The topic of a vegan diet – in particular when pregnant or breastfeeding – brings up controversial opinions among experts time and again, and also leads to uncertainties among pregnant and breastfeeding women. Scientists are studying this topic in detail, with the aim of establishing greater clarity. As a vegan dietitian and nutritionist, in this expert article I intend to address the special nutritional requirements of pregnant and breastfeeding women, and also examine the challenges that arise in providing advice to these women, including the latest scientific findings.
In my day-to-day work, I frequently encounter pregnant women who have been following a vegan diet for several years, and who have experienced criticism from medical professionals due to their nutritional intake during pregnancy. They are often advised to opt instead for a mixed diet or at least a vegetarian diet and are informed that this is the only way that they can be confident of covering all the important nutrients. Such attitudes bring about a sense of insecurity and apprehension in expectant mothers, because they feel misunderstood and dismissed while also wishing to avoid causing any to harm their child. And so it is that they start eating cheese again against their beliefs or choose to take nutrient preparations that have not been suitably adapted to their needs without consulting a specialist. This in turn increases the risk of nutrient deficiency, which could have been avoided through adequate education. Situations like this clearly show that more information based on science is required in this area, in order that vegan women can receive appropriate support during nutritionally sensitive stages of their lives.
Knowing that a well-planned vegan diet incorporating critical nutrients is possible during nutritionally sensitive life phases, we establish a foundation for this by providing advice to the relevant groups of people. Protein, vitamin D, omega-3 fatty acids (in particular eicosapentaenoic acid and docosahexaenoic acid), calcium, iron, zinc, vitamin B2, vitamin B12, iodine, and selenium are considered critical, whereby vitamin B12 is the most critical nutrient in a vegan diet because it is produced by microorganisms and is only found in appreciable amounts in animal-based foods. Vitamin B12 is vital for cell division, blood production, and for keeping the human nervous system healthy. A deficiency of vitamin B12 during pregnancy and breastfeeding can lead to neural tube defects, pre-eclampsia, or neurological damage in the infant. Reliable and professional supplementation by means of dietary supplements is therefore essential (2). The ÖGKJ recommends that pregnant and breastfeeding women supplement their diets with 50-100 micrograms of vitamin B12 daily (5).
It is important to find a way to respect vegan pregnant and breastfeeding women in their dietary decision and to support them with expertise, to avoid nutritional deficiencies in both mother and baby. Interdisciplinary work and referring breastfeeding and expectant moms to nutrition experts are helpful ways in which to achieve this, so that the appropriate food choices, vital nutrients, and the necessary supplements can be discussed in consultation with the acting physicians.
After all, the question should not be whether but how a vegan diet can be designed to meet the needs of all individuals during the sensitive phases of life. By working in this way, we as medical professionals mutually ensure that misinformation and deficiencies are avoided and that women who choose a vegan diet even during these special periods of life are provided with the relevant information and given the best possible advice.
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2Keller M, Gätjen E. (2017): Vegane Ernährung. Schwangerschaft, Stillzeit und Beikost. [Vegan diet. Pregnancy, lactation and complementary feeding] Stuttgart: Eugen Ulmer Verlag
3German research institute for plant-based nutrition (IFPE): "Pregnant Veggie Study – Studie zur veganen Ernährung bei Schwangeren in Deutschland" [Pregnant Veggie Study – Study of vegan diet among pregnant women in Germany] at: https://ifpe-giessen.de/preggie-studie/ (accessed 5/9/2023)
4DGE (2016): Richter M, Boeing H, Grünewald-Funk D, Heseker H, Kroke A, Leschik Bonnet E, Oberritter H, Strohm D, Watzl B. Vegan diet. Position of the German Nutrition Society (DGE). Nutrition review 63(04): 92–102.
5ÖGKJ (2018): Plank R. Nutrition Commission of the Austrian Society for Pediatrics and Adolescent Medicine. Safety and risks of vegetarian and vegan diets during pregnancy, lactation, and the early years. Monatsschrift Kinderheilkunde 2018; doi: 10.1007/ s00112-018-0554-7.
6DGE (2020): Richter M, Kroke A, Grünewald-Funk D, Heseker H, Vir- mani K, Watzl B. Ergänzung der Position der Deutschen Gesellschaft für Ernährung e. V. zur veganen Ernährung hinsichtlich Bevölkerungsgruppen mit besonderem Anspruch an die Nährstoffversorgung. [Addendum to the position of the German Nutrition Society on vegan nutrition with regard to population groups with special nutritional requirements] Nutrition review 2020; 5th special issue: 64-72.
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9American Dietetic Association; Dietitians of Canada. Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets. J Am Diet Assoc. 2003 Jun;103(6):748-65. doi: 10.1053/jada.2003.50142.