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Plant-based nutrition during pregnancy
Table of Contents
1. The description of the plant-based diet and safety of its use
A plant-based diet generally involves renouncing meat, fish, and animal products. However, the scope of the exclusions may vary, so we can distinguish between a lacto-vegetarian diet (most often referred to as vegetarian), which eliminates the consumption of flesh, fish, and seafood, while allowing the use of dairy products and eggs, and its two variations: dairy diet (it does, however, plan to eat protein, but renounces animal diet) and egg diet (more than egg-based diets). A diet that consists exclusively of vegetable ingredients from pregnant women and contains all the components of plant health foods from the diet of vegans and vegans. However, the applied nutritional model is often somewhere between all the described types. According to the statement of the American Academy of Nutrition and Dietetics, a well-planned plant-based diet (both vegetarian and vegan) is safe to use at every stage of life – including during pregnancy and lactation (V. Melina et al. 2016). The data on the course of pregnancy and the health of newborns of women on a vegetarian and vegan diet compared to toddlers of mothers eating traditionally are limited. However, based on available research, no evidence has been found that the use of the plant model is associated with an increased risk of complications and side effects that pose a threat to mother and child. It has been noted, however, that children of vegetarians and vegans more often have a lower birth weight – these are not, however, dangerous values for health and life. This could be related to a lower intake of protein and some nutrients by pregnant women, which additionally indicates how important proper meal planning is (G. B. Piccoli et al. 2016; S. F. Yisahak et al. 2021). So what should one pay attention to and how can one meet the demand for nutrients?2. The caloric content of the diet and the frequency of meals
A pregnant woman's energy needs change over time. In the first trimester they increase by 85 kcal/day, in the second trimester by 285 kcal/day, and in the third trimester by 475 kcal/day compared to pre-pregnancy values (M. Jarosz et al. 2020). It may be useful for the additional energy to come from high-quality foods, such as protein, iron, or folic acid. As for the frequency of meals, it may be beneficial to eat smaller portions more often. In the first trimester, this practice can be helpful in reducing nausea and vomiting. In the following trimesters, it may provide an opportunity to increase calorie intake without increasing portion sizes to a difficult-to-handle size, as plant-based dishes often have a larger volume than traditional meals. However, it is important to consider the health status, habits, and preferences of the future mother.3. The proportion of macro and micro-nutrients
The increase in calorie requirements during pregnancy is also linked to changes in the proportion of various nutrients in the diet. Protein demand increases in this period to 0.98-1.2 g/kg of actual body weight per day, while it is about 0.73-0.9 g outside of pregnancy. It is important to note that this refers to the current body weight, which means that the amount of protein that needs to be consumed will gradually increase as weight increases throughout pregnancy. Protein sources in a plant-based diet should primarily consist of legumes and their derivatives such as tofu, tempeh or soy products. In addition to protein, they also contain other nutrients such as iron and zinc. If legumes are poorly tolerated, it may be beneficial to consume them in the form of pastes, soups, or savory snacks. Other protein sources in a plant-based diet are nuts and seeds as well as grains such as oatmeal, quinoa or buckwheat. In order to ensure the provision of all necessary amino acids, it is advisable to combine different food groups in a meal. Women who follow a vegetarian diet can also obtain protein from eggs and dairy products, but they should avoid raw or semi-raw eggs and products based on unpasteurized milk that have not been thermally treated. During pregnancy, it is also recommended to add fat to the diet. In the first trimester, this is about 3 g/day, in the second 10-11 g, and in the third 16-19 g. Fat can be provided by adding nuts, seeds, or oil to meals. In this period, the consumption of hardened vegetable fats should be avoided, which can have negative effects on fetal development. The demand for carbohydrates does not change during pregnancy and they make up the remainder of the diet, providing 45-65% of the total energy intake of the menu.4. Content of mineral components and vitamins
To provide optimal conditions for the healthy growth of a developing organism during pregnancy, the body's demand for many nutrients changes. The use of a plant-based diet also poses certain challenges related to the supply of essential substances. It is therefore worthwhile to look at the key micronutrients in the diet of growing plants and vegetarian plants and the ways in which they are supplied to the body. The first of these ingredients is iron, the demand for which increases during pregnancy from 18 mg/day to 27 mg/day. Iron from plant sources is also harder to absorb than iron from animal products. Therefore, it is important to use proper processing techniques and to compose meals in a way that allows for optimal absorption. For example, it is recommended to soak seeds and nuts before consumption, choose full-grain bread based on sourdough, and avoid consuming calcium-rich products in combination with iron-rich products. Coffee, tea, and cocoa should also be avoided during meals. To ensure an adequate intake of iron from plant sources, it is important to include legumes, nuts and seeds, some grains such as buckwheat, millet, and amaranth, as well as vegetables such as parsley and broccoli in the diet. An iron deficiency during pregnancy increases the risk of anemia, which can cause premature placental abruption and low birth weight of the newborn.5. Nutrient supplementation during pregnancy
Pregnancy is a period in which it is necessary to provide certain nutrients in the form of medications or supplements. According to the recommendations of the Polish Society of Obstetricians and Gynecologists, healthy pregnant women should take: - folic acid at 0.4 mg/day before conception and 0.4-0.8 mg/day during pregnancy (depending on the stage of pregnancy) - docosahexaenoic acid (DHA) at 200 mg per day for all pregnant women, and for those who consume small amounts of fish (e.g. vegetarians and vegans), the dose should be increased up to 1000 mg/day - vitamin D at 1500-2000 IU/day - iodine in an amount of 150-200 µg/day (M. Zimmer et al. 2020). The Society also recommends monitoring blood parameters (hematology and ferritin concentration) during pregnancy to prevent the development of iron deficiency anemia. In case of its occurrence, supplementation should also be introduced (M. Zimmer et al. 2020). In addition – as mentioned earlier – women on a vegetarian or vegan diet should supplement vitamin B12.6. Summary of plant-based diet during pregnancy
The application of a plant-based diet during pregnancy can be safe if the menu is correctly balanced, which means providing the right amount of calories and nutrients and applying the correct supplementation. This requires commitment, nutritional knowledge, and skills. Therefore, it is worth it for women on a plant-based diet to prepare for these challenges during the planning phase of pregnancy and regularly monitor their health and that of their child.
