Miriam's casebook - The vegetarian mother
Anne became a vegetarian two years ago, a year after the birth of her second child, Katie, now three years old. Anne's diet includes dairy produce and eggs and she's very healthy, but she's concerned about the extra nutrients her body will need during her pregnancy. We looked at her various worries and, once we'd identified possible protein and calcium deficiencies, I suggested some ways of boosting her diet.
Being vegetarian during pregnancy
Having already had two babies, Anne knew that she might need to make some changes to her diet during her pregnancy, and now she was a vegetarian, she wanted to check a few things.
For example, she'd heard that a vegetarian diet might be short of vitamin B12; if so, would that harm her baby? She'd also read something about folic acid and spina bifida. Was her diet lacking in folic acid, and should she take supplements? She knew that some pregnant women take iron supplements; would she need to?
Anne knew that the main change she had to make to her diet would be to make sure she ate more protein, but she wanted to check what kind of protein would be best and which foods provide it. During pregnancy, the body demands increased calcium intake. Would it be best to take calcium tablets or would she be able to get enough by eating plenty of calcium-rich and calcium-fortified foods?
Opinions on a vegetarian diet during pregnancy differ widely. They range from those of vegans who believe that women can carry a healthy baby to term without eating any animal protein or even taking vitamin B12 supplements, to doctors and healthcare professionals who insist that meat and fish are essential foods for a pregnant woman. In fact, both views are wrong and I'll explain why.
In the case of vegans, if no animal products, including dairy products, are eaten, vitamin B12 supplements are absolutely essential. B12 is vital to the healthy growth and development of the fetus, as well as that of a breastfed baby. Vegetarian diets often lack B12 as it only exists naturally in animal products. A vegetarian woman may need to take supplements to ensure the healthy growth of her baby.
Vegan mothers can opt either to add milk and eggs to their diet, or to take synthetic B12, during pregnancy and while they're breastfeeding.
A vegetarian diet that includes dairy products can support a pregnancy, and later breastfeeding, perfectly well, as long as you have more protein and calcium. All pregnant women should increase their milk intake to 500ml (1pt) a day (skimmed and semi-skimmed milk contain as much calcium as whole milk). Anne can also boost her protein and vitamin intake by drinking vitamin-fortified soya milk and eating lots of other soya and dairy products.
How to meet increasing needs
The simplest way for Anne to increase the protein and vitamin content of her diet would be for her to eat at least four eggs a week. Eggs will provide iron too, although not as much iron as is provided by red meat. While some vegetarians claim that they can get the same amount of iron that red meat provides by eating more green leafy vegetables, they'd have to eat almost 2kg (5lb) of these vegetables per day to do so!
I advised Anne to accept her obstetrician's advice if she is prescribed vitamin, iron, and calcium supplements, but reassured her that if her obstetrician presses her on eating meat, she should contact the Vegetarian Society (see Useful addresses) for support and further information. The following menu should take care of Anne's needs.
Suggested daily vegetarian menu
- Breakfast: Two slices of wholemeal toast with yeast extract. Cup of decaffeinated tea with skimmed milk. One banana.
- Mid-morning snack: Selection of raw vegetables with hummus (chickpea dip) and wholemeal pitta bread.
- Lunch: Baked potato, topped with cottage cheese, red pepper, tomatoes, and watercress. Glass of tomato juice. Chopped nuts and dried fruit.
- Afternoon snack: Broccoli and cheese soup (preferably fresh) with chopped walnuts and low-fat fromage frais. Two slices of rye bread.
- Dinner: Mushroom and tofu lasagna, spinach, steamed mangetout, and wholemeal garlic bread. Fresh fruit with low-fat yogurt. Grapefruit juice.
- Bedtime snack: Boiled egg and wholemeal toast “soldiers” with yeast extract. Glass of skimmed milk.
Good nutrition for a pregnant mother
Nature makes sure that a baby's nutritional needs are supplied by the body before the mother's. Anne's baby, therefore, could be better nourished than she is herself. The umbilical cord links Anne's baby with her placenta. All the nutrients necessary for healthy growth and development pass to Anne's baby through the cord. A baby needs plenty of iron for blood formation and organ growth. This can be supplied by eating iron-rich foods such as egg yolks, cereals, and molasses. Calcium is very important as it builds healthy bones and teeth. Anne needs a diet that is rich in calcium to maintain her own needs as well that of her baby. Her diet should also be packed with protein-rich foods that will nourish her baby's fast-growing muscles, bones, skin, and vital organs.
The healthy development of her baby's brain and nervous system depends on sufficient supplies of Vitamin B12 as well as on Anne having sufficient levels of folic acid in her blood. The blood sugar of the baby is always lower than that of his mother because it's used so quickly, so a constant supply of calories is needed for healthy growth.
Miriam's top tips
- Make sure you are getting the recommended daily dose of 400mcg of folic acid, either through foods rich in folic acid or by taking a folic acid supplement.
- If you don't eat any animal or dairy products, vitamin B12 supplements, available from your local pharmacy, are absolutely essential.
- A vegetarian diet that includes dairy products can support a pregnancy, and later breastfeeding, perfectly well, as long as you have more protein and calcium in your diet.
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