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For reasons of health, or conscience, or religion, or simply preference, vegetarianism is increasingly popular. According to a publication in the Journal of the American Dietetic Association, up to 2.5% of American adults and 4% of Canadian adults follow versions of the vegetarian diet (ADA, 2003). Although we don't have statistics for South Africa, it's possible that we have similar trends in this country.
While a vegetarian diet doesn't pose problems for adults, vegetarians who are pregnant need to take special care in planning an adequate diet that will provide all the nutrients required for their own health and that of the unborn baby.
Different vegetarian diets
Different types of vegetarian diets are used worldwide. The standard vegetarian diet excludes meat, fish and fowl (chicken, turkey, and so forth), but still includes dairy products and eggs. This type of diet is sometimes also referred to as a lacto-ovo vegetarian diet.
Vegan or macrobiotic diets exclude all animal products, including dairy products, eggs, gelatin and even honey. While adults can use strict vegan diets, vegan moms-to-be should consider changing to a standard vegetarian diet during the conception period and pregnancy as this will make it easier to obtain all the necessary nutrients for the healthy development of the baby.
Important nutrients during pregnancy
According to the United States Department of Agriculture (USDA, 2008), "Vegetarian diets can meet all the requirements for nutrients." The USDA continues by saying that it's necessary for vegetarians to eat a variety of foods and to select foods from the following food groups:
1. Protein
Combine plant foods, which are rich in plant protein. These include dry cooked beans, peas and lentils (also called legumes), nuts and nut butters (e.g. peanut butter) and soy foods (tofu, tempeh, vegetarian patties and burgers). Milk and dairy products like yoghurt, cheese, cottage cheese and eggs can make an important contribution to the diet of the pregnant woman. According to the Food Standards Agency (FSA) of the UK, soy foods and the grain called quinoa (which you can find at health shops) are the only vegetarian sources of the complete mix of essential amino acids we require for growth and tissue repair.
2. Iron
Iron deficiencies are common among many women of childbearing age due to menstrual losses and an inadequate diet. Because iron is the prime oxygen transporter in the blood, it is a vital nutrient during pregnancy to ensure that your baby obtains sufficient oxygen and that you, as the mother, don't develop iron-deficiency anaemia. Good sources of iron in the vegetarian diet are iron-fortified breakfast cereals, bread and maize meal (the fortification of bread and maize meal is mandatory in SA), spinach, kidney beans, lentils, turnip greens, molasses, peas and certain dried fruits (e.g. dried apricots, prunes and raisins).
3. Calcium
Babies need calcium to build strong bones and teeth, and moms need calcium to maintain their own bone strength. Good sources of calcium in the vegetarian diet are soy products (tofu, and soy milks that are fortified with calcium), dark green leafy vegetables (turnip greens, bok choy (buy at speciality green grocers) and mustard greens. Milk and dairy products, as listed under "Protein" above, are excellent sources of calcium when you're pregnant.
4. Zinc
Zinc acts as a so-called catalyst in many essential body functions and ensures a strong immune system. Vegetarian sources of zinc include different varieties of dried beans, zinc-fortified breads and breakfast cereals, wheat germ and pumpkin seeds. Milk also supplies zinc to the diet of lacto-vegetarians.
5. Vitamin B12
This vitamin ensures that you and your baby don't develop so-called "megaloblastic anaemia". Sources of vitamin B12 for vegetarian moms are milk products, eggs and foods that have been fortified with vitamin B12 (breakfast cereals, soy drinks, veggie burgers and nutritional yeast).
6. Folic acid
Folic acid is important to prevent neural tube defects in the unborn baby. South African breads and maize meal are fortified with folic acid by government decree, to help prevent folic-acid deficiency.
Omega-3 fatty acids are essential for the optimum development of your child’s nervous system and eyes. Although fish and shellfish are the best sources of omega-3 fatty acids, vegetarians can use plant sources of the omega-3 fatty acid called ALA (alpha-linolenic acid), such as green leaves (spinach, pumpkin leaves), rapeseed, canola and soya oils, flaxseed or linseed oils, walnut oil and foods enriched with ALA (e.g. eggs produced by chickens fed on linseed or flaxseed oils).
Keep in mind that babies still need a good supply of omega-3 fatty acids for the first year of life to ensure proper development of their nervous system and eyes, so you need to continue eating foods that are good sources of ALA throughout the breastfeeding period.
Should you use supplements?
Pregnant vegetarians should consider taking complete vitamin and mineral supplements if they don't include milk and dairy products or eggs in their diet. Discuss this with the doctor who is monitoring your pregnancy. The doctor may for example suggest that you take iron, vitamin B12 and calcium supplements during your pregnancy and when you breastfeed. Note that the latest research indicates that it's important to use a calcium supplement that also contains vitamin D and vitamin K2.
If you're following a vegetarian diet and are contemplating pregnancy or are pregnant already and worried about the adequacy of your diet, it's best to consult a clinical dietician. He or she will help you determine if your nutrient intake is adequate to meet the increased needs of pregnancy. Visit the Association for Dietetics in SA Website at www.adsa.org.za to find a dietician in your area.
The dietician will also be able to assist you if you think you're gaining too much weight or if you're not gaining enough.
References:
(ADA (2008). Position of the ADA & Dietitians of Canada: Vegetarian Diets. J Am Diet Assoc, 103(6):748-65; FSA (2008). Vegetarian & Vegan. http://www.eatwell.gov.uk/ healthydiet/vegaveg (Accessed on 29/11/08); USDA (2008) My Pyramid - Vegetarian Diets. http://www.mypyramid.gov/tips_resources/vegetarian_diets (Accessed on 29/11/08); Van Heerden, IV (2005). Fish oils vs plant oils in omega-3 supplementation - which are better? Industrial Report)
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