Learn about the essential nutrients for vegans and vegetarians during pregnancy to ensure they don’t become deficient.
If you missed our Part 1, we recently discussed the common misconception that eating a vegan, or even vegetarian, diet during pregnancy is bad for baby. That myth has been officially BUSTED. Having said that, there are a few essential nutrients vegans and vegetarians need to watch during pregnancy to ensure they stay on track. Namely vitamin B12, iron, omega-3’s, calcium, vitamin D, zinc, choline, iodine and protein, depending on which foods are avoided (e.g. fish, eggs, dairy). These nutrients are sometimes found in smaller amounts in plant-based foods but are important during this time of baby’s growth. Let’s take a look at each of these nutrients to see why you need them during pregnancy and where you can find them.
Essential Nutrients FOR Vegans and Vegetarians During Pregnancy
Vegan and Vegetarian’s B12 Needs during Pregnancy
Before pregnancy, just being a vegan or vegetarian alone may have required additional planning to get adequate amounts of B12 in your daily diet. B12 works with folic acid in the production of all blood cells (especially red blood cells) and DNA, helps the body use fats and amino acids, and plays a fundamental role in maintaining a healthy nervous system, and brain development. The mother has a large influence on the health of her baby, and the demands for B12 of her developing child is high for growth and development. If left undetected and untreated, a deficient mother with low B12 levels in the first trimester can result in NTDs, preterm delivery, low birth weight, refusal of solid foods, megaloblastic anemia, reduced muscle mass, muscle weakness, low bone mineral density, enlarged liver and spleen, delayed speech development, and irreversible neurological and developmental abnormalities including IUGR, and in some cases, fetal losses. Although vitamin B12 absorption is increased during pregnancy, avoiding the possibility of being deficient is vital for preventing severe consequences.
Since B12 is primarily found in foods of animal origin, it will be more challenging to get it from plant-based, particularly vegan diets. Nearly all studies involving vegetarians have shown that vitamin B12 deficiency is a major concern, with a higher risk of deficiency among pregnant vegetarian and vegan women, as well as their offspring. A current review indicated that B12 deficiencies in vegetarian pregnant women ranged from 17 to 39% depending on the trimester, which was higher in vegans compared to vegetarians. Despite there being very limited research on vegan pregnant women regarding B12 status, findings have shown that switching from a vegan to lacto-ovo-vegetarian diet, along with consuming B12-fortified soymilk, can lead to significant increases in B12 levels. Obviously, though, I get that for some of my vegan followers, that just won’t fly. Even though 2.6 mcg/day is the recommended amount by Dietitians of Canada, other studies have suggested that B12 intakes should be higher due to cases where infants still ended up being B12-deficient even when consuming the recommended amount. In light of this, the newest recommendations set by the European Food Safety Authority (EFSA) for B12 is 4.5 mcg/day during pregnancy, which may be more beneficial for vegans. It’s best to speak to your doctor about your needs when you decide you want to conceive or find out that you are pregnant.
How can I make sure I’m meeting my B12 requirements as a vegetarian or vegan?
Good news is – if you’re a vegetarian who enjoys adding dairy products like milk and yogurt, and eggs in their diet, a lot of your B12 needs can be met. The thing is, there are very few non-animal based foods with the active B12 form. Since it is more difficult to ingest optimal amounts of B12 from dietary sources, pregnant vegans should regularly select reliable sources including supplements or fortified foods. Nowadays there is a larger variety of B12-fortified foods designed for vegans on the market, including non-dairy milks (e.g soy, rice, almond, coconut), breads, some meat substitute products (e.g texturized vegetable proteins [TVPs]), veggie burgers, soy products including tofu, cereals, and certain brands of nutritional yeast. Don’t forget to double-check the ingredients list to make sure it’s been fortified with B12 since it’s not guaranteed that all of these foods will contain it. The B12 content can also vary drastically between products and the fortification amount can also change! Although seaweed (e.g nori), fermented products such as tempeh, miso, sauerkraut, chlorella, spirulina algae, nutritional yeast, shiitake and porcini mushrooms, and sprouted beans, still have nutritional benefits, you cannot rely on them for getting all the B12 needed while pregnant. They may even contain B12 analogs or “anti-nutrients” which decrease the absorption of B12. Be sure to consume foods containing vitamin B12 at frequent intervals and in smaller amounts, so it can be absorbed more effectively.
It is possible to consume an adequate amount of B12 from fortified foods, but the easiest and most reliable way is for vegans and vegetarians to regularly take a vitamin B12 supplement, especially if your prenatal supplement does not include it. Usually prenatal supplements will contain between 4 to 12 mcg of B12 so hopefully that is enough. Whenever possible, opt for the cyanocobalamin (or cobalamin) form of vitamin B12 over methylcobalamin because research has indicated that it is more active, absorbable, and two times more effective for elevating B12 levels in deficient individuals.
Vegan and Vegetarian’s Iron Needs during Pregnancy
By deciding to go the plant-based route, it’s likely you’re going to have non-vegetarians ask, “But where do you get your iron?” Truth is, meat-eaters are not protected from getting iron-deficiency anemia during pregnancy, because it is a very common condition for both omnivores and vegans/vegetarians alike. You can definitely get plenty of iron from eating a variety of vegan-friendly sources every day to support you and your baby without iron-rich meat. Plant sources of iron include dark leafy greens, dried fruits like apricots, raisins and prunes, prune juice, whole grains (especially quinoa and amaranth), enriched grain products and cereals, sweet potatoes and white potatoes (with skin), lentils, peas, beans, nuts (e.g cashew, pine, hazel nuts), seeds (e.g pumpkin, sesame seeds), meat alternatives like TVPs and veggie burgers, tofu and other soy products and molasses. Studies have shown that vegetarians tend to have similar or slightly higher iron intakes than omnivores, although iron stores have been found to be lower.
So do pregnant vegan or vegetarian women need more iron?
Plant-based moms will need almost double the amount of iron during pregnancy for a total of 50 mg per day. Whether from animal or plant sources, iron absorption from both are greatly enhanced with each trimester that passes by. However, over time, the body can adapt to low iron intakes and significantly enhance absorption of non-heme iron (up to 40%), despite the presence of inhibitors or enhancers. Nonetheless, vegans and vegetarians are still at a higher risk of iron deficiency and developing anemia. Because of the higher potential risks, plant-based pregnant women should take a 30 mg iron supplement if not provided by a prenatal supplement. Research has shown that taking an iron supplement along with folic acid supplement on a weekly basis, can reduce the risk of being iron-deficient without potential side effects.
What are some practical ways of increasing iron absorption from plant sources?
Depending on factors including the mother’s iron status, dietary choices and combinations of food within a meal, absorption of non-heme iron (in plant foods) can vary drastically. The amount of inhibitors found within many plant sources such as phytates (e.g in whole grains, legumes, some vegetables, unleavened whole grain breads), tannins, caffeine (in tea and/or coffee), polyphenols, calcium (from foods with over 300 mg), and high amounts of fiber, or enhancers, like citric acid, vitamin C and other organic acids in fruits, have a large impact on iron absorption.
It’s best to consume foods containing iron-inhibitors 1-2 hours after meals (or take iron supplements between meals). Research has shown that the foods we eat together can have a greater effect on iron absorption, which means you will need to be more mindful of ways that you can enhance non-heme iron absorption from plant foods since it cannot be effectively absorbed.
To increase absorption of (non-heme) iron from plant sources, add foods high in vitamin-C to iron-rich meals (e.g. peppers, berries, kiwis, tomatoes, melons, mangoes, citrus fruits, peppers, cauliflower, broccoli and kale), which works by reducing the effects of phytates. Other ways include combining animal- and plant-based foods (i.e., heme and non-heme iron) together if that’s an option for you, or sprouting your legumes and grains to reduce the amount of compounds interfering with iron absorption. Another option is to cook your food in cast-iron pots, which increases absorption as well. With careful planning, an iron-rich plant-based diet can provide adequate iron for your growing baby while maintaining optimal iron stores of the mother throughout pregnancy.
Vegan and Vegetarian’s Calcium Needs during Pregnancy
Generally, lacto-ovo-vegetarians are able to meet or exceed recommended calcium intakes through dairy and other calcium-containing foods, while vegans may need a bit more planning. Having said that, there is currently no clear evidence showing a causal relationship between calcium deficiencies in vegan pregnant women and potential negative health consequences.
Nevertheless, it’s all about knowing which types of foods are best and can be absorbed well by the body. Calcium bioavailability (i.e., amounts the body can absorb and use) from plant foods is disrupted by oxalates and phytates. Fiber can also interfere with calcium absorption. Although calcium-containing plant sources such as rhubarb, beet greens, spinach and swiss chard contain calcium, their high oxalate content means that calcium absorption can be as low as 5%. Despite providing moderate amounts of calcium, oranges, figs, almonds, red and white beans, nuts like almonds, chia and sesame seeds, tahini and blackstrap molasses are also still not well absorbed (about 20%).
For good sources of calcium, choose low-oxalate foods including broccoli, bok choy, napa (Chinese) cabbage, kale, okra, as well as collard, turnip and mustard greens, which will allow more calcium to be absorbed (as high as 50%). Even though absorption is slightly lower (about 30%), other good sources include soybeans, calcium-set tofu (shown as a calcium salt such as “calcium chloride” or “calcium sulfate” in the ingredients list), and most fortified plant milks (e.g. soy, hemp milk) which is similar to cow’s milk. Due to the lower calcium absorption of plant-based diets, vegetarians and vegans are recommended to consume at least 8 servings of calcium-rich foods to reach a total of 1200 to 1500 mg/day (approximately 20% more calcium). If you are unable to consume good sources of calcium as a regular part of your diet, or on days when you have a poor appetite, taking a low-dose calcium supplement with your prenatal vitamin (at least 2 hours away from an iron supplement) is definitely an option to ensure you’re getting enough. Be sure to speak with your doctor before taking any supplements.
Vegan and Vegetarian’s Vitamin D Needs during Pregnancy
Despite no changes in vitamin D requirements among pregnant women, vegans still tend to have lower vitamin D intakes compared to lacto-vegetarians and omnivores. However, low vitamin D consumption is VERY possible and common for both vegetarians and vegans. Vitamin D2 made from yeast and lichen-derived vitamin D3 are both vegan-friendly, but evidence suggests that vitamin D2 is less efficiently absorbed at higher doses. Most D3 sources are found in animal products or synthesized via skin exposure to sunlight. For this reason, some believe that you may need a higher dose if choosing to take vitamin D2. While limited, vegan sources of vitamin D include fortified soy and other non-dairy milks, orange juice, cereals, and UV-treated mushrooms, which should be included regularly in the prenatal diet, especially throughout the winter. If encountering difficulty obtaining vitamin D from food, women on a plant-based diet are recommended to meet their needs through a separate supplement, although some prenatal supplements contain vitamin D as well.
Vegan and Vegetarian’s Omega 3 Needs during Pregnancy
If you don’t have fish in your diet, you’ll want to make an effort to incorporate a number of different plant sources of Omega 3s. Out of the types of omega-3s, DHA is the one with special importance during pregnancy which helps baby’s brain, nervous system and eyes develop. However, since DHA is largely found in animal products (aka. fish), these omega-3’s tend to be lower in vegetarians and possibly absent in vegans. Despite lower intakes, vegetarian and vegan children do not appear to suffer from impaired mental or visual development. With no evidence showing pregnancy complications or poor child development when excluding fish from the prenatal diet, health outcomes from lower EPA and DHA status of vegetarians and vegans have yet to be established.
Plant sources of omega-3’s largely come in the form of ALA, such as in soy, nuts and seeds. ALA is not readily available for your body to use, so it must convert to the other, more available omega-3 fatty acids – EPA and especially, DHA. This can look like including vegetable oils (e.g., canola, flax oil, walnut, camelina, soybean oil) in your cooking, adding tofu to meals, and snacking on ground nuts and seeds (especially walnut, flax seeds, chia seeds, hemp seeds, pumpkin seeds. The only thing is, the conversion rate of ALA to these usable forms is very low and less efficient, with approximately 0.1% of ALA converted to DHA in healthy adults. This means you may be more prone to having low DHA levels, particularly vegans, because you are not getting “as much” EPA/DHA from ALA plant foods, compared to direct DHA sources. The only vegan direct source of DHA is algae, which can be purchased in gelatin-free capsules as a supplement. If you’re not down with that, some experts suggest that vegans should double their ALA intake because of the poor conversion factor. Even so, evidence still indicates that the conversion of ALA to EPA and DHA is sufficient and needs can be met with ALA in healthy individuals. Typically, 2 teaspoons of flaxseed oil or 2 tablespoons of ground flaxseeds or canola oil is sufficient to meet the daily requirement for ALA. With integral importance of ALA in vegetarian and vegan diets during pregnancy, this essential fat must be included when carefully planning out your diet.
But then there’s the issue of Omega 6 interfering with the ratio here. Since vegetarian diets are usually high in omega-6’s thanks to higher amounts of grains, vegetable oils, nuts, seeds and leafy vegetables, there’s a concern about achieving the ideal ratio of omega 3 to 6. Within the body, omega-3’s and -6’s compete with each other for enzymes required to be converted into usable forms. This means if you consume very high levels of omega-6’s, DHA production will be suppressed. In order to have optimal conversion of ALA, an omega-6 to ALA ratio of less than 4:1 has been suggested. By using omega-3 rich oils in place of those that are higher in omega-6’s, or maintaining proper portion sizes of seeds containing more omega-6’s, you can achieve an overall, more balanced intake. Also, another good reason to avoid trans fats, other than CVD, is that it can also hinder production of DHA.
Not unlike with many omnivores, aiming to get in lots of dietary sources of omega-3’s or a direct DHA supplement (or ALA supplement containing 1.4 g of ALA/day) is definitely a priority for pregnant vegetarians and vegans. Getting a variety of omega-3’s in your daily diet before, during, and after pregnancy, ensures that you and your baby will have optimal amounts to reap the benefits. For your own insurance, a reliable way of getting a direct EPA/DHA source (so you don’t need to double your ALA intake or worry about how much is getting converted), is to take that vegan-friendly microalgae supplement providing a low dose (i.e., 200 to 300 mg of DHA) on a daily basis. After all, fish are rich in DHA by feeding on algae in the first place!
Vegan and Vegetarian’s Zinc Needs during Pregnancy
This overlooked mineral is extremely important for growth and development of your baby, wound-healing, and maintaining a strong immune system. Zinc requirements will increase to meet the demands of pregnancy (to about 11 mg), regardless of whether you’re vegetarian or not. The overall evidence regarding differences in zinc intakes and status between vegetarian and non-vegetarian pregnancies is unclear. Some studies have found that although zinc status is lower among vegetarians, they remain within a normal range so that is at least some good news. Even though our bodies absorb zinc better from meat sources, it doesn’t seem to be a problem for vegetarians who include egg and dairy products, or even vegans in Western countries.
Plant sources of zinc include beans, peas, lentils, soy foods, nuts (e.g. cashews, pecans, peanuts, brazil nuts), seeds (e.g. flax, pumpkin, sesame seeds, tahini), wheat germ, miso, whole-grains, enriched breads, fortified cereals, and vegetables. However, zinc absorption is typically lower in plant-based diets high in phytates, fiber and calcium. If taking high dose iron supplements without eating any food, it’s best to take them separate from zinc-rich foods since it can reduce zinc absorption.
Another cool thing? Techniques in food preparation that can enhance zinc bioavailability! Try soaking and cooking legumes, sprouting grains, nuts, seeds and beans, along with bread-leavening, all of which reduces the amount of zinc that’s inhibited by phytates. Similar to iron, consuming zinc-containing foods with acidic ingredients (e.g. tomato sauce, lemon juice) increases its absorption to a certain extent. Check that your prenatal supplements contains about 15 mg of zinc, especially if you’re vegetarian or vegan.
Vegan and Vegetarian’s Choline Needs during Pregnancy
Choline is probably one of the most unheard of, but key pregnancy nutrients. Products from the metabolism of choline are needed for healthy cell membranes, nerve cells, and other functions involved in brain and tissue development. Since choline functions in the same metabolic pathways as folate, higher intakes of choline during the periconceptional period has been linked to a decreased risk of NTDs. The only concern for vegetarian and vegan pregnancy women is that meat, fish, some dairy products like milk, and egg yolks are some of the richest choline sources, with lower concentrations found in plant foods. Research has suggested that high intakes of choline (450 mg/day) during pregnancy has been linked to improved stress responses of the fetus and enhanced placenta function. Although it is possible to get small amounts of choline in a vegan diet (e.g. from soy foods like tofu, navy or kidney beans, some veggies, nuts, grains), a choline supplement may be needed, especially since many prenatal multivitamin and mineral supplements don’t include it (or very much).
Vegan and Vegetarian’s Iodine Needs during Pregnancy
Vegetarian-friendly sources of iodine include cow’s milk and yogurt, although there are a limited number of plant sources suitable for vegans. Seaweeds and kelp are known to be high in iodine, but they will have large variations in iodine content (and depending on the source, potentially high concentrations of heavy metals and arsenic). If you prefer buying other varieties of salt such as Kosher and sea salt, it’s important to know that they do not contain as much iodine as table salt (which contains 380 mcg per tsp). The same goes for organic milk (containing 40% less iodine than regular milk), soy and other non-dairy milks. Soy consumption can also hinder iodine absorption, however this can be avoided by having sufficient iodine intakes. Since prenatal supplements are typically not a reliable source of iodine, a better (and easier) way to meet your needs is to add a small amount of iodized salt to your diet.
Vegan and Vegetarian’s Protein Needs during Pregnancy
Protein is involved in numerous critical functions such as producing and maintaining red blood cells and enzymes, and supporting growth and development of muscle, tissues and cells of your baby. As a vegetarian or vegan, being asked about where you get your protein may be something you’re very used to. There’s no questioning the importance of protein in a prenatal diet since insufficient amounts can result in long-term damage to the fetus, such as reduced brain size and birth weight, modified fat distribution, energy metabolism and muscle tone, increased sensitivity to stress and obesity. Like calories, protein needs increase when you’re pregnant, but not by an extreme amount even if plant-based. Pregnant women just need to add an extra 25 grams of protein a day for a total of 71 g during the second and third trimesters (with approximately 21 g of it used for the fetus, placenta and other maternal tissues).
However, what many people still don’t know (and haven’t quite accepted yet), is that quality plant-based proteins can be just as effective as animal proteins for meeting your protein needs during pregnancy! Appropriately-planned vegetarian and vegan diets generally meet or exceed protein recommendations, with no studies indicating protein deficiencies among pregnant vegetarians. Even if avoiding eggs and dairy, it’s not difficult to get in your days’ worth of protein with plenty of plant proteins including meat alternatives, soy products, legumes such as beans, lentils, nuts (and their nut butters), seeds, as well as whole grains. Including an ample amount of these foods will not only help you meet protein requirements, but also provide good sources of folic acid, iron, zinc and magnesium. Soy in particular, is an excellent plant-based source of protein, but is also known to be high in phytoestrogens. Although the media has created a bad rep for soy, a recent meta-analysis found that higher intakes of phytoestrogens the year before pregnancy and during pregnancy, resulted in a decreased risk of hypospadias (a birth defect that occurs in boys’ penis). This may seem like a soy advantage, but due to some inconsistencies with other studies, more research is needed before coming to any conclusions.
Since many plant proteins are incomplete and do not contain all of the essential amino acids (EAAs), forming complementary proteins (e.g rice and beans) can help make sure you are not missing out on any of them. Contrary to previous beliefs, complementary proteins actually do NOT need to be consumed within the same meal, but rather, having them throughout the course of a day is just fine.
Bottom Line on the Essential Nutrients for Vegans and Vegetarians During Pregnancy
So as you can probably see from this comprehensive guide, it’s totally possible to eat a vegetarian or vegan diet and thrive during pregnancy. As long as they are well-planned with these essential nutrients, vegan and vegetarian pregnant women can provide their baby with everything they need.
Have you read part one about the benefits and potential risks of a vegan and vegetarian diet during pregnancy? Check that post out here!
Now tell me, if you’re a vegetarian or vegan, did you struggle to meet any of these essential nutrients during pregnancy?
Leave me a comment below with your thoughts
RD2B Rachel Shim
Abbey Sharp is a Registered Dietitian, an avid food writer and blogger, a cookbook author and the founder of Abbey’s Kitchen Inc.