Vegetarian Diet During Pregnancy, Childhood, and Old Age – Is It Safe?

Vegetarian Diet During Pregnancy

Following alternative diets, including vegetarian ones, during pregnancy raises concerns among doctors and family members. An improperly balanced vegetarian diet may lead to poor weight gain, impaired placental function, increased risk of preterm birth, or low birth weight (1).

Vegetarian diets have many benefits. They are characterized by:

• low levels of saturated fatty acids and cholesterol,

• high levels of unsaturated fatty acids, complex carbohydrates, fiber, and water-soluble vitamins, especially vitamin C.

However, they also carry the risk of deficiencies in several nutrients important for both mother and child, including:

• protein,

• DHA fatty acids,

• vitamin D,

• iron,

• zinc,

• vitamin A.

Vegan diets additionally pose a risk of deficiencies in calcium, vitamin B2, and vitamin B12.
Vegetarian diets also contain a high amount of antinutrients that inhibit the absorption of key minerals such as iron, zinc, calcium, and magnesium.

Despite these potential risks, well-planned vegetarian diets can be safe for pregnant women and prevent nutrient deficiencies.

Vegetarian Diet in Pregnancy – Deficiencies and Recommendations

Nutritional guidelines for vegetarian and vegan pregnant women do not differ significantly from those on a standard diet (2).
However, plant-based diets may require increased intake of certain nutrients. Pregnant women following vegetarian diets should pay particular attention to:

• Iron: The recommended amount is 48 mg/day (1.8 times more than for pregnant women on an omnivorous diet) (3).

• Zinc: Needs increase by 50%. Zinc is involved in organ development and supports the fetal immune system. Deficiency may increase the risk of miscarriage and neural or immune disorders (4).

• DHA: Studies show vegetarians may have lower serum DHA levels than non-vegetarians. DHA is crucial for the nervous system development of the baby. Women who do not consume fish should take DHA supplements and eat plant-based omega-3 sources like chia seeds or walnuts.

• Vitamin B12: Deficiency is common in vegetarian and vegan pregnant women (5). Daily requirements increase from 2.4 to 2.6 µg during pregnancy. Prenatal supplements often contain insufficient doses, so vegans should consider additional supplementation. Vitamin B12 and folate deficiencies may lead to anemia.

• Folic Acid: Essential before conception and during the first trimester to prevent neural tube defects. Pregnant vegetarians should consume:
  • 1–2 servings of dark green leafy vegetables,

  • 4–5 servings of other fruits and vegetables,

  • 3–4 servings of legumes,

  • ≥6 servings of whole grain products,

  • 1–2 servings of nuts, seeds, or sprouts per day (6).

Vegetarian Diet During Breastfeeding

Elimination diets are generally not recommended during lactation, as they may negatively impact milk production. However, safety depends on the type of vegetarian diet followed and how well it is planned.

Vegetarian diets during breastfeeding may lack key nutrients such as protein, calcium, vitamins B12 and D, and iodine (7). The fatty acid profile of vegetarian mothers’ milk may differ from that of omnivores, but it can still support proper infant growth if the diet is balanced.

Lactating women should especially focus on their intake of unsaturated fatty acids, particularly long-chain polyunsaturated fats (LCPUFAs) like DHA. If fish are excluded, DHA supplements are recommended.
Protein sources should include legumes, eggs, nuts, seeds, and dairy. Diets should be consulted with a dietitian, and pediatricians should be informed. If supplementation is not provided to the mother, it may be necessary to supplement the infant.

According to some experts, strict forms of vegetarianism such as vegan or fruitarian diets may not fully meet the nutritional needs of breastfeeding mothers or their babies, especially due to the exclusion of all animal-derived products.

Vegan and Vegetarian Diets in Children

Both the Academy of Nutrition and Dietetics and Dietitians of Canada agree that well-planned vegan diets can meet the nutritional needs of infants and support healthy development (8).

However, studies show that children on vegetarian, especially vegan diets, may grow more slowly and have lower body weight. Poorly balanced diets increase the risk of anemia and low bone density.
Strict dietary restrictions in vegan diets may fail to meet the needs of rapidly developing children. Therefore, it is essential to monitor their nutritional status and growth.

Infants and young children on vegetarian diets should receive adequate amounts of milk (breast or formula). When introducing complementary foods, ensure sufficient intake of dairy.
A lacto-ovo-vegetarian diet (including dairy and eggs) appears to be safe. Regardless of the diet model, children’s diets should be varied and well-balanced, especially in terms of energy, protein, and essential nutrients such as vitamin B12 and iron.

Vegetarian Diet in the Elderly

There is limited research on plant-based diets in older adults.
With aging, the risk of nutritional deficiencies increases, due to factors like:

• dental problems,

• lack of appetite,

• digestive and absorption issues,

• multiple medications,

• chronic illnesses,

• poor eating habits,

• economic status.

Older adults are also at higher risk of conditions such as cardiovascular disease, hypertension, osteoporosis, and diabetes. Due to its favorable fat and carbohydrate profile, the vegetarian diet is recommended for preventing these diseases.
However, gastrointestinal problems may require product elimination, which can complicate proper diet planning in this group.

Vegetarian Diet in the Elderly – Key Nutrients

Although energy needs decrease with age, nutritional requirements stay the same—or even increase. For example, older adults need more protein, which on a vegan diet comes only from plant-based sources, posing a challenge.

Other key nutrients to focus on include:

• vitamin D,

• B vitamins,

• antioxidants (A, E, C),

• calcium,

• iron,

• omega-3 fatty acids.

Due to decreased absorption, older adults may need to increase intake of foods rich in B vitamins and iron.
Calcium needs also rise by about 10% after age 65.
Increased demand for antioxidants and omega-3s is associated with aging and chronic inflammation.
Since skin synthesis of vitamin D declines with age, supplementation is often necessary.

Is a Vegetarian Diet Safe?

Properly balanced vegetarian diets can be safely followed by pregnant and breastfeeding women, children, and seniors. However, it’s crucial to ensure adequate intake of nutrients that may be lacking.

Monitoring nutritional status is important to prevent undernutrition, weight loss, or growth delays. The best approach is to work with an experienced dietitian to ensure dietary adequacy.

If you want reliable support and access to nutritionally balanced recipes created by clinical dietitians, check out the vegetarian meal plan in the Peater app. We also offer a vegan option. This way, you can be confident your diet is well-balanced and get answers to your questions from a dietitian in a convenient online chat.

References:

1. Giorgia Sebastiani et al. The effects of vegetarian and vegan diet during pregnancy on the health of mothers and offspring. Nutrients 2019; 11(3):557

2. Luciana Baroni et al. Vegan nutrition for mothers and children: practical tools for healthcare providers. Nutrients 2019; 11(1):5

3. Angela V Saunders et al. Iron and vegetarian diets. Med J 2013; 199(4):S11-S16

4. Meika Foster et al. Zinc status of vegetarians during pregnancy: a systematic review and meta-analysis. Nutrients 2015; 7(6):4512-25

5. Juan A Aguirre et al. Serious neurological compromise due to vitamin B12 deficiency in infants of vegan and vegetarian mothers. Arch Argent Pediatr 2019; 117(4):e420-e424

6. Penney DS et al. Nutritional counseling for vegetarians during pregnancy and lactation. J Midwifery Womens Health 2008; 53:37-44

7. B L Specker. Nutritional concerns of lactating women consuming vegetarian diets. Am J Clin Nutr 1994; 59(5):182S–1186S