vegans and vegetarians can be at a disadvantage in balancing this ratio, because they may limit sources of ALA n-3 or DHA in their diet, and they typically consume an abundance of LA [ 63 ].
Good plant sources of omega-3 fatty acids include ground flaxseeds and flaxseed oil, ground chia seeds, and walnuts. Olive oil has a low influence in this ratio and, in addition to flaxseed oil, and should be the only additional oil to use as omga-3 source. In a recent Cochrane review, the authors studied supplement of omega-3 fatty acids in pregnant women. No differences were found for SGA or intrauterine growth restriction. It seems reasonable to recommend a daily supplementation of DHA for all pregnant women [ ].
Even at the pregestational level, an intake of adequate amounts of n—3 PUFAs and DHA plays a major role; indeed, small variations in the habitual maternal dietary composition before pregnancy are likely to be more effective in improving the delivery of long-chain PUFAs to the fetus than large dietary changes in the late stages of pregnancy [ 92 ].
In these stages, a daily intake of to mg microalgae-derived DHA supplement is suggested [ ]. Legumes, soy, nuts, seeds, and grains are all rich in zinc [ ].
Zinc absorption can be improved by adopting food preparation methods soaking, germination fermentation, sourdough leavening of bread that reduce phytate levels in zinc rich foods. Zinc-fortified foods e.
Zinc-rich foods should be eaten together with foods that contain organic acids such as fruit, and vegetables of Brassicaceae family [ 16 ] in order to improve zinc absorption.
Vegan diets could provide low intake of iodine, although iodine deficiencies are quite uncommon in Western countries. Iodized salt is the safest way to reach iodine requirements in vegan pregnant and lactating women. Iodized salt varies among countries. Higher salt intake during pregnancy in vegans is considered harmless because of the low incidence of hypertension in this population, and can facilitate to meet the iodine requirements.
Another option can be an algae-derived supplement. Iron supplementation is only recommended if iron status has been shown to be low by appropriate blood tests [ 16 ]. A well planned vegan diet can meet iron needs. During pregnancy it is recommended a daily consumption of iron rich foods as soy, beans, seeds, nuts, and green leafy vegetables as well as vitamin-C in combination.
Some cooking considerations and food preparations should also improve iron absorption [ ]. A vegan diet can protect calcium stocks by increasing absorption [ 94 ].
Therefore, supplementation is rarely needed. Ideally, low-oxalate foods high bioavailability , such as broccoli or bokchoi, must be preferred. Another important source of calcium is hard water. Most of the varied diets above kcal should completely cover calcium needs [ ]. Villar et al. In the intervention group the intake was 1. They did not find differences in PE. They found a reduction of severe preeclamptic complications index.
Neonatal mortality rate was lower in the calcium group. This supplement was associated with a significant reduction in the risk of preeclampsia, particularly for women with low calcium diets but the significant reduction in the risk of PE associated with calcium supplementation might be overestimated small effect, high heterogeneity and publication bias [ ].
The World Health Organization recommends 1. Vegans must rely strongly on ultraviolet B rays—the band of ultraviolet that causes synthesis of vitamin D-3—from direct sunlight, to obtain sufficient vitamin D.
Extending sunlight exposure and consuming vitamin D fortified foods may be appropriate strategies to avoid possible vitamin D deficiencies [ 92 ]. Adequate levels of this molecule and the maintenance of proper metabolism during pregnancy need to be emphasized because some beneficial effects have been reported.
For example vitamin D enhances insulin responsiveness for glucose transport, through the modulation of insulin receptor expression. Vitamin D induces insulin secretion and decreases insulin resistance preventing gestational diabetes. In addition, it plays a critical role in the regulation of blood pressure and electrolyte and plasma volume homeostasis; therefore, normal serum vitamin D levels help to prevent hypertension and PE through suppression of the renin—angiotensin system [ ].
Nevertheless, excess vitamin D may also have detrimental effects because it might decrease progesterone concentrations causing a preterm labor or impair fertility outcomes, so supplementation should be selective [ ]. Good sources of vitamin D are found in fish, liver oils, fatty fish, and egg yolks, but vitamin content in these foods varies by the time of year [ 63 ]. Plant sources of vitamin D are beans, broccoli, and leafy greens, but its content of this molecule without fortification is low, except for some wild mushrooms that contain a relevant concentration of this vitamin; therefore, vegetarian and vegan women are at risk of vitamin D deficiency.
Serum levels of vitamin D are easily measured if there is concern regarding intake of this essential nutrient [ 94 ]. Most of prenatal vitamins contain insufficient vitamin D in order to prevent infant vitamin D deficiency, so to get the recommended doses of to IU per day, are considered safe in pregnancy [ ].
A recent Cochrane review underlines that supplementing pregnant women with vitamin D in a single or continued dose increases serum hydroxyvitamin-D, and may reduce the risk of preeclampsia, low BW, and preterm delivery.
However, when vitamin D and calcium are combined, the risk of preterm birth is increased. Further studies are needed to evaluate vitamin D supplementation and the correct dose during pregnancy [ ]. Vitamin B12 is not found in plant sources, and therefore must be obtained through animal consumption or via supplements [ 94 ]. Since vitamin B12 deficiency may appear in pregnant vegetarian women, in particular vegans, an adequate B12 status should be improved, so the use of B12 supplements is necessary.
Foods fortified with vitamin B12 include meat substitute products, breakfast cereals, soymilks, tofu, cereals, and nutritional yeast. Seaweed and tempeh are generally not reliable sources of vitamin B Four servings daily of vitamin Bfortified foods are recommended in pregnancy and lactation [ 63 ].
Pregnant and lactating vegetarian and vegan mothers should be encouraged to take an individual B12, supplement and dissolve it under the tongue or chew it slowly in order to increase absorption [ ]. In the case of vitamin B12 deficiency, the majority of clinical studies suggest starting with high parenteral doses of B12, after which oral treatment is continued. Vitamin B12 status serum B12, along with homocysteine and folic acid should be regularly checked throughout pregnancy also in women with optimal B12 levels in the first trimester, and it is necessary to adjust supplementation schemes according to the laboratory results [ ].
The present study corresponds to a descriptive review in which the majority of papers evaluated maternal dietary intake through a food frequency questionnaire. The main limitations of these questionnaires are the different food list and the possible mistakes of reporting.
However, some of them describe specific populations in India or Africa with lower economic status and particular idiosyncrasy. For that, ethnicity and poverty have to be taken into account as a cause of an unbalanced diet, micronutrient deficiency, and poor pregnancy outcome.
Mother undernutrition could be multifactorial, so it is important to mention the difficulties to determine the molecular mechanisms promoted by each micronutrient which may affect specifically the maternal nutritional profile. Diet is one of the most significant lifestyle-related factors in determining health state and predisposing the offspring to develop several diseases.
Vegetarian and vegan diets are emerging worldwide due to the evidence that plant-based dietary patterns reduce the risk of coronary heart disease, high blood pressure, type 2 diabetes, and cancer. Pregnancy is a critical window of opportunity to provide dietetic habits that are beneficial for fetal healthy.
It is also an exclusive condition in which the requirements of energy and micronutrients intake increase to maintain the supply of essential nutrients for fetal development. Each stage of fetal growth is dependent on appropriate maternal nutrient transfer, so a balanced diet is essential to avoid fetal complications. The choice of vegetarian or vegan diet is always in the preconception period due to ethical reasons or poor social condition, so a well-adjusted preconception nutrition is essential for healthy pregnancy.
Available data demonstrated that micronutrients insufficiency and caloric restriction are more common in developing countries, where vegetarian diets are chosen because of socioeconomic reasons.
On the contrary in developed countries, the consciousness and the concern of a balanced diet is taken more into account. Generally it is difficult to verify the effects of such diets on pregnancy outcomes and to separate them from other confounding factors such as ethnicity, lifestyles or smoking.
Although more high quality evidence is needed, balanced plant-based diets rich in fibers and low in fat are considered to be protective against poor pregnancy outcomes such as PE, DG, and preterm delivery. However, these protective effects disappear if micronutrients deficiencies emerge.
Moreover unbalanced dietary patterns with lack of macro- and micronutrients such as proteins, vitamin B12, vitamin D, calcium, DHA, and iron are at more risk of fetal impairment low BW, neurological disabilities, and fetal malformations. Maternal undernutrition may potentially alter fetal growth trajectory by modifying placental weight and nutrient transfer capacity; depending on the severity of the nutritional deprivation and on the timing of depletion.
Thus, plant-based diets during pregnancy and lactation require a strong awareness for a complete intake of essential key nutrients and vitamin supplements, according to international guidelines. In addition, during breastfeeding both vegetarian and nonvegetarian mothers need caloric reserves to reach sufficient energy average.
The composition of human milk changes dynamically and may vary according to many maternal factors, such as nutritional status. Nutritional supplements do not change milk composition in observational studies, also proteins concentration in human milk does not vary in relation to maternal intake of vegetal or animal proteins, but maternal body composition may be associated with the nutritional value of human milk.
So maternal undernutrition, producing lack of vitamin B12, vitamin D, calcium, and DHA during lactation may lead to low vitamin content in breast milk, which can cause permanent neurological disabilities in infants or low bone mineralization. Finally, the current manuscript supports the evidence that maternal nutritional status is the key condition for health benefits of plant-based diets. Vegetarians and vegans are at risk of nutritional deficiencies, but if the adequate intake of nutrients is upheld, pregnancy outcomes are similar to those reported in the omnivorous population.
In this regard, specific dietary interventions before, during, and after gestation that are aimed at improving diet quality and adjusting appropriate intakes of macro- and micronutrients might avoid maternal health impairment, mental diseases during pregnancy, and consequent physical and neurological fetal disabilities.
The vegetarian-type pattern should be considered safe and it is not associated with preterm birth, BW, or SGA if the requirements are met. Therefore, healthcare professionals might have knowledge about plant-based diets characteristics in order to implement balanced dietary patterns, enhancing supplement intake, and paying attention to critical nutrients to avoid dangerous health outcomes.
Further large-scale observational studies would help to define correlations between plant-based diets, gestation, and health, and might be suitable to design pregestational nutrition intervention strategies. Studies about the effects of Vegetarian and vegan diet on maternal outcomes; Table S4: Studies about the effects of vegetarian and vegan diets on fetal outcomes. All authors contributed to the work reported.
National Center for Biotechnology Information , U. Journal List Nutrients v. Published online Mar 6. Find articles by Giorgia Sebastiani. Find articles by Ana Herranz Barbero. Find articles by Miguel Alsina Casanova. Find articles by Victoria Aldecoa-Bilbao.
Find articles by Mireia Pascual Tutusaus. Author information Article notes Copyright and License information Disclaimer. Received Jan 30; Accepted Mar 1. This article has been cited by other articles in PMC. Associated Data Supplementary Materials nutrientss Abstract Vegetarian and vegan diets have increased worldwide in the last decades, according to the knowledge that they might prevent coronary heart disease, cancer, and type 2 diabetes.
Keywords: vegetarian diets, vegan diets, plant-based diets, nutrition, pregnancy, breastfeeding, human milk, micronutrients, fetal development. Accordingly, there are two main directions: 1. Review 2. International Guidelines for Vegetarian and Vegan Diets According to the Academy of Nutrition and Dietetics a well planned plant-based eating pattern could be appropriate for all stages of life if adequate and healthy recommendations are followed.
The Effects of Vegetarian and Vegan Diets during Pregnancy on Maternal Nutritional Profile see Table S2 Vegetarian and vegan diets have been considered a nutritional challenge during pregnancy, and they require strong awareness to achieve complete intake of essential nutrients, as such, these diets are at risk of nutritional deficiencies.
Vitamin B12 A recent review shows that there is a high prevalence of vitamin B12 depletion or deficiency among vegetarians [ 62 ]. Vitamin D and Calcium Plasma levels of vitamin D during pregnancy depend on sunlight exposure and intake of foods high in vitamin D, fortified foods, or supplements. Iron During pregnancy, mild anemia is physiologic as a consequence of the normal hemodilution status. Zinc Zinc is less bioavailable and it is likely to be present in lower ranges when obtained from plant-derived compared to animal food sources [ 47 ].
Iodine, Magnesium Vegetarian or vegan diets may result in low iodine intake because the main dietary sources of iodine are meat, fish, and dairy products, but iodine in the salt could avoid the risk of deficiency [ 92 ]. Preeclampsia PE Studies about the effects of vegetarian and vegan diet on maternal outcome have yielded incongruent results. Gestational Diabetes Vegetarian diets and high intake of fiber could avoid the development of Gestational Diabetes GD.
Preterm Delivery Data correlating preterm delivery and vegetarian diets are controversial. The Effects of Vegetarian and Vegan Diets during Pregnancy on Fetal Outcomes see Table S4 Fetal outcomes depend on a balanced interchange between maternal nutrients, placental transport and fetal growth factors. The Effects of Vegetarian and Vegan Diet on the Composition of Human Milk Vegetarian diets differ between individuals: without good information and well planned diets, vegetarians may be at risk for some deficiencies during pregnancy and consequently during breastfeeding period.
Vegetarian and Vegan Diet during Pregnancy and Lactation: Target Therapy and Health Intervention Specific dietary interventions before, during, and after gestation that are aimed in improving diet quality and setting appropriate intakes of macro- and micronutrients are important to avoid maternal health impairment with consequent physical and neurological fetal abnormalities.
Proteins Protein needs are particularly high during pregnancy and lactation. Fibers Fiber intake is recommended in pregnancy because it improves the richness of microbiota and avoids constipation but an excessive consume can difficult the meeting of appropriate nutrient and energy absorption. Iodine Vegan diets could provide low intake of iodine, although iodine deficiencies are quite uncommon in Western countries. Iron Iron supplementation is only recommended if iron status has been shown to be low by appropriate blood tests [ 16 ].
This is because non-vegans get most of their calcium from dairy foods. Talk to your midwife or doctor about how you can get all the nutrients you need for you and your baby.
Page last reviewed: 8 August Next review due: 8 August The answer is a resounding yes. You can be a pregnant vegetarian and still get all the protein, vitamins, minerals, and other nutrients you need.
Plant foods should take center stage to help ensure an abundant supply of every essential vitamin and mineral needed to fuel you and your growing baby. Dairy products can help boost your intake of protein, calcium and vitamin D. Dairy foods also add vitamin B12, which comes only from animal or fortified foods. To be on the safe side, you should also take a prenatal vitamin that contains percent of the vitamin B12 and iron you need.
Follow these guidelines during your pregnancy to ensure that you and your baby get the proper nutrition:. Calorie Counts: Add about calories a day to your diet during your second and third trimesters. What to Avoid: To reduce the risk of illness from the listeria bacterium, steer clear of uncooked, unpasteurized cheeses such as feta, brie, Camembert, and blue-veined or Mexican-style cheeses.
Never eat raw or undercooked animal foods such as meat, sushi, seafood or eggs; avoid fish that may contain excessive mercury swordfish, shark, king mackerel and tilefish ; and limit shellfish and canned fish to 12 ounces a week.
Avoid alcohol , tobacco, and medications that have not been approved by your doctor. Vitamins: Take a daily supplement , as recommended by your physician, that supplies to percent of the Dietary Reference Intake for all vitamins and minerals. This nutrient is vital for cell growth and development —yours as well as your developing baby's—and you need about 70 grams every day right now.
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