"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.
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.
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 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.
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 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.