A HEALTHY START Vegan Diets in Pregnancy and Breast-Feeding

Family members, friends, and even your health-care provider might express surprise and concern at the idea of a vegan pregnancy. But vegan diets can easily meet the nutritional needs of you and your growing baby. The proof comes from a 1987 study of 775 women living on the Farm, a vegan community in Tennessee.1 The researchers looked at weight gain in pregnant women and birth weights of their babies—two important measures of a healthy pregnancy.

They found that the women’s vegan diets had no effect on the birth weights of their babies and that their own weight gain during pregnancy was adequate. In fact, these women actually gained a little bit more than women in the general meat-eating population. And the longer they had been vegan, the better their weight gain.
One other finding was surprising: Preeclampsia, a potential complication of pregnancy that occurs in 5 to 10 percent of pregnant women, was nearly nonexistent among vegan pregnant women living on the Farm. Along with another smaller study, these findings give reassurance that vegan diets are safe and healthy for pregnancy.


In some studies of women following very restrictive diets, particularly macrobiotic diets, infants sometimes had lower birth weights. In these cases, it wasn’t a vegan diet that was to blame. Rather, the diets at issue were too low in fat and calories. It’s important to note that the
findings about poor pregnancy outcomes are from older studies when
vegans had less access to nutrition information and a variety of vegan foods. That’s all changed dramatically in the past several decades, and today it’s easier than ever to plan a healthy vegan pregnancy.


GETTING ENOUGH CALORIES


Although adequate weight gain is important for a healthy vegan pregnancy, eating for two doesn’t mean eating twice as many calories. On average, pregnant women need an extra 340 calories per day during the
second trimester and 450 extra calories during the last three months of pregnancy. But needs for certain nutrients increase by as much as 50 percent, so packing a lot of good nutrition into that little bit of extra
food is important.

with just a few adjustments that we’ve shown in the Modified Food An added serving each of whole grains and leafy green vegetables and two additional servings of protein-rich foods (legumes, nuts, and soyfoods) will give you needed calories and help meet nutrient needs during the second trimester. During the last trimester, when your baby is growing fastest, add one more serving of either whole grains or legumes/soyfoods. Calorie-counting during pregnancy isn’t an exact science, but your health-care provider will help you stay on track by monitoring your
weight gain. Poor weight gain during pregnancy is associated with lowbirth-weight babies, who are at risk for health problems.


NUTRITION CONSIDERATIONS IN VEGAN PREGNANCY


The table on page 139 shows changes in nutrient needs for pregnant and nursing women.
Protein needs increase by almost 50 percent in pregnancy. Most non-pregnant omnivore women consume enough protein to meet the
needs of pregnancy, but that may not be true of all vegan women. It isn’t difficult to get enough, but it’s important to make sure you are including at least five to six servings of protein-rich foods from the food
guide in your daily menus.
Iron absorption—especially of the nonheme iron found in plant foods—increases significantly during pregnancy while the lack of menstruation reduces iron losses. Even so, iron requirements nearly double during pregnancy. Some of the increased iron requirement is due to the manufacture of red blood cells in the growing fetus, but most of it is needed to support the expansion of the mother’s blood volume during pregnancy. Theoretically, vegans could be at higher risk for iron deficiency in pregnancy, but the truth is that all women are at risk. It’s difficult to plan diets for either vegans or omnivores that meet iron needs of pregnancy. For that reason, iron supplements are almost always recommended for pregnant women.


Pregnant women typically have zinc intakes that are lower than recommendations, unless they are taking supplements. The benefits of zinc supplements in pregnancy aren’t known, but they may be beneficial for pregnant vegans since zinc absorption from plant foods is lower than from meat.
Vitamin D requirements don’t change with pregnancy, but getting enough is important for both the mother’s and baby’s health. With the exception of vitamin B
12 and iron and—depending on your diet—possibly vitamin D and iodine, it is possible to meet all of the nutrient needs of pregnancy on a vegan diet without the use of supplements.
But most health professionals recommend a prenatal multivitamin and mineral supplement, particularly one that includes iron and folate, as sensible insurance for both vegan and omnivore women.


Pregnant vegetarians have lower blood levels of DHA (the longchain omega-3 fatty acid) than pregnant nonvegetarians.
2 We don’t know whether that’s a problem, but there is some evidence that DHA intake during pregnancy and breast-feeding improves visual acuity and brain function in the infant. Experts recommend that pregnant women consume 300 milligrams of DHA per day, so we recommend DHA algaederived supplements for vegans.


Here are some tips for a healthy vegan pregnancy:


• If you are planning a pregnancy, now is the time to take a good look at your eating habits. Healthy nutrition in the early weeks of pregnancy—often before a woman knows that she is pregnant—is important. Make sure your diet includes plenty of foods that are rich in the B-vitamin folic acid. Good sources are legumes and leafy green vegetables. Think about cutting alcohol out of your diet, too, if there is any chance you might become pregnant,
and if you are a coffee drinker, now is the time to cut back.


• Talk to your health-care provider about your weight-gain goals. If you have trouble gaining weight, emphasize foods with a little more fat, such as tofu, nut butters, and avocados.

 

 

• Protein needs go up by about 25 grams beginning with the second trimester. It’s not difficult to meet those needs on a vegan diet, but it might require extra attention. Take a look at the list of proteinrich foods in Chapter 2. Aim  20 grams of protein in each meal and choose a few protein-rich snacks as well.


• Eat plenty of iron-rich foods and include a good source of vitamin C at every meal to boost absorption. Most health-care professionals recommend iron supplements for all pregnant women. This can be especially helpful for vegans since iron needs are higher for those on plant-based diets.


• Eat plenty of foods high in the B-vitamin folic acid. If you don’t typically use refined enriched grain products, which are fortified with folic acid, make sure you are consuming plenty of folic acid–rich foods if there is a possibility you could become pregnant. Vegans generally have higher intakes of folic acid than omnivores, but they still aren’t high enough to meet pregnancy
needs. A prenatal supplement that contains folic acid is a wise choice for all pregnant women.


• Some pregnant vegans don’t meet requirements for zinc, a nutrient that can fall short even in well-planned vegan diets. Be sure to include whole grains, legumes, and a serving or two of nuts or seeds in your meals. A supplement providing 15 to 25 milligrams of zinc can be a good choice for pregnant vegans. It should also supply 2 milligrams of copper since zinc can lower copper absorption.


• Because calcium absorption is more efficient during pregnancy, pregnant women don’t have increased needs for this nutrient. It’s important to get enough, though, so make sure you emphasize foods that are calcium-rich. Make it a daily habit to eat a serving or two of leafy green vegetables and choose calcium- fortified soymilk and orange juice. Recommendations for calcium intake are 1,000 milligrams per day.


• Supplement daily with vitamin B
12 and, unless you are abso – lutely certain that you are getting adequate sun exposure, take a supplement of vitamin D as well.


• Although it is usually called morning sickness, nausea associated with early pregnancy can occur at any time of day. In addition to being unpleasant, nausea can keep you from eating healthfully. Here are a few tips to help you deal with pregnancyinduced nausea:


Eat frequent small meals since an empty stomach can make nausea worse. (Small meals can also help with heartburn, which can be a problem for some pregnant women.)
Eat something immediately upon waking, when your stomach is likely to be empty. Keep crackers or raisins or whatever appeals to you on the bedside table. Avoid liquids with meals if you find that this increases your nausea.
 Identify healthy foods that are less likely to make you feel sick.


You’ll need to follow your own instincts, but good choices to
consider include whole-grain breads, dry cereals, cooked or dried fruits, and white or sweet potatoes. Try adding small pieces of vegetables and tofu to miso soup to make them saltier and easier on your stomach.


VEGAN NUTRITION FOR NURSING MOMS


The rate of breast-feeding is higher among vegan mothers than in the general population. And that’s nice for their babies since breast milk is the ideal food for infants. Ideally, babies should be fed human milk for at least the first year of their lives and preferably throughout the second year as well.


Nursing mothers need extra calories for the process of synthesizing milk and to provide the calories that babies need for growth. Energy needs, therefore, are higher during lactation than in pregnancy. If you have post-pregnancy pounds to drop, a small reduction in calories can usually produce a gradual weight loss while still maintaining adequate milk volume. Don’t decrease calories too much, though, as it can cause the milk supply to decrease as well. Drinking plenty of fluids is also important for producing adequate milk.


Needs for some nutrients go up slightly, so keeping the emphasis on nutrient-rich foods is as important as ever. (One exception is iron:


Since breast-feeding women don’t menstruate, iron needs drop to very low levels during lactation.) Diet affects the levels of all of the vitamins in breast milk as well as the type of fat.


The two nutrients that require the most attention in vegan diets


are ones that nutrition-savvy vegans are already focusing on—vitamin D and vitamin B
12. Deficiencies of these nutrients have been seen in babies whose mothers didn’t follow recommended guidelines and they can cause serious problems. Nursing women should consume a daily vitamin B 12 supplement. We also recommend continuing with a DHA supplement since one study showed that the milk of vegan women is lower in this nutrient than that of omnivores.

Many women continue with a prenatal supplement for the first few months of breast-feeding (but without the extra iron). And the American Academy of Pediatrics recommends vitamin D supplements for all breast-fed infants (not just those in vegan families).

NUTRIENT RECOMMENDATIONS FOR
NONPREGNANT, PREGNANT, AND BREAST-FEEDING WOMEN
Nutrient Non-pregnant Pregnant Breast-feeding
Protein (g)*
Thiamin (mg)
Riboflavin (mg)
Niacin (mg)
Vitamin B
6 (mg)
Folic acid (μg)
Vitamin B
12 (μg)
Vitamin C (mg)
Vitamin A (μg)
Vitamin D (IU)
Vitamin E (mg)
Vitamin K (μg)
Calcium (mg)
Iodine (μg)
Iron (mg**)
Magnesium (mg)
Phosphorus (mg)
Selenium (μg)
Zinc (mg)***
46
1.1
1.1
14
1.3
400
2.4
75
700
600
15
90
1,000
150
18
310–320
700
55
8
71
1.4
1.4
18
1.9
600
2.6
85
770
600
15
90
1,000
220
27
350–360
700
60
11
71
1.4
1.6
17
2.0
500
2.8
120
1,300
600
19
90
1,000
290
9
310–320
700
70
12
*Protein needs may be slightly higher for pregnant vegans. Use the guidelines in Chapter 2 to calcu
late your pre-pregnancy protein requirements and then add 25 to 28 extra grams of protein for
pregnancy.
** Iron recommendations for vegetarians and vegans are 1.8 times higher than this.
***Zinc requirements for some vegans could be as much as 50 percent higher
MODIFIED FOOD GUIDE FOR
PREGNANCY AND BREAST-FEEDING
These are minimum servings and should be used as a general guide. Some women will
need more than this to support adequate weight gain.
Servings per day
during pregnancy
Servings per day
while breast-feeding
Food group
Grains and starchy vegetables
Legumes and soyfoods
Nuts
Vegetables
Fruits
Fats
Calcium-rich foods
6–7
5–6
2
5
(include at least one
leafy green vegetable)
2
3
8
6–7
6
2
5
2
3
8

Supplements for pregnant vegans:



• Prenatal supplement that provides folic acid, zinc, iron, and copper.
• A calcium supplement if you feel you are falling short of the 1,000 milligrams of calcium recommended during pregnancy.
• 300 milligrams of DHA from algae.
• 150 micrograms of iodine (which may already be included in your prenatal supplement).
• 600 to 1,000 IU vitamin D unless you are certain that you have adequate sun exposure.


Supplements for breastfeeding vegans:


• A chewable or sublingual vitamin B12 supplement
• 300 milligrams of DHA
• 150 micrograms of iodine

 

SAMPLE MENUS


You may very well feel like cooking up a storm during and after your pregnancy. But just in case you don’t have the time or energy for much food prep, we’ve kept things simple with these sample menus.


They are meant to illustrate the ease of planning healthy vegan menus without fuss. These menus utilize six mini-meals, which can be helpful with managing heartburn and nausea.

Sample Menu for Pregnancy


Breakfast


 1 cup fortified breakfast cereal
1 cup fortified soymilk
 Banana


Snack


¼ cup almonds
Raw vegetables


Lunch


 Miso soup with ½ cup tofu and 1 cup cooked kale or collards
 Serving of whole-grain crackers


Snack


 Whole-grain bread with ½ cup hummus
½ cup fortified orange juice


Dinner


4 1 cup brown rice
4 ½ cup baked beans
4 1 cup steamed vegetables sautéed in 2 teaspoons canola oil
Snack
4 ½ whole-grain English muffin with 2 tablespoons almond
butter
4 1 cup fortified soymilk

 

Sample Menu for Breast-Feeding
Breakfast
½ cup scrambled tofu cooked in 1 teaspoon canola oil
 1 slice whole-wheat toast with 1 teaspoon margarine
 1 cup calcium-fortified orange juice Snack
 ½ cup grapes
 Serving of whole-grain crackers with 2 tablespoons almond butter Lunch
Veggie burger
Whole-wheat hamburger roll

 Slice tomato and lettuce

 Broccoli salad with ½ tablespoon vegan mayonnaise Snack
Small bran muffin
 1 cup fortified soymilk


Dinner


 1 cup lentil soup
 1 cup steamed collards


 Green salad with dressin Whole-wheat dinner roll  Snack Smoothie


 ½ cup fortified soymilk
 ½ cup frozen fruit
 ¼ banana
 1 teaspoon ground flaxseed

 

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