Vegetarian and vegan diets during pregnancy
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 need. A lot of the information below is also relevant before conception, to make sure the body’s nutrient stores are ready for pregnancy, and afterwards during breastfeeding.
Similar to any healthy diet, you should make sure you include foods from the four main food groups:
- Plenty of starchy carbohydrates. Choose wholegrain or higher fibre options where possible, like wholewheat pasta, wholegrain breakfast cereals, brown rice, or potatoes with their skins, as fibre is an important part of a healthy diet, and can help to prevent constipation (common in pregnancy).
- Plenty of fruit and vegetables, which can be fresh, frozen or tinned. Try to have five portions a day, and aim for a variety of different types. A small glass of 100% unsweetened fruit or vegetable juice (150ml) counts as one portion.
- Protein-rich foods, which for a vegetarian or vegan include foods like tofu, beans and other pulses, 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 and iodine) if you are vegan, or do not eat dairy products.
- 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 which need careful consideration in a vegetarian and vegan diet include:
- Omega-3 fats
- Vitamin B12
- Riboflavin (vitamin B2)
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:
- Dairy products, such as milk, yogurt and cheese
- Some dairy alternatives, such as soya-based drinks and yogurts (choose versions fortified with calcium and other nutrients)
- Beans and other 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)
- Mycoprotein-based products
Some grains (such as quinoa) can also contribute to your protein intake.
Long-chain omega-3 fats, in particular DHA (docosahexaenoic acid), 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 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 found in oily fish. The body is able to convert a small proportion of these short-chain fats into long-chain omega-3s, but this process is not thought to be very efficient. Levels of long-chain omega-3 fats 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 this lower long-chain omega-3 fat intake in vegans and vegetarians.
Algae-based omega-3 supplements are available that provide a vegan-friendly source, but check that any supplements you are taking do not contain vitamin A and are suitable for pregnancy. There are also a limited range of foods and drinks fortified with long-chain 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 flaxseed, rapeseed and soyabean oil)
- Soya beans
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 (e.g. beans, peas and lentils)
- Green leafy vegetables (e.g. watercress)
- Wholemeal, seeded and wheatgerm bread
- Iron-fortified breakfast cereals (check the label)
- Dried apricots and figs
- Sesame and pumpkin seeds
Calcium is important for the growth of your baby’s bones, as well as helping to maintain your own bone health. 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 lower fat and lower sugar versions where possible, as 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 are not safe to eat, including mould-ripened soft cheeses with white rinds (e.g. brie and chevre), soft blue veined cheese (e.g. Danish blue), and any cheeses made from unpasteurised cows', goats' or sheep's milk.
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 almond-based dairy alternative drinks and yogurts)
- Calcium-set tofu (those prepared using calcium)
To check whether fortified products contain calcium, check the label.
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. Typically, vitamin B12 is only found naturally in foods from animal sources (meat, dairy products and eggs). So vegtarians who consume dairy products and eggs can get enough vitamin B12 from their diet; however vegans may not get enough of this vitamin, due to the lack of reliable sources. 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 or vegan spreads)
- 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).
Riboflavin (vitamin B2)
Similar to vitamin B12, riboflavin (also known as vitamin B2) is important for the normal growth and development of your baby and helps the body release energy from the food you eat. Riboflavin 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 riboflavin), you should be getting enough. If you are vegan, products other than eggs and dairy foods which contain riboflavin include:
- Some nuts and seeds (such as almonds)
- Yeast extract (savoury spread) (especially fortified varieties)
- Riboflavin-fortified dairy alternatives (such as soya, oat and almond-based drinks)
- Riboflavin-fortified breakfast cereals
To check whether fortified products contain riboflavin, check the label.
Selenium is needed for the normal function of the immune system, and to help protect your body’s cells from damage due to oxidative stress. 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 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 of selenium vary depending on the soil in which plant foods 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 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 iodine intakes of UK adults. Vegetarians, and particularly vegans, are at risk of iodine deficiency as they do not eat foods that are a source of iodine (e.g. fish and dairy products). Dairy alternative drinks are not always fortified with iodine (check the label), and therefore dietary sources are limited.
Vegan sources of iodine include:
- In many countries globally, iodine is added to salt by law. However, this does not occur in the UK and there is a government recommendation to reduce salt intakes, which are currently higher than recommended. Therefore, iodised salt should not be relied upon as a means to increase iodine intakes.
- 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.
- Iodine supplements are available.
Talk to your GP or midwife about how you can get all of the nutrients you need for you and your baby.
Like all mums-to-be, there are certain supplements you need to take during pregnancy:
- Folic acid: It is recommended that you take a daily folic acid supplement containing 400 µg (micrograms) from before you become pregnant until 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.
- Vitamin D: Pregnant and breastfeeding women should take a daily supplement containing 10μg (micrograms) of vitamin D during the autumn and winter months to help protect their bone and muscle health, as this advice applies to all adults in the UK. However, if you are not exposed to much sunlight (e.g. if you cover your skin or spend a large amount of time indoors), or if you have dark skin (for example, you have an African, African-Caribbean or South Asian background), your skin will not produce as much vitamin D naturally from sunlight. Therefore, you should take a daily supplement containing 10μg of vitamin D all year round.
If you decide to take a multivitamin 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.
A healthy balanced diet is also important when you are breastfeeding to help your baby get all the nutrients needed 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, as these contain more fibre.
- Some breakfast cereals are fortified with a number of essential vitamins and minerals, including iron, vitamin B12 and riboflavin (check the label). Where possible, go for wholegrain varieties.
- Eat a range of foods containing plant protein. Good sources of essential amino acids for vegetarians include dairy foods and eggs, and sources suitable for both vegetarians and vegans include beans and other pulses, soya dairy alternatives, nuts, and tofu.
- Milk, cheese and yogurt are a good source of calcium, iodine, vitamin B12 and riboflavin if you are vegetarian. You should eat a moderate amount of these in your diet. Where possible, choose lower fat or reduced fat products, and those lower in sugar.
- When choosing dairy alternative drinks and yogurts if you are vegan, look for ones fortified with calcium, vitamin B12, iodine and riboflavin. Some of these may also be fortified with vitamin D.
- You can also get iron 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 riboflavin, 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, riboflavin and short-chain omega-3 fats.
- Yeast extract, particularly fortified varieties, are a good source of vitamins B12 and riboflavin and can taste great on toasted seeded bread!
- Make sure you remember to take your folic acid supplements, and take a vitamin D supplement during the autumn/winter months, or all year round if you have dark skin or do not expose your skin to much sunlight.
Information reviewed April 2015
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