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

Vegetarian Diets

Vegetarian diets are composed of foods from plant sources. There are some variations of vegetarian diets: lacto-ovo vegetarian diets include dairy and eggs, whereas vegan diets exclude dairy and any other products from animal sources. A macrobiotic diet includes mostly grains, legumes, and vegetables, and, to a lesser extent, seeds, fruits, and nuts. When limited amounts of fish are included in the macrobiotic diet, it is no longer considered vegetarian.

The reasons for choosing any type of vegetarian diet are varied and may include religion, beliefs about animal rights, concern about environmental conservation, world hunger issues, and health.[1,2] Perhaps because of this conscious choice to avoid meat products, vegetarians and vegans have been found to be more concerned about health issues[3,4] and usually are fairly well informed about a balanced vegetarian diet. The number of persons who choose a vegetarian diet is increasing in North America.[5] About 2.5% of adults in the United States follow a vegetarian diet, and about 1% of those are vegan.[5] Typically, vegetarians are most often female and live in large cities and coastal areas.[5]

Some misunderstand and may criticize the nutritional adequacy of such diets. The American Dietetic Association asserts that a balanced vegetarian and vegan diet is adequate to maintain health for all stages of life, including during pregnancy and lactation.[6] The Physicians Committee for Responsible Medicine[7] and the American College of Obstetricians and Gynecologists[8] agree that well planned vegetarian diets can be a healthy choice for pregnant women. Dietary guidelines from the US Department of Health include vegetarian diets as a way of achieving recommended nutrient intakes.[9]

Epidemiologic nutritional studies have documented numerous benefits of vegetarian diets. Vegetarians have been reported to have low rates of obesity, coronary diseases, diabetes, and many cancers.[10] High consumption of foods commonly found in vegetarian diets, such as fruits and vegetables, legumes and unrefined cereals, and nuts have been consistently associated with a lower risk for developing many chronic degenerative diseases.[10] Data from the National Health and Nutrition Examination Survey (NHANES 2001-2002)[11] revealed a deficiency in the American diet of fruits, vegetables, and whole grains. The US Dietary Guidelines and the objectives for Healthy People 2010[12] endorse an increase in fruit, vegetable, and whole grain consumption for Americans in order to improve health.


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