Doctor’s tip: Special nutritional needs during pregnancy and lactation

This is the final column in a series from “Nourish, The Definitive Plant-Based Nutrition Guide for Families,” by Stanford-affiliated pediatrician Reshma Shah, MD, MPH, and registered dietitian Brenda Davis.

If you are planning a pregnancy, “Nourish” recommends the following: 1) Achieve an ideal body weight by eating a variety of vegetables, fruits, whole grains, nuts and seeds. 2) Avoid tobacco, alcohol, and all recreational drugs, including marijuana. 3) Avoid exposure to dangerous chemicals. 4) Exercise daily. 5) Get enough rest. 6) Practice relaxation through meditation or yoga.

Before and during pregnancy, take a daily prenatal vitamin with 400-800 mcg. folic acid, which helps prevent neural tube defects in the fetus. The natural form of folic acid is folate, found in plant foods such as green vegetables, beans/lentils, avocados, asparagus, beets, mangoes, papayas, oranges and sunflower seeds . Make sure your supplement contains iron, iodine, zinc, vitamin B12, calcium, and vitamin D. Due to lack of scrutiny on supplements, many contain harmful contaminants, so beware. you. If you’re taking prescription or over-the-counter medications, check with your doctor to make sure they’re safe during pregnancy.

Avoid environmental toxins such as pesticides, heavy metals and PCPs. The best way to do this is to eat at the bottom of the food chain (plants), instead of animal products at the top of the food chain (meat, poultry, dairy, eggs, seafood). Buying organic products also helps, if it’s affordable.

If you’re wondering if plant-based diets are adequate during pregnancy, “Nourish” notes that pregnant vegan women have fewer C-sections, less postpartum depression, lower neonatal and maternal death rates, fewer less pre-eclampsia and eclampsia and less pre-pregnancy and postpartum obesity.

Weight gain for underweight women (BMI < 18,5) est de 28 à 40 livres ; pour un poids normal (IMC 18,5-24,9) 25-35 livres ; pour le surpoids (IMC 25-29,9) 15-25 livres ; obèse (IMC > 30) 11-20 lbs. Extra calories are not needed in the first trimester, 340 extra calories per day are needed in the second trimester, and 450 extra calories per day in the third trimester. Those extra calories should come primarily from plant-based protein: high-protein non-dairy soy or pea milk; lentils or beans at least twice a day; soy in the form of tofu, tempeh, edamame, and vegetarian soy-based “meats”; and seeds, nuts and nut butter. Protein supplements can contain heavy metals and BPA, so head over to the Clean Label Project to check.

Omega-3 fatty acids (EPA plus DHA) are important for pregnant women and their fetuses, and can be obtained from a daily handful of walnuts and 2 tablespoons of ground flax seeds. Note that exposure to potential allergens such as nuts leads to a decreased incidence of childhood allergies. Women who do not eat fish should also consider a dose of 500-750 mg. daily supplement of vegan omega-3s derived from seaweed, such as the Nordic Natural brand at Natural Grocers.

Choline is important for fetal development and is found in shiitake mushrooms, soy products, legumes, quinoa, nuts, seeds, vegetables and fruits, and some prenatal supplements. Additional calcium can be obtained through tofu, beans, green vegetables, almonds, chia seeds and calcium-fortified non-dairy products.

Nursing mothers need 500 extra calories and 8-12 cups of extra fluids per day. Most things the mother ingests – including pollutants, medications and supplements – show up in breast milk, so take the same precautions as listed above during pregnancy.

Dr. Feinsinger is a retired family physician with a special interest in the prevention and reversal of disease through nutrition. Free services offered by the Center for Prevention and the People’s Clinic include: one-hour consultations, shopping with a doctor at Carbondale City Market, and cooking classes. Call 970-379-5718 for an appointment or email

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