Nutritional Counseling for Vegetarians During Pregnancy and Lactation

Debra S. Penney, CNM, MS, MPH; Kathleen G. Miller, CNM, MS


J Midwifery Womens Health. 2008;53(1):37-44. 

In This Article


A woman's nutritional status directly affects pregnancy outcome and the quality of breast milk after birth. Clinicians who provide prenatal care have an important role in assessing the nutritional status of women and directing them to appropriate resources while respecting their choices. Vegetarian and vegan diets may present with unique nutrient deficiencies that can be addressed during prenatal nutritional counseling.

Tina, a 27-year-old primigravida, presented for her initial prenatal visit at 10 weeks' gestation. Her family and medical histories were unremarkable. She reported healthy behaviors such as moderate exercise, refraining from caffeine, tobacco products, and drugs. Her body mass index was 22. She had been a vegan for the past 5 years. She verbalized awareness of food sources that were rich in iron and combinations of food that make complete proteins. Her initial prenatal labs revealed mild anemia (hematocrit, 32%; hemoglobin, 10.8 g/dL) and further indices were all within the normal range (mean cell volume, 90 fL; mean cell hemoglobin concentration, 33 g/dL; mean corpuscular hemoglobin, 30 pg). She was asked to bring a 3-day diet history so that her food choices could be evaluated. Evaluation of her diet revealed a deficiency of iron-rich foods, but sufficient intake of foods high in folate.

In the third trimester of pregnancy, Tina's hemoglobin was 10.8 g/dL and her hematocrit was 32.0%. She had a total weight gain of 25 pounds during her pregnancy. Her prenatal hematocrit was 32.3% before delivery.

Tina gave birth to an infant who weighed 2600 grams at 37 and a half weeks' gestation. She was discharged with a hematocrit of 31.0% and was given iron supplements (325 mg/daily).

At her 2-week postpartum visit, Tina was continuing to breast feed successfully. She brought a 3-day diet history, which was notable for a lack of iron-rich food sources and insufficient caloric intake. With her provider, Tina selected sources of iron-rich foods from a list and agreed to add nutritious snacks to increase her caloric intake. She was also given written examples of healthy vegetarian meals and snacks for lactation.

At 6 weeks postpartum, Tina's hematocrit was 35%. Tina's diet history confirmed that she was getting sufficient calories to provide an adequate milk supply. Her baby continued to be exclusively breastfeed and was gaining sufficient weight. Her health care provider was concerned about sufficient sources of docosahexaenoic acid (DHA) in her diet and breast milk, especially because she was not consistently taking her multivitamin, and recommended food sources rich in fatty acids and DHA.

*This is a composite patient.


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