Nutrition

With some careful meal planning and by eating a variety and balance of different vegetarian or vegan foods, vegetarian and vegan mums-to-be should be able to get all the nutrients that they and their baby needs. A lot of the information below is also relevant before conception, to make sure the body’s nutrient stores are ready for pregnancy, and during breastfeeding.

Plenty of starchy carbohydrates, such as bread, pasta, rice and potatoes. Base your meals around these. Choose wholegrain options, like wholewheat pasta, wholegrain breakfast cereals and brown rice or potatoes with skins where possible, as these contain more fibre which is an important part of a healthy diet and can help to prevent constipation (common in pregnancy).

Similar to any healthy diet, you should make sure you include foods from the four main food groups:

• Plenty of fruit and vegetables, which can be fresh, frozen or tinned. Try to have five portions a day. A glass of 100% unsweetened fruit or vegetable juice counts as one portion.
• Protein-rich foods, which for a vegetarian or vegan include foods like tofu, beans, pulses and nuts, and eggs for those who include them in their diet.
• Milk and dairy, such as milk, cheese and yogurt, or non-dairy alternatives which are fortified with vitamins and minerals (e.g. calcium) if you are vegan.
• Meat, fish and dairy are good sources of a number of essential nutrients. Most of these nutrients can also be found in foods (including fortified foods) that are suitable for vegans and vegetarians, but vegetarian and vegan mums-to-be need to make sure they are getting enough of these foods in their diet.

Nutrients to consider in a vegetarian and vegan diet

The importance of supplements during pregnancy and healthy eating whilst breastfeeding

Top tips for vegetarian and vegan mums-to-be

Nutrients which need careful consideration in a vegetarian and vegan diet include:

Protein

Protein is made up of amino acids, which are the building blocks of your body's cells – and of your baby's. Essential amino acids are those that the body cannot make itself and so are needed from the diet. Most vegans and vegetarians get enough protein from their diets. However, it is important to consume a range of different proteins to make sure you get enough of all of the different essential amino acids. Soya is a particularly good source of protein for vegetarians and vegans as it contains a good range of essential amino acids.

Other vegetarian sources of protein include:

• Eggs
• Dairy products (such as milk, yogurt and cheese)
• Some dairy-free alternatives (such as soya dairy-free alternative drinks and yogurts)
• Beans and pulses (such as chickpeas, kidney beans, soya beans and lentils)
• Some nuts and nut butters (such as peanuts, almonds and cashews) (where possible, choose the no added salt or sugar varieties)
• Tofu
• Mycoprotein (such as ‘Quorn’- not suitable for strict vegans as it contains egg)

Some grains (such as quinoa) can also contribute to protein intake.

Omega-3

Long-chain omega-3 fats, in particular, docosahexaenoic acid (DHA), are important for the normal development of your baby’s brain and eyes. Oily fish, such as salmon, mackerel and trout are rich sources of long-chain omega-3 DHA. If you don't eat fish, you can get short chain omega-3 fats, such as α-linolenic acid (ALA), from other foods (see list below). The omega-3 fats these foods contain are not the long-chain versions like DHA found in oily fish. The body is able to convert a small proportion of these fats into long chain omega-3s but this process is not thought to be overly efficient. Levels of long chain fatty acids in vegans and vegetarians have been found to be lower than in fish eaters. However, there is no strong evidence of adverse effects on health from the lower long chain fatty acid intake in vegans and vegetarians.

Algae-based (vegetarian) omega-3 DHA supplements are available (check that any supplements you are taking do not contain vitamin A and are suitable for pregnancy) in addition to a limited range of foods and drinks fortified with omega-3 DHA. 

Foods which contain short-chain omega-3 fats (ALA) include:

• Some seeds (such as flax and chia seeds)
• Walnuts and walnut oil
• Vegetable oils (such as flax seed, rapeseed and soyabean oil)
• Soybeans

Iron

Iron is important for the normal growth and development of your baby. A lack of iron can make you feel tired too. Anaemia due to iron deficiency can often occur during pregnancy, and your doctor or midwife can diagnose this through a simple blood test. 

The iron found in plant foods is less readily absorbed than that from animal products, so vegetarians and vegans need to ensure they include good sources of iron in their diet such as:

• Pulses (such as beans, peas and lentils)
• Green leafy vegetables (such as watercress)
• Wholemeal, seeded and wheatgerm bread
• Quinoa
• Iron-fortified breakfast cereals
• Dried apricots and figs
• Sesame and pumpkin seeds

Calcium

Calcium is important for the growth of your baby’s bones as well as helping to maintain yours. Calcium is also important when breastfeeding and requirements for calcium increase during this time. Dairy foods, such as milk and yogurt, are a good source of calcium. Try to select low fat versions where possible, these are likely to contain at least the same amount of calcium but without the extra calories. Cheese is also a great source of calcium but many can be high in fat and salt so eat in moderation and choose reduced-fat varieties where possible. Many varieties of cheese are safe to eat in pregnancy. However, some cheeses aren't safe to eat including soft cheeses with white rinds (e.g. brie and chevre) and soft blue veined cheese (e.g. Danish blue).

If you are vegan you should try to eat more calcium-containing foods which include:

• Bread (breads made using flour which does not contain the wholegrain, such as white and some brown breads in the UK, have to be fortified with calcium by law)
• Some green leafy vegetables (such as kale, rocket and watercress)
• Calcium-fortified breakfast cereals
• Calcium-fortified dairy alternatives (such as soya, oat, rice or nut dairy-free alternative drinks and yogurts)
• Calcium-set tofu (those prepared using calcium)

To check whether fortified products contain calcium, check the label.

Vitamin B12

Vitamin B12 is important for the normal growth and development of your baby and helps the body to release the energy from the food
 you eat. Vitamin B12 is found in animal foods (meat, dairy products and eggs) and is generally not naturally found in significant amounts in plant foods. Studies have shown low intake and blood concentrations of vitamin B12 in vegans and vegetarians.

If you are vegetarian and eat eggs and dairy foods regularly, you should be getting enough vitamin B12. However, the only reliable source of B12 for a vegan are fortified foods. Products other than eggs and dairy foods which contain vitamin B12 include:

• Vitamin B12-fortified yeast extract (savoury spread)
• Vitamin B12-fortified dairy-free alternatives (such as soya, oat and almond dairy-free alternative drinks)
• Vitamin B12-fortified breakfast cereals

To check whether fortified products contain vitamin B12, check the label.

Alternatively, you could take a vitamin B12 supplement (always read the label and talk to a health professional if you are unsure which supplements are safe to use during pregnancy).

Vitamin B2

Similar to vitamin B12, Vitamin B2 (also known as riboflavin) is important for the normal growth and development of your baby and helps the body release energy from the food you eat. Vitamin B2 is also found in animal products (meat, dairy products and eggs) but unlike vitamin B12, it is also found in some plant based foods. If you are vegetarian and eat eggs and dairy foods regularly (milk is a good source of vitamin B2), you should be getting enough vitamin B2. If you are vegan, products other than eggs and dairy foods which contain vitamin B2 include:

• Mushrooms
• Some nuts and seeds (such as almonds)
• Yeast extract (savoury spread) (especially fortified varieties)
• Vitamin B2-fortified dairy-free alternatives (such as soya, oat and almond dairy-free alternative drinks)
• Vitamin B2-fortified breakfast cereals

To check whether fortified products contain vitamin B2, check the label.

Selenium

Selenium is needed for the normal function of the immune system and to help protect your body’s cells. Dietary surveys show that a substantial proportion of the population may not have an adequate intake of selenium. However the health implications of this are currently unclear. Meat and fish are really good sources of selenium, and eggs are also a good source. If you're a vegetarian or vegan, it's important to make sure you're eating other foods which contain a source of selenium (although the actual levels are variable dependent on the soil in which they are grown), these include: 

• Some nuts and seeds (especially Brazil nuts but also cashew nuts and sunflower seeds)

• Some breakfast cereals (such as puffed wheat cereal, shredded wheat and cornflakes)

• Some breads (such as seeded and wheatgerm bread)

Iodine

Iodine is particularly important for your baby's brain development and your requirements increase during pregnancy. Sources of iodine include fish, eggs, milk and milk products, with dairy contributing around one third to average daily UK iodine adult intake. Vegetarians and particularly vegans are at risk of iodine deficiency as they do not eat rich iodine sources (fish and/or dairy products). Soya and dairy alternative drinks are not typically fortified with iodine (check label) and therefore sources are limited.
Vegan sources of iodine include:

• Some edible seaweeds (such as nori which is used to wrap sushi). Although seaweed is a concentrated source of iodine, it can provide excessive amounts (particularly brown seaweed e.g. kelp) and therefore eating it more than once a week is not recommended, especially during pregnancy or breastfeeding.
• In some countries, iodine is added to salt. However, this does not occur in the UK and there is a government recommendation to reduce salt intakes. Therefore, iodised salt should not be relied upon as a means to increase iodine intakes.

Supplements

Like all mums-to-be, there are certain supplements you need to take during pregnancy:

• Vitamin D (10 µg per day). Vitamin D3 supplements are often derived from live sheep wool, which may be acceptable to vegetarians. However, there is a vitamin D3 supplement derived from lichen (fungus/algae), which is suitable for both vegetarians and vegans (check the label).
• Folic acid (400 µg per day, up to 12 weeks of pregnancy). If you didn't start taking folic acid before you conceived, you should start as soon as you find out that you are pregnant.

If you decide to take a multi-vitamin and mineral supplement, select one which is specifically for pregnancy or which doesn’t contain vitamin A, as high levels of vitamin A during pregnancy can harm your baby. Check with a health professional if you are unsure which supplements are safe to use during pregnancy.

Breastfeeding

A healthy balanced diet is also important when you are breastfeeding to help your baby get all the nutrients he/she needs to grow. For vegetarian and vegan mums, the nutrients mentioned previously for pregnancy are things to still be aware of during breastfeeding.

Top tips for vegetarian and vegan mums-to-be

• Eat plenty of fruit and vegetables. Aim for at least five a day and make sure you eat a variety of types and colours!
• Base your meals on starchy carbohydrates, such as bread, rice, pasta or potatoes. Where possible, go for wholegrain varieties and potatoes with skins.
• Some breakfast cereals are fortified with a number of essential vitamins and minerals, including iron and vitamins B12 and B2 (check the label), and are a great way to start the day. Where possible, go for wholegrain varieties.
• Eat a range of foods containing plant protein. Great sources of essential amino acids for vegetarians to include in your diet include dairy foods and eggs, whereas great sources for both vegetarians and vegans include beans and pulses, soya dairy-free alternatives, nuts and tofu.
• Milk, cheese and yogurt are great for boosting your calcium, iodine and vitamin B12 and B2 intake if you are vegetarian. You should eat a moderate amount of these in your diet. Where possible, choose low or reduced fat products.
• When choosing dairy-free alternative drinks and yogurts if you are vegan, look for ones fortified with calcium, vitamin B12, vitamin B2 and iodine. Some of these may also be fortified with vitamin D.
• You can also keep your iron levels topped up by including foods like beans, lentils, quinoa or wholemeal bread and green leafy vegetables in your lunch or dinner.
• For vegetarians, eggs also contain iron, iodine, selenium and vitamins B12 and B2, and are affordable and versatile.
• Why not have a small handful of nuts and seeds as a snack, some nuts and seeds can be a good source of iron, selenium, vitamin B2 and short-chain omega-3 ALA.
• Yeast extract, particularly fortified varieties, are a good source of vitamins B12 and B2 and can taste great on toasted seeded bread!
• Make sure you remember to take your folic acid and vitamin D supplements.

For more information on the sources used in this text, please contact postbox@nutrition.org.uk

---