Is a Vegetarian Diet Appropriate During Pregnancy?

NDFS 2020 Lifecycle Nutrition Paper #1 Pregnancy

Ryan Seguin Spring 2013

A mothers diet plays a huge role in determining the success of her pregnancy and contributes largely to the overall health of her baby. Pregnant women who practice vegetarian diets run a higher risk of developing deficiencies in protein as well as in several vitamins and minerals that contribute to the proper growth of the fetus (1). Insufficient amounts and low bioavailability of these nutrients tend to be the main causes of deficiencies. Vegetarian women who are attempting to have a child, pregnant, or breast feeding must understand these shortcomings in their diet. They should pay special attention to protein consumption and monitor their intake of vitamin B12, zinc, copper and other vitamins and minerals which play important roles in human development. If left unaddressed, these deficiencies can lead to failed pregnancies and a number of developmental problems for the child before and after birth. Protein. The 9 months of pregnancy represent the most intense period of growth and development humans ever experience (2). During this 9 month period protein, the building block of life is a vital part of the fetus nutrient intake. That nutrient intake comes from the mother and is directly related to her diet. In order to get the necessary amount of amino acids, pregnant woman must consume a sufficient amount of high quality proteins. Given the significant role protein plays in fetal development, is it possible for a woman adhering to a vegetarian diet to have a successful pregnancy and a healthy baby? To evaluate the quality of a specific protein source, the U.S. Food and Drug Administration (FDA) uses a method called the Protein Digestibility Corrected Amino Acid Score (PDCAAS). This process measures how much of a protein can be digested, absorbed and utilized by the body, as well as the quantity of the essential amino acids it provides (3). Due to their molecular makeup and limited spectrum of amino acids, plant proteins typically have lower PDCAAS than animal proteins. The FDA has established a higher protein intake requirement for vegetarians, which is based on the assumption that close to 50% of a vegetarians protein comes from animal sources such as eggs and dairy (1). However, in a 2011 study at Arizona State University (1), it was found that only around 20% of proteins consumed by vegetarians were animal proteins. This leads to an overall PDCAAS as low as 54% for vegetarians, whereas the average Western diet typically scores in the upper nineties. Although vegetarians have access to excellent sources of animal protein such as eggs and

dairy products, many derive the majority of their amino acids from cereals and other plant sources. If a vegetarian woman follows these trends during pregnancy it is very likely that she will suffer from a protein deficiency which will, in turn, affect the development of her rapidly-growing fetus. Vitamin B12. Not only will a lack of animal protein affect the amount of quality amino acids available to the fetus, it will also have a critical impact on the intake of vitamin B12. Found exclusively in animal products, vitamin B12 is required for the formation of red blood cells, proper neurological function, DNA synthesis, and plays an important role in the production of many hormones, proteins, and lipids (4). The requirements for B12 increase during pregnancy and low concentration of this vitamin is an independent risk factor for neural tube defects, pre-eclampsia, and other pregnancy-related complications (5). The importance of vitamin B12 intake is often underestimated because, in the typical Western diet, most people are well over the recommended intake levels (5). However, pregnant women consuming a vegetarian diet, characterized by a reduced consumption of animal proteins, are at a high risk for deficiency. In a study conducted at the University of Giessen in Germany (5), it was found that throughout pregnancy the daily vitamin B-12 requirement (2.6 g), as proposed by the U.S. Institute of Medicine, was met by only 60% of vegetarians. The percentage increased to 94% for those who considered themselves low-meat eaters, and was met by all women who did not abstain from meats. This study provides strong evidence that the risk of vitamin B12 deficiency decreases as meat consumption increases. In a study done at the Trinity College School of Medicine in Dublin (6), it was found that pregnant women with vitamin B12 deficiency in early pregnancy were up to five times more likely to have a child with neural tube defects, such as spina bifida, compared to women with high levels of vitamin B12. However, the risks of B12 deficiency go beyond early pregnancy. Vitamin B12 levels have been shown to be strongly related between mother and fetus. A mothers low intake of B12 may lead to a B12 deficiency in the newborn. To complicate matters, deficient mothers who choose to breast feed continue to put their child at risk of not having ample amounts of this important vitamin (7). This combination puts the child at risk of developmental

abnormalities, growth failure, and anemia. These deficiencies can also lead to complications for the mother such as macrocytic anemia, neurological complications, and cognitive disabilities (5). Other vitamin and minerals. Aside from vitamin B12, there are several minerals that vegetarian mothers are at risk of being deficient in, such as zinc, copper and manganese. Although the mineral content of vegetarian diets may be similar, or even higher, than that of omnivorous diets, the absorption and utilization of those minerals is questionable. High protein diets based on animal sources enhance the bioavailability of copper and zinc and increase manganese absorption. On the other hand, high amounts of phytic acid and dietary fiber in vegetarian diets inhibit the absorption and retention of these minerals (8). Although these micronutrients are sometimes overlooked when evaluating dietary deficiencies, they each play important roles in proper development. Manganese, for example, plays an important role in bone and cartilage development and is necessary for normal brain and nerve function (9). Copper is essential in forming red blood cells which is critical during pregnancy due to the need for an increased blood supply and is needed for a healthy immune system (10). Zinc is important in the production and function of DNA, and is critical during periods of rapid growth such as pregnancy, infancy and childhood (11). Low levels of these minerals increase the risk of pregnancy and delivery complications and have been directly associated with growth and development complications (8). Although vegetarian mothers are at risk of not getting sufficient amounts of several nutrients that play important parts in fetal and child development, it is still possible for a pregnant vegetarian to meet the recommendations for all of these nutrients (13). In the Arizona State University study (1) mentioned earlier, it was determined that vegetarian mothers who get less than 50% of their protein from animal sources can still get adequate amounts of usable protein by simply increasing their intake. For most women an increase of between 12 and 15 grams per day was sufficient. An alternative to increasing protein would be to make an effort to consume more animal protein. Eggs and dairy have very high PCDAA scores and will not only lead to better absorption and utilization, but will also provide a broader spectrum of amino acids in a single food.

Trace amounts of vitamin B12 are found in foods such as milk, yogurt and eggs, but unless these foods are consumed regularly, vegetarian mothers should take a vitamin B12 supplement. Vitamin B12 is found in most prenatal vitamins, but is also available by itself in many forms pills, powders and patches. Pregnant women not eating meat should keep track of their B12 intake through supplementation and diet to ensure that they are getting the recommended amounts. Given that a vegetarian diet can have a negative effect on mineral absorption, it is also true that the longer a vegetarian diet is practiced, the better the body becomes at utilizing what is available. For example, long-term vegetarians were shown to utilize zinc from vegetarian diets better than omnivores consuming the same diet (8). Also, vegetarian mothers tend to consume many more fruits, vegetables and raw foods that are dense in vitamins and minerals than do their meat-eating counterparts. This not only counters the effects of low absorption rates, but boosts their levels of other essential minerals. For instance, another study performed at the University of Giessen (12) showed that vegetarian women had higher levels of folate, which is critical in the development of the fetus neural tube and whose deficiency is linked to severe d eformities and health issues. Folate status was highest in the vegetarian group in all three trimesters of pregnancy, followed by low meat eaters and was lowest in the average Western diet group. In 2009 the American Dietetic Association issued its official position statement on this matter, declaring that well-planned vegetarian diets are appropriate for individuals during all stages of the lifecycle, including pregnancy, lactation, *and+ infancy. (13). Despite all the possible risks of a vegetarian diet during pregnancy, with careful planning and appropriate supplementation vegetarians can have highly successful pregnancies.

References Cited 1. Kniskern MA, Johnston CS. Protein dietary reference intakes may be inadequate for vegetarians of low amounts of animal protein are consumed. Nutrition. 2011;6:727-730. Available at: http://www.sciencedirect.com/science/article/pii/S0899900710003059. Accessed on: Jan 23, 2013. 2. Brown, JE. Nutrition during pregnancy. In: Nutrition Through the Life Cycle, 4th ed. California: Thomson Wadsworth Publishing; 2011:88. 3. Schaafsma G. Advantages and limitations of the protein digestibility-corrected amino acid score (PDCAAS) as a method for evaluating protein quality in human diets. Br J Nutr. 2012;108:S333-S336. Available at: http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN108_S2%2FS0007114512002541a.p df&code=9a81afdc7fe4b29e7fc0936b8a4b398c. Accessed on: Feb 17, 2013. 4. Office of Dietary Supplements. Dietary Supplement Fact Sheet: Vitamin B12. Available at: http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/. Accessed on: Feb 19, 2013. 5. Koebnick C, Hoffmann I, Dagnelie PC, Heins UA, Wickramasinghe SN, Ratnayaka ID, Gruendel S, Lindermans J, Leitzmann C. Long-term ovo-lacto vegetarian diet impairs vitamin B12 status in pregnant women. J Nutr. 2004;134:3319-3326. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15570032. Accessed on: Jan 23, 2013. 6. Warner J. Birth defects linked to low vitamin B12. 2009;123:917-923. Available at: http://www.webmd.com/baby/news/20090302/birth-defects-linked-to-low-vitamin-b12. Accessed on: Jan 23, 2013. 7. Weiss R, Fogelman Y, Bennett M. Severe vitamin B12 deficiency in an infant associated with a maternal deficiency and a strict vegetarian diet. J Pediat Hematol Onc. 2004;26:270-271. Available at: http://xz6kg9rb2j.scholar.serialssolutions.com/?sid=google&auinit=R&aulast=Weiss&atitle=Severe+vit amin+B12+deficiency+in+an+infant+associated+with+a+maternal+deficiency+and+a+strict+vegetarian +diet&title=Journal+of+pediatric+hematology/oncology&volume=26&issue=4&date=2004&spage=270 &issn=1077-4114. Accessed on: Jan 27, 2013. 8. Gibson RS. Content and bioavailability of trace elements in vegetarian diets. Am J Clin Nutr. 1994;59:12235-12325. Available at: http://ajcn.nutrition.org/content/59/5/1223S.full.pdf+html. Accessed on: Jan 23, 2013. 9. University of Maryland Medical Center. Manganese. Available at: http://www.umm.edu/altmed/articles/manganese-000314.htm. Accessed on: Feb 19, 2013. 10. University of Maryland Medical Center. Copper. Available at: http://www.umm.edu/altmed/articles/copper-000296.htm. Accessed on: Feb 19, 2013.

11. Office of Dietary Supplements. Dietary Supplement Fact Sheet: Zinc. Available at: http://ods.od.nih.gov/factsheets/Zinc-QuickFacts/. Accessed on: Feb 19, 2013. 12. Koebnick C, Heins UA, Hoffmann I, Dagnelie PC, Leitzmann C. Folate status during pregnancy in women is improved by long-term high vegetable intake compared with the average western diet. J Nutr. 2001;131:733-739. Available at: http://jn.nutrition.org/content/131/3/733.long. Accessed on: Jan 27, 2013. 13. Craig WJ, Mangels AR. Position of the American dietetic association: vegetarian diets. J Am Diet Assoc. 2009;109:1266-1282.