Your Comprehensive Guide to a Healthy and Nutrient-Dense Vegetarian Pregnancy
Let me be clear first before we dive in… you can absolutely have a healthy pregnancy and be a vegetarian! When you consume animal products it is “easier” to get a lot of essential nutrients, so it just takes a little more attention to detail to ensure you’re getting what you need on a vegetarian diet.
As someone who whole-heartedly believes meat and animal products can be very nourishing parts of a well-rounded diet, for some reason I tend to attract vegetarians in my practice… and I love that! As I tell every single one of them, you are always in the driver's seat and there will never be any judgement from me. You make the rules and you get to eat however you want. AND since they have hired me to support their prenatal nutrition, we then talk about what to pay attention to within the context of a vegetarian diet, always ensuring they feel confident and comfortable with the goals we set together.
There are a few nutrients that become more of a challenge with a vegetarian or vegan diet. B12, choline, glycine, preformed vitamin A (retinol), vitamin K2, DHA, iron, and zinc (1). If you are strictly vegan (no animal products of any kind) some of these nutrients will be impossible to consume adequate amounts of from your diet alone without supplementation.
If you’re worried about finding the right supplements, I have a free guide for picking the best prenatal vitamin that walks you through it all!
Vitamin B12
Vitamin B12 is found primarily in animal foods. It is very important for fetal development, and on average about 62% of vegetarian pregnant women are deficient (2). Without enough B12 the risk goes up for things like miscarriage, pre-term delivery, and neural tube defects (3). Even after birth, B12 deficiency can be a problem if the parent is breast/chestfeeding since their milk can then not provide enough of this incredibly important nutrient.
Studies have shown that pregnant people likely need more than 3x the recommended RDA (4), so if vegetarians and vegans are already falling behind, it is even more important to ensure you’re paying special attention to this nutrient and not solely relying on a prenatal that has “100% of RDA” value.
B12 is found most abundantly in foods like organ meats, seafood, beef, dairy products, and eggs. Some vegetarian and vegan foods are fortified with B vitamins, like some cereals and nutritional yeast. While these can help prevent deficiency in some, whole-food sources are always best when possible, especially if you have an MTHFR mutation (more on this at a later date). A great way to cover your bases is to ensure you’re taking a prenatal with bioavailable sources of these important nutrients - I have a free prenatal vitamin guide that can help you!
Choline
I have a whole blog post on the importance of choline if you want to read more in depth - it is such a crucial part of solid prenatal nutrition. It is essential for baby’s brain development, and linked to placental health and function as well.
The best places to get choline are from eggs and liver. If you’re vegan or a vegetarian who does not eat eggs, it will be very hard to reach adequate prenatal choline intake (450 mg minimum, closer to 930mg is ideal) through food alone and a high quality prenatal supplement with plenty of choline will be very important.
Glycine
Glycine is an amino acid that is found most abundantly in collagen. It is typically not considered “essential” (aka we can make enough glycine normally and technically do not need to consume it) but it becomes conditionally essential during pregnancy (5). Basically, we need more glycine than our bodies can make during pregnancy. It is important for supporting your growing baby’s teeth, bones, organs, skeletal system, etc., but also for supporting your growing and expanding body.
The most abundant sources of glycine are found in animal products with connective tissue like bone-in/skin-on chicken, bone broths, collagen/gelatin powders, seafood, etc. There are some plant-based sources (seaweed, seeds, legumes, watercress, asparagus, and spinach), but it is hard to get enough through these foods alone.
Vitamin A (retinol)
Vitamin A is another important prenatal vitamin since it is involved in the development of the heart, eyes, ears, limbs, and immune system. Not getting enough can lead to serious malformations. Too much can also be a serious problem; the maximum daily allowance is up to 10,000 IU daily or 25,000 IU weekly (6).
The type of Vitamin A during pregnancy is also important. You may have heard that you can get plenty of vitamin A through orange foods, and while yes, these foods (like sweet potatoes and oranges) do have beta-carotene which is a precursor to vitamin A, they do not have performed vitamin A (retinol). This means your body has to convert the plant-based source (carotenoids) into retinol before utilizing it, and there are many factors that impact how well we make that conversion.
Just eating a ton of sweet potatoes won’t do the trick - you need preformed vitamin A, whether that’s through animal based sources (like full-fat dairy or eggs), or through a supplement. Many conventional prenatal vitamins only contain vitamin A as beta-carotene, so selecting the right brand is important. As I noted above, supplementing too much can also pose a risk, so working with healthcare providers is always important.
Vitamin K2
Different from vitamin K1 (which is found in dark leafy greens), vitamin K2 is a relatively newly researched vitamin (7). It is found primarily in fatty animal foods like eggs and full fat dairy. It is important for proper development of your baby’s skeleton. It also aids in our metabolism of vitamin D which is another essential prenatal vitamin. If you are a strict vegan who eats no animal products, a supplement with vitamin K2 will be important, although most prenatals do not contain K2 so choosing wisely is important.
DHA
DHA is a type of omega-3 fatty acid that is especially important during pregnancy for your baby’s brain development(8), and it remains very important during the first 2 years of life.
You might say “but flax seeds and chia seeds have omega-3’s!” And yes, they do, and they are absolutely a great fat source, but the type of omega-3 found in plant-based sources is called ALA… ALA is not active in the body and must be converted to EPA and DHA. However, our bodies are not great at this conversion; less than 0.5% is converted to DHA(9). DHA is what we need for baby’s brain development long term AND to support the pregnant person. Studies have shown that not getting enough DHA during pregnancy can even increase the risk for maternal anxiety (10).
Food based sources of DHA are primarily fish and shellfish. If you are a vegan or vegetarian who does not eat seafood, a high quality DHA supplement from algae may be a good option to ensure you’re getting enough DHA prenatally.
Iron
There are absolutely plant-based sources of iron, but just like with vitamin-A, it’s important to note that there are different forms of this mineral. Heme iron is what is in animal foods, and non-heme iron is found in plant based foods. Our bodies tend to absorb heme iron more efficiently (11). The RDA for iron during pregnancy is actually set 1.8x higher for vegetarians for this reason! During pregnancy, our need for iron increases throughout gestation - I’ve talked with many parents who started off with ideal iron levels at the beginning of pregnancy, only to enter their third trimester anemic.
Adequate iron intake during pregnancy is incredibly important. Inadequate intake is a risk factor for things like preeclampsia, hypothyroidism, preterm birth, postpartum depression, and for impairing fetal brain development, increasing baby’s risk of high blood pressure, diabetes, obesity, etc. (12).
It is essential to work with your healthcare provider around iron supplementation as too much iron can also be dangerous. Ideally your provider will run lab work to check your iron status before recommending a supplement containing iron.
Zinc
Zinc is another mineral that is available in both plant and animal foods, but is more readily absorbed and utilized when it comes from animal sources. Zinc needs are actually set 50% higher for vegetarians, and that may not even be enough (12)!
During pregnancy, zinc deficiency is linked to increased chances of miscarriage, preterm birth, neural tube defects, low birth weight (13), and more. Zinc deficiency can greatly impact your baby’s health, and some studies even show these impacts can pass on to future generations (14).
Zinc is found most abundantly, and in it’s most bioavailable form, in red meat, poultry, and shellfish, dairy, and eggs. Plant-based sources include things like legumes, nuts, and whole grains.
How can you ensure you’re getting enough of these nutrients as a vegetarian?
Like I said at the beginning, you are 100% in control of how you eat, and you are 100% able to have a healthy, thriving pregnancy as a vegetarian. Here are some things you can incorporate to ensure you’re covering your nutritional bases!
Invest in a high quality prenatal vitamin with bioavailable forms of all vitamins and minerals, especially those listed above. Check out my free guide for more specifics about what to look for!
If you eat eggs, try to incorporate eggs daily. I typically talk with my vegetarian clients about having 2 pasture-raised eggs per day for a good dose of b-vitamins, choline, vitamin A, and DHA. If this is not something you are comfortable with, you may need an additional choline supplement along your prenatal.
I have had some clients decide that while pregnant they would eat certain types of seafood. If there are any seafood items that you are comfortable consuming, try to incorporate those once per week, aiming for low-mercury options.
Consider oysters! Many vegetarians, and even vegans, will still consume oysters. The reason for this is that they do not have a central nervous system and it is believed that they do not feel pain. They are an incredible source of B12 and zinc. 1 oz of oysters alone provides more than the RDA for B12.
If seafood is not in the cards for you, consider an algae DHA supplement, and incorporate seaweed into your diet.
Consume full-fat dairy daily (ideally grass-fed if that’s available to you and within your budget). I will have an article coming soon with more details, but full-fat dairy is linked with improved fertility.
Soak your grains and beans! One reason so many plant-based sources of these vitamins and minerals are not as bioavailable as animal sources is because of something called phytic acid, which can block absorption. Soaking or sprouting grains reduces levels of phytic acid. Some stores carry pre-sprouted grains and beans, but it’s also easy to do at home. There are even some bread brands made with sprouted grains, like Ezikel bread.
Read Real Food for Pregnancy by Lily Nichols and keep it on hand as a reference throughout your pregnancy. Much of this article was inspired by book and her in-depth research into prenatal nutrition. I recommend this book to every single one of my clients - it is the holy grail of prenatal nutrition information!
Work with a supportive provider who can help you evaluate your current diet and fill in any gaps!
Sources:
Real Food for Pregnancy by Lily Nichols, RD
https://journals.sagepub.com/doi/pdf/10.1177/15648265080292S114
