"My doctor says I have to drink a quart of cow's milk a day. My parents
are convinced I'm doing something harmful. I'm starting to wonder if my diet
is all right."
Even the most committed and knowledgeable vegan may face doubts when pregnant.
After all, the so-called experts are all questioning her dietary choices.
Actually, it is reasonably simple to follow a vegan diet throughout pregnancy
while eating foods that meet your needs and the needs of your baby. I know;
I've done it twice. Here are some things to consider.
Weight Gain
How much weight you gain during your pregnancy has a marked impact on the baby's
size and health at birth. Women of average weight should aim for a 25-35 pound
weight gain, and overweight women should strive to gain 15-25 pounds. If you
were underweight prior to your pregnancy, you should try to gain 28-40 pounds.
Adolescents may need to gain 30-45 pounds. A general trend is to have little
weight gain for the first 12 weeks. Then, in the second and third trimesters,
a weight gain of a pound a week is common.(1) Many vegans begin pregnancy on
the slim side and may gain weight very slowly. If this sounds like you, you
will need to eat more food. Perhaps eating more often or eating foods higher
in fat and lower in bulk will help. I found it easiest to drink extra calories
and treated myself to a soymilk shake (soymilk blended with fruit and tofu or
soy yogurt) in the evening for a few weeks when weight gain was low. Other concentrated
sources of calories include nuts and nut butters, dried fruits, soy products,
and bean dips. If, on the other hand, your weight gain seems too high to you
and your health care provider, look at the types of food you are eating. Simply
replacing sweets and fatty foods with fruits, vegetables, grains, and legumes
can lead to more moderate weight gain. Daily exercise, as approved by your health
care provider, can also help.
Protein
You will probably get lots of questions about whether you are getting enough
protein. Current recommendations for protein in pregnancy call for 60 grams
per day. This is 10 grams more than non-pregnant women aged 25-50 need. One
study showed that the average non-pregnant vegan woman was eating 65 grams of
protein daily, enough to meet her needs during pregnancy.(2) If your diet is
varied and contains good protein sources such as soy products, beans, and grains,
and you are gaining weight, you can relax and not worry about getting enough
protein. Many women simply get the extra protein they need by eating more of
the foods they usually eat. As an example, you can add 10-15 grams of protein
to your usual diet by adding 2 cups of soy milk, 9 ounces of tofu, 3 ounces
of tempeh, or 1 1/2 bagels.
Calcium and Vitamin D
Vegans also get lots of questions about calcium. Both calcium and vitamin D
are needed for the development of the baby's bones and teeth. There is some
evidence that pregnant women adapt to low calcium intakes and increased needs
by increasing calcium absorption and reducing calcium losses.(3) This certainly
is worthy of additional study and may be pertinent to vegans whose diets may
be low in calcium. However, for the time being, calcium intakes of 1200 milligrams
daily are recommended for women under 25 and of 600-1200 milligrams daily for
women 25 and older.(1) Pregnant vegans should make a special effort to have
3 to 4 or more good sources of calcium daily. Some plant-based calcium sources
that are well absorbed are calcium-fortified soy milk and orange juice; dark
green leafy vegetables like collard greens, kale, and turnip greens; and calcium-precipitated
tofu. (Calcium content of tofu varies, read labels.)
While sufficient amounts of vitamin D can be made by our bodies following sunlight
exposure, it is difficult to define adequate sunlight exposure.(4) The National
Academy of Sciences recommends that a vitamin D supplement of 10 micrograms
(400 IU) daily be taken by pregnant vegans who live at northern latitudes in
the winter and by those with minimal exposure to sunlight.(1) Supplements of
vitamin D should be used only with the approval of your health care provider,
since high doses of vitamin D can be toxic. Fortified foods like some cereals
and some brands of soy milk are another way to meet vitamin D needs.
Iron
Iron deficiency anemia is not uncommon during pregnancy, among both vegans and
non-vegetarians. Iron needs are much higher than usual in pregnancy because
of the increase in the volume of the mother's blood and because of blood formed
for the baby. Iron supplements of 30 milligrams daily during the second and
third trimesters are commonly recommended.(1) Additional iron may be needed
in case of iron deficiency. Iron supplements should not be taken with calcium
supplements and should be taken between meals in order to maximize absorption.
Even when iron supplements are used, pregnant vegans should have daily servings
of high-iron foods like whole grains, dried beans, tofu, and green leafy vegetables.
Vitamin B-12
The use of vitamin B-12 supplements or fortified foods is recommended for all
pregnant vegans. Vitamin B-12 plays an important role in the developing fetus.
When breastfeeding, it is also important to make sure that you have enough vitamin
B-12 stored to meet the baby's needs. Fortified foods include some breakfast
cereals, some soy milks, and Red Star brand T-6635 nutritional yeast.
Folic Acid
Folic acid has recently been in the news because of its connection with a type
of birth defect called neural tube defect. Studies have shown that women who
have infants with neural tube defect have lower intakes of folate and lower
blood folate levels than other women. Folic acid is needed early in pregnancy
(before many women know they are pregnant) for normal neural tube development.
Many vegan foods including enriched bread, pasta, and cold cereal; dried beans;
green leafy vegetables; and orange juice are good sources of folic acid. Vegan
diets tend to be high in folic acid; however, to be on the safe side, many health
care providers are recommending multi-vitamins containing 400 micrograms of
folic acid.
All this advice to eat a plant-based, whole foods diet sounds wonderful to many
pregnant women. What are the barriers to eating a healthful vegan diet?
Nausea and Vomiting
Nausea and vomiting, also called morning sickness, are a concern of many pregnant
women, vegans included. Many women are repulsed by foods which used to make
up the bulk of their diet. These aversions are extremely common in early pregnancy
and are believed to be due to a heightened sense of smell, possibly due to hormonal
changes.(5) While every woman and every pregnancy will vary in terms of coping
with nausea and vomiting, here are some things to try.
If it tastes good, eat it! I can remember wanting nothing but saltines and ginger
ale for days at a time. Then, one day when my husband was warming up some leftover
pasta, it smelled wonderful. I ate three bowls full and never regretted it.
Try eating lowfat, high carbohydrate foods. These are digested more quickly
and stay in the stomach for less time, giving less time for queasiness. Eat
often. Sometimes nausea is really due to hunger.
Avoid foods that have strong smells. Sometimes cold foods are better tolerated
because they don't smell as much. Have someone else do the cooking if possible
and go away from the house while cooking is being done.
Be sure to drink juice, water, soy milk, or miso broth if you can't eat solid
food. Keep trying to eat whatever you can. Contact your health care provider
if you are unable to eat or drink adequate amounts of fluids for 24 hours.
Lack of Time
Whether you're working full time outside the home or at home full time (or some
variation), the thought of preparing elaborate meals and snacks will probably
seem daunting. Meals do not have to be elaborate. A meal can be as simple as
a bowl of cereal and fruit with soy milk, peanut butter and crackers, or a baked
potato and a salad. Use convenience foods like canned beans, frozen vegetables,
mixes, pre-chopped vegetables, and frozen entrees to reduce preparation time.
Use time-saving appliances like crock-pots, pressure cookers, and microwave
ovens. Plan to have leftovers. Check out some quick and easy vegan cookbooks
for ideas. (See the catalog on pages 33 and 34 of the Vegetarian Journal.)
Your Health Care Provider
While many family practice physicians, obstetricians, nurses, and midwives may
be quite knowledgeable about nutrition, many are not familiar with vegetarian
diets and especially not vegan diets. Your health care provider may have questions
about what you are eating and whether you will be able to meet your needs. Look
on this as an opportunity to educate someone about vegan nutrition. Try sharing
this article and other materials from the resource list with your health care
provider. Keeping a record of what you eat for several days may help convince
your health care provider that what you're doing is fine or may highlight areas
needing improvement. If you have specific concerns and questions, you may choose
to consult a registered dietitian (R.D.) with expertise in vegetarian nutrition.
Remember, a varied vegan diet can meet your needs and the needs of your baby
during this exciting time.