Vegetarian Diets in Pregnancy

  • Ann Reed MangelsEmail author
Part of the Nutrition and Health book series (NH)


A vegetarian diet, defined as an eating style that avoids meat, fish, and poultry, can be healthful and nutritionally adequate for a pregnant woman. Some vegetarians, called vegans, avoid dairy products and eggs as well as meat, fish, and poultry. Vegan diets can also be healthful and nutritionally adequate for pregnancy. Vegetarian diets can provide long-term health benefits including a lower risk of cardiovascular disease, some cancers, and hypertension. Key nutrients for vegetarian pregnancy include protein, iron, zinc, calcium, vitamin D, vitamin B12, iodine, and omega-3 fatty acids. Standard weight gain recommendations should be followed. A vegetarian or vegan diet can meet requirements for all of these nutrients with fortified foods or supplements being especially useful in meeting recommendations for some nutrients. Vegetarian prenatal multivitamin-mineral supplements should be evaluated for adequacy. Dietetics professionals play important roles in counseling pregnant vegetarians and may be called upon to address issues including family concerns and pressure, becoming vegetarian during pregnancy, foods and food preparation, meal planning, and coping with nausea and other common concerns of pregnancy.


Vegetarian Vegan Pregnancy Iron Cobalamin Zinc Omega-3 fatty acids Calcium Vitamin D Iodine 


  1. 1.
    Craig WJ, Mangels AR. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc. 2009;109:1266–82.CrossRefGoogle Scholar
  2. 2.
    Mangels R, Messina V, Messina M. The dietitian’s guide to vegetarian diets: issues and applications. 3rd ed. Sudbury, MA: Jones and Bartlett Learning; 2011.Google Scholar
  3. 3.
    Koebnick C, Garcia AL, Dagnelie PC, Strassner C, Lindemans J, Katz N, et al. Long-term consumption of a raw food diet is associated with favorable serum LDL cholesterol and triglycerides but also with elevated plasma homocysteine and low serum HDL cholesterol in humans. J Nutr. 2005;135:2372–8.CrossRefGoogle Scholar
  4. 4.
    Barr SI, Chapman GE. Perceptions and practices of self-defined current vegetarian, former vegetarian, and non-vegetarian women. J Am Diet Assoc. 2002;102:354–60.CrossRefGoogle Scholar
  5. 5.
    Finley DA, Dewey KG, Lonnerdal B, Grivetti LE. Food choices of vegetarians and nonvegetarians during pregnancy and lactation. J Am Diet Assoc. 1985;85:676–85.Google Scholar
  6. 6.
    Haddad EH, Tanzman JS. What do vegetarians in the United States eat? Am J Clin Nutr. 2003;78(Suppl 3):626S–32S.CrossRefGoogle Scholar
  7. 7.
    Lindeman M, Sirelius M. Food choice ideologies: the modern manifestations of normative and humanist views of the world. Appetite. 2001;37:175–84.CrossRefGoogle Scholar
  8. 8.
    The Vegetarian Resource Group. How often do Americans eat vegetarian meals? And how many adults in the U.S. are vegetarian? 2015. Available at: Accessed 17 Mar 2016.
  9. 9.
    Shridhar K, Dhillon PK, Bowen L, Kinra S, Bharathi AV, Prabhakaran D, et al. Nutritional profile of Indian vegetarian diets--the Indian Migration Study (IMS). Nutr J. 2014;13:55. Scholar
  10. 10.
    U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th ed. 2015. Available at: Accessed 17 Mar 2016.
  11. 11.
    Academy of Nutrition and Dietetics. Evidence Analysis Library. Pregnancy and nutrition-vegetarian nutrition. 2007. Available at: Accessed 1 Mar 2016.
  12. 12.
    Pistollato F, Sumalla Cano S, Elio I, Masias Vergara M, Giampieri F, Battino M. Plant-based and plant-rich diet patterns during gestation: beneficial effects and possible shortcomings. Adv Nutr. 2015;6(5):581–91. Scholar
  13. 13.
    Piccoli GB, Clari R, Vigotti FN, Leone F, Attini R, Cabiddu G, et al. Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review. BJOG. 2015;122(5):623–33. Scholar
  14. 14.
    Larsen PS, Nybo Andersen AM, Uldall P, Bech BH, Olsen J, Hansen AV, et al. Maternal vegetarianism and neurodevelopment of children enrolled in The Danish National Birth Cohort. Acta Paediatr. 2014;103(11):e507–9. Scholar
  15. 15.
    Orlich MJ, Jaceldo-Siegl K, Sabaté J, Fan J, Singh PN, Fraser GE. Patterns of food consumption among vegetarians and non-vegetarians. Br J Nutr. 2014;112(10):1644–53. Scholar
  16. 16.
    Stuebe AM, Oken E, Gillman MW. Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain. Am J Obstet Gynecol. 2009;201(1):58.e1–8. Scholar
  17. 17.
    Rizzo NS, Jaceldo-Siegl K, Sabate J, Fraser GE. Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet. 2013;113:1610–9. Scholar
  18. 18.
    Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC-Oxford lifestyle characteristics and nutrient intakes in a cohort of 33883 meat-eaters and 31546 non meat-eaters in the UK. Public Health Nutr. 2003;6:259–68.CrossRefGoogle Scholar
  19. 19.
    Koebnick C, Heins UA, Hoffmann I, Dagnelie PC, Leitzmann C. Folate status during pregnancy in women is improved by long-term high vegetable intake compared with the average Western diet. J Nutr. 2001;131:733–9.CrossRefGoogle Scholar
  20. 20.
    Koebnick C, Leitzmann R, Garcia AL, Heins UA, Heuer T, Golf S, et al. Long-term effect of a plant-based diet on magnesium status during pregnancy. Eur J Clin Nutr. 2005;59:219–25.CrossRefGoogle Scholar
  21. 21.
    Carter JP, Furman T, Hutcheson HR. Preeclampsia and reproductive performance in a community of vegans. South Med J. 1987;80:692–7.CrossRefGoogle Scholar
  22. 22.
    Thomas J, Ellis FR. The health of vegans during pregnancy. Proc Nutr Soc. 1977;36:46A.PubMedGoogle Scholar
  23. 23.
    Frederick IO, Williams MA, Dashow E, Kestin M, Zhang C, Leisenring WM. Dietary fiber, potassium, magnesium and calcium in relation to the risk of preeclampsia. J Reprod Med. 2005;50:332–44.PubMedGoogle Scholar
  24. 24.
    Longo-Mbenza B, Kadima-Tshimanga B, Buassa-bu-Tsumbu B, M’Buyamba K Jr. Diets rich in vegetables and physical activity are associated with a decreased risk of pregnancy induced hypertension among rural women from Kimpese, DR Congo. Niger J Med. 2008;17(1):45–9.CrossRefGoogle Scholar
  25. 25.
    Maslova E, Rytter D, Bech BH, Henriksen TB, Rasmussen MA, Olsen SF, et al. Maternal protein intake during pregnancy and offspring overweight 20 y later. Am J Clin Nutr. 2014;100(4):1139–48. Scholar
  26. 26.
    Ohrich MJ, Fraser GE. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings. Am J Clin Nutr. 2014;100(Suppl 1):353S–8S. Scholar
  27. 27.
    Spencer EA, Appleby PN, Davey GK, Key TJ. Diet and body mass index in 38,000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obes Relat Metab Disord. 2003;27:728–34.CrossRefGoogle Scholar
  28. 28.
    Procter SB, Campbell CG. Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014;114:1099–103. Scholar
  29. 29.
    Rasmussen KM, Yaktine AL. Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: National Academies Press; 2009.Google Scholar
  30. 30.
    King JC, Stein T, Doyle M. Effect of vegetarianism on the zinc status of pregnant women. Am J Clin Nutr. 1981;34:1049–55.CrossRefGoogle Scholar
  31. 31.
    Ward RJ, Abraham R, McFadyen IR, Haines AD, North WR, Patel M, et al. Assessment of trace metal intake and status in a Gujerati pregnant Asian population and their influence of the outcome of pregnancy. Br J Obstet Gynecol. 1988;95:676–82.CrossRefGoogle Scholar
  32. 32.
    Drake R, Reddy S, Davies J. Nutrient intake during pregnancy and pregnancy outcome of lactoovo-vegetarians, fish-eaters and non-vegetarians. Veg Nutr. 1998;2:45–52.Google Scholar
  33. 33.
    Lakin V, Haggarty P, Abramovich DR. Dietary intake and tissue concentrations of fatty acids in omnivore, vegetarian, and diabetic pregnancy. Prostaglandins Leukot Essent Fatty Acids. 1998;58:209–20.CrossRefGoogle Scholar
  34. 34.
    Dagnelie PC, van Staveren WA, van Klaveren JD, Burema J. Do children on macrobiotic diets show catch-up growth? Eur J Clin Nutr. 1988;42:1007–16.PubMedGoogle Scholar
  35. 35.
    Dagnelie PC, van Staveren WA, Vergote FJ, Burema J, van’t Hof MA, van Klaveren JD, et al. Nutritional status of infants aged 4 to 18 months on macrobiotic diets and matched omnivorous control infants: a population-based mixed-longitudinal study. II. Growth and psychomotor development. Eur J Clin Nutr. 1989;43:325–38.PubMedGoogle Scholar
  36. 36.
    Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for vitamin a, vitamin k, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academies Press; 2000.Google Scholar
  37. 37.
    Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academies Press; 2002.Google Scholar
  38. 38.
    Cook JD. Adaptation in iron metabolism. Am J Clin Nutr. 1990;51:301–8.CrossRefGoogle Scholar
  39. 39.
    Alwan NA, Greenwood DC, Simpson NA, McArdle HJ, Godfrey KM, Cade JE. Dietary iron intake during early pregnancy and birth outcomes in a cohort of British women. Hum Reprod. 2011;26:911–9. Scholar
  40. 40.
    Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr. 2003;78(Suppl 3):633S–9S.CrossRefGoogle Scholar
  41. 41.
    Allen LH. Multiple micronutrients in pregnancy and lactation: an overview. Am J Clin Nutr. 2005;81(Suppl):1206S–12S.CrossRefGoogle Scholar
  42. 42.
    Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005;81(Suppl):1218S–22S.CrossRefGoogle Scholar
  43. 43.
    Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. Morb Mortal Wkly Rep. 1998;47:1–29.Google Scholar
  44. 44.
    Foster M, Herulah UN, Prasad A, Petocz P, Samman S. Zinc status of vegetarians during pregnancy: a systematic review of observational studies and meta-analysis of zinc intake. Nutrients. 2015;7:4512–25. Scholar
  45. 45.
    Foster M, Samman S. Vegetarian diets across the lifecycle: impact on zinc intake and status. Adv Food Nutr Res. 2015;74:93–131. Scholar
  46. 46.
    Gibson RS, Heath AL, Szymlek-Gay EA. Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries? Am J Clin Nutr. 2014;100(Suppl 1):459S–68S. Scholar
  47. 47.
    Kaiser LL, Campbell CG, Academy Positions Committee Workgroup. Practice paper of the Academy of Nutrition and Dietetics abstract: nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014;114:1447.CrossRefGoogle Scholar
  48. 48.
    Leung AM, LaMar A, He X, Braverman LE, Pearce EN. Iodine status and thyroid function of Boston-area vegetarians and vegans. J Clin Endocrinol Metab. 2011;96:E1303–7. Scholar
  49. 49.
    Leung AM, Pearce EN, Braverman LE. Iodine nutrition in pregnancy and lactation. Endocrinol Metab Clin N Am. 2011;40:765–77. Scholar
  50. 50.
    Public Health Committee of the American Thyroid Asssociation, Becker DV, Braverman LE, Delange F, Dunn JT, Franklyn JA, et al. Iodine supplementation for pregnancy and lactation—United States and Canada: recommendations of the American Thyroid Association. Thyroid. 2006;16:949–51.CrossRefGoogle Scholar
  51. 51.
    Leung AM, Pearce EN, Braverman LE. Iodine content of prenatal multivitamins in the United States. N Engl J Med. 2009;360:939–40. Scholar
  52. 52.
    Teas J, Pino S, Critchley A, Braverman LE. Variability of iodine content in common commercially available edible seaweeds. Thyroid. 2004;14:836–41.CrossRefGoogle Scholar
  53. 53.
    Nishiyama S, Mikeda T, Okada T, Nakamura K, Kotani T, Hishinuma A. Transient hypothyroidism or persistent hyperthyrotropinemia in neonates born to mothers with excessive iodine intake. Thyroid. 2004;14:1077–83.CrossRefGoogle Scholar
  54. 54.
    Guan H, Li C, Li Y, Fan C, Teng Y, Shan Z, et al. High iodine intake is a risk factor of postpartum thyroiditis: result of a survey from Shenyang, China. J Endocrinol Investig. 2005;28:876–81.CrossRefGoogle Scholar
  55. 55.
    Olausson H, Goldberg GR, Laskey MA, Schoenmakers I, Jarjou LM, Prentice A. Calcium economy in human pregnancy and lactation. Nutr Res Rev. 2012;25:40–67. Scholar
  56. 56.
    O’Brien KO, Donangelo CM, Vargas Zapata CL, Abrams SA, Spencer EM, King JC. Bone calcium turnover during pregnancy and lactation in women with low calcium diets is associated with calcium intake and circulating insulin-like growth factor 1 concentrations. Am J Clin Nutr. 2006;83:317–23.CrossRefGoogle Scholar
  57. 57.
    Kristensen NB, Madsen ML, Hansen TH, Allin KH, Hoppe C, Fagt S, et al. Intake of macro- and micronutrients in Danish vegans. Nutr J. 2015;14:115. Scholar
  58. 58.
    Weaver C, Proulx W, Heaney R. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin Nutr. 1999;70(Suppl 3):543S–8S.CrossRefGoogle Scholar
  59. 59.
    Luhby AL, Cooperman JM, Donnenfeld AM, Herman JM, Teller DN, Week JB. Observations on transfer of vitamin B12 from mother to fetus and newborn. Am J Dis Child. 1958;96:532–3.Google Scholar
  60. 60.
    Allen LH. Vitamin B-12 metabolism and status during pregnancy, lactation, and infancy. Adv Exp Med Biol. 1994;352:173–86.CrossRefGoogle Scholar
  61. 61.
    Muthayya S, Kurpad AV, Duggan CP, Bosch RJ, Dwarkanath P, Mhaskar A, et al. Low maternal vitamin B12 status is associated with intrauterine growth retardation in urban South Indians. Eur J Clin Nutr. 2006;60:791–801.CrossRefGoogle Scholar
  62. 62.
    Finkelstein JL, Layden AJ, Stover PJ. Vitamin B-12 and perinatal health. Adv Nutr. 2015;6:55263. Scholar
  63. 63.
    Rush EC, Katre P, Yajnik CS. Vitamin B12: one carbon metabolism, fetal growth and programming for chronic disease. Eur J Clin Nutr. 2014;68:2–7. Scholar
  64. 64.
    Bjørke Monsen AL, Ueland PM, Vollset SE, Guttormsen AB, Markestad T, Solheim E, et al. Determinants of cobalamin status in newborns. Pediatrics. 2001;108:624–30.CrossRefGoogle Scholar
  65. 65.
    Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B-6, folate, vitamin B-12, pantothenic acid, biotin, and choline. Washington, DC: National Academies Press; 1998.Google Scholar
  66. 66.
    Heyssel RM, Bozian RC, Darby WJ, Bell MC. Vitamin B12 turnover in man: the assimilation of vitamin B12 from natural foodstuff by man and estimates of minimal daily dietary requirements. Am J Clin Nutr. 1966;18:176–84.CrossRefGoogle Scholar
  67. 67.
    Berlin H, Berlin R, Brante G. Oral treatment of pernicious anemia with high doses of vitamin B12 without intrinsic factor. Acta Med Scand. 1968;184:247–58.CrossRefGoogle Scholar
  68. 68.
    Adams JF, Ross SK, Mervyn L, Boddy K, King P. Absorption of cyanocobalamin, coenzyme B 12, methylcobalamin, and hydroxocobalamin at different dose levels. Scand J Gastroenterol. 1971;6:249–52.CrossRefGoogle Scholar
  69. 69.
    Williams CM, Burdge G. Long-chain n-3 PUFA: plant v. marine sources. Proc Nutr Soc. 2006;65:42–50.CrossRefGoogle Scholar
  70. 70.
    Gibson RA, Muhlhausler B, Makrides M. Conversion of linoleic acid and alpha-linolenic acid to long-chain polyunsaturated fatty acids (LCPUFAs), with a focus on pregnancy, lactation and the first 2 years of life. Matern Child Nutr. 2011;7(Suppl 2):17–26. Scholar
  71. 71.
    DeGroot RH, Hornstra G, van Houwelingen AC, Roumen F. Effect of alpha-linolenic acid supplementation during pregnancy on maternal and neonatal polyunsaturated fatty acid status and pregnancy outcome. Am J Clin Nutr. 2004;79:251–60.CrossRefGoogle Scholar
  72. 72.
    Jensen CL. Effects of n-3 fatty acids during pregnancy and lactation. Am J Clin Nutr. 2006;83(Suppl 6):1452S–7S.CrossRefGoogle Scholar
  73. 73.
    Sanders TA. Essential fatty acid requirements of vegetarians in pregnancy, lactation, and infancy. Am J Clin Nutr. 1999;70(Suppl 3):555S–9S.CrossRefGoogle Scholar
  74. 74.
    Geppert J, Kraft V, Demmelmair H, Koletzko B. Docosahexaenoic acid supplementation in vegetarians effectively increases omega-3 index: a randomized trial. Lipids. 2005;40:807–14.CrossRefGoogle Scholar
  75. 75.
    Conquer JA, Holub BJ. Supplementation with an algae source of docosahexaenoic acid increases (n-3) fatty acid status and alters selected risk factors for heart disease in vegetarian subjects. J Nutr. 1996;126:3032–9.CrossRefGoogle Scholar
  76. 76.
    Carlson SE, Colombo J, Gajewski BJ, Gustafson KM, Mundy D, Yeast J, et al. DHA supplementation and pregnancy outcomes. Am J Clin Nutr. 2013;97:808–15. Scholar
  77. 77.
    Smuts CM, Huang M, Mundy D, Plasse T, Major S, Carlson SE. A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy. Obstet Gynecol. 2003;101:469–79.PubMedGoogle Scholar
  78. 78.
    Smuts CM, Borod E, Peeples JM, Carlson SE. High-DHA eggs: feasibility as a means to enhance circulating DHA in mother and infant. Lipids. 2003;38:407–14.CrossRefGoogle Scholar
  79. 79.
    Arterburn LM, Oken HA, Hoffman JP, Bailey-Hall E, Chung G, Rom D, et al. Bioequivalence of docosahexaenoic acid from different algal oils in capsules and in a DHA-fortified food. Lipids. 2007;42:1011–24.CrossRefGoogle Scholar
  80. 80.
    Koletzko B, Lien E, Agostoni C, Bohles H, Campoy C, Cetin I, et al. The roles of long chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med. 2008;36:5–14. Scholar
  81. 81.
    Adlercreutz H, Yamada T, Wahala K, Watanabe S. Maternal and neonatal phytoestrogens in Japanese women during birth. Am J Obstet Gynecol. 1999;180:737–43.CrossRefGoogle Scholar
  82. 82.
    Carmichael SL, Cogswell ME, Ma C, Gonzalez-Feliciano A, Olney RS, Correa A, et al. National Birth Defects Prevention Study. Hypospadias and maternal intake of phytoestrogens. Am J Epidemiol. 2013;178:434–40. Scholar
  83. 83.
    Munro IC, Harwood M, Hlywka JJ, Stephen AM, Doull J, Flamm WG, et al. Soy isoflavones: a safety review. Nutr Rev. 2003;61:1–33.CrossRefGoogle Scholar
  84. 84.
    Davis B, Melina V. Becoming vegan. Comprehensive edition. Summertown, TN: Book Publishing Company; 2014.Google Scholar
  85. 85.
    Messina V. Vegan for her. Boston: Da Capo Lifelong; 2013.Google Scholar
  86. 86.
    Thorn B, Huret N, Bellows D, Ayo E, Myers R, Wilcox-Cook E. WIC food packages policy options study II. Project officer: grant Lovellette. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support; 2015.Google Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The Vegetarian Resource GroupBaltimoreUSA

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