Vegan-vegetarian diets in pregnancy: Danger or panacea? A systematic narrative review

BJOG: An International Journal of Obstetrics and Gynaecology

Volumn 122, Issue 5, 2015, Pages 623-633

  Piccoli, G B ^a   Clari, R ^a   Vigotti, F N ^a   Leone, F ^b   Attini, R ^b   Cabiddu, G ^c,d   Mauro, G ^b   Castelluccia, N ^b   Colombi, N ^b   Capizzi, I ^a   Pani, A ^c   Todros, T ^b   Avagnina, P ^a  

^a UNIVERSITY OF TURIN   (Italy)

^b UNIVERSITY OF TURIN   (Italy)

^c BROTZU HOSPITAL   (Italy)

^d Study Group on Kidney and Pregnancy of the Italian Society of Nephrology   (Italy)

Author keywords

Birthweight; maternal fetal outcomes; pregnancy; vegan diet; vegetarian diet

Indexed keywords

CYANOCOBALAMIN; VITAMIN; PROTEIN INTAKE;

ADVERSE OUTCOME; COCHRANE LIBRARY; CYANOCOBALAMIN DEFICIENCY; DATA EXTRACTION; EMBASE; FEMALE; FETUS OUTCOME; HIGH BIRTH WEIGHT; HUMAN; HYPOSPADIAS; IRON DEFICIENCY; LOW BIRTH WEIGHT; MALNUTRITION; MATERNAL NUTRITION; MEDICAL SUBJECT HEADINGS; MEDLINE; NUTRITIONAL DEFICIENCY; OMNIVORE; POVERTY; PREGNANCY; PREGNANCY OUTCOME; PREGNANT WOMAN; PRIORITY JOURNAL; REVIEW; SYSTEMATIC REVIEW; VEGAN; VEGAN DIET; VEGETARIAN; VEGETARIAN DIET; ADMINISTRATION AND DOSAGE; ADVERSE EFFECTS; EPIDEMIOLOGY; FEEDING BEHAVIOR; HEALTH CARE POLICY; NUTRITIONAL REQUIREMENT; PROTEIN INTAKE; RISK FACTOR; STATISTICS AND NUMERICAL DATA;

CONFOUNDING FACTORS (EPIDEMIOLOGY); DIET, VEGETARIAN; DIETARY PROTEINS; FEMALE; FOOD HABITS; HUMANS; MATERNAL NUTRITIONAL PHYSIOLOGICAL PHENOMENA; NUTRITION POLICY; NUTRITIONAL REQUIREMENTS; PREGNANCY; PREGNANCY OUTCOME; RISK FACTORS; VITAMINS;

EID: 84925236366     PISSN: 14700328     EISSN: 14710528     Source Type: Journal    
DOI: 10.1111/1471-0528.13280     Document Type: Review

References (66)

1. Willett WC,. Diet and health: what should we eat? Science 1994; 264: 532-7.
2. Hu FB, Willett WC,. Optimal diets for prevention of coronary heart disease. JAMA 2002; 288: 2569-78.
3. Fung TT, Hu FB,. Plant-based diets: what should be on the plate? Am J Clin Nutr 2003; 78: 357-8.
4. Zhang C, Ning Y,. Effect of dietary and lifestyle factors on the risk of gestational diabetes: review of epidemiologic evidence. Am J Clin Nutr 2011; 6 (Suppl): 1975S-9S.
5. Ajala O, English P, Pinkney J,. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr 2013; 97: 505-16.
6. Estruch R, Ros E, Salas-Salvadõ J, Covas MI, Corella D, Arõs F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279-90.
7. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med 2014; 174: 577-87.
8. Craig WJ, Mangels AR,. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc 2009; 109: 1266-82.
9. Craig WJ,. Health effects of vegan diets. Am J Clin Nutr 2009; 89: 1627S-33S.
10. Sommer C, Sletner L, Jenum AK, Mørkrid K, Andersen LF, Birkeland KI, et al. Ethnic differences in maternal dietary patterns are largely explained by socio-economic score and integration score: a population-based study. Food Nutr Res 2013; 8: 57.
11. De Irala-Estevez J, Groth M, Johansson L, Oltersdorf U, Prattala R, Martinez-Gonzalez M,. A systematic review of socioeconomic differences in food habits in Europe: consumption of fruit and vegetables. Eur J Clin Nutr 2000; 54: 706-14.
12. Dynesen AW, Haraldsdottir J, Holm L, Astrup A,. Socio-demographic differences in dietary habits described by food frequency questions-results from Denmark. Eur J Clin Nutr 2003; 57: 1586-97.
13. Gex-Fabry M, Raymond L, Jeanneret O,. Multivariate analysis of dietary patterns in 939 Swiss adults: sociodemographic parameters and alcohol consumption profiles. Int J Epidemiol 1988; 17: 548-55.
14. Northstone K, Emmett P, Rogers I,. Dietary patterns in pregnancy and associations with socio-demographic and lifestyle factors. Eur J Clin Nutr 2008; 62: 471-9.
15. Cuco G, Fernandez-Ballart BJ, Sala J, Viladrich C, Iranzo R, Vila J, et al. Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum. Eur J Clin Nutr 2006; 60: 364-71.
16. Dyett PA, Sabaté J, Haddad E, Rajaram S, Shavlik D,. Vegan lifestyle behaviors: an exploration of congruence with health-related beliefs and assessed health indices. Appetite 2013; 67: 119-24.
17. Key TJ, Appleby PN, Rosell MS,. Health effects of vegetarian and vegan diets. Proc Nutr Soc 2006; 65: 35-41.
18. Cade JE, Burley VJ, Greenwood DC,; UK Women's Cohort Study Steering Group. The UK Women's Cohort Study: comparison of vegetarians, fish-eaters and meat-eaters. Public Health Nutr 2004; 7: 871-8.
19. Chiu TH, Huang HY, Chiu YF, Pan WH, Kao HY, Chiu JP, et al. Taiwanese vegetarians and omnivores: dietary composition, prevalence of diabetes and IFG. PLoS ONE 2014; 9: e88547.
20. Gilsing AM, Weijenberg MP, Goldbohm RA, Dagnelie PC, van den Brandt PA, Schouten LJ,. The Netherlands Cohort Study-Meat Investigation Cohort; a population-based cohort over-represented with vegetarians, pescetarians and low meat consumers. Nutr J 2013; 12: 156.
21. Nyaradi A, Li J, Hickling S, Foster J, Oddy WH,. The role of nutrition in children's neurocognitive development, from pregnancy through childhood. Front Hum Neurosci 2013; 7: 97.
22. Zeisel SH,. Is maternal diet supplementation beneficial? Optimal development of infant depends on mother's diet. Am J Clin Nutr 2009; 89: 685S-7S.
23. American Dietetic Association; Dietitians of Canada. Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets. J Am Diet Assoc 2003; 103: 748-65.
24. International Confederation of Dietetic Associations. [ www.internationaldietetics.org ]. Accessed 15 October 2014.
25. Plotnikoff GA,. Nutritional assessment in vegetarians and vegans: questions clinicians should ask. Minn Med 2012; 95: 36-8.
26. Williams D, Davison J,. Chronic kidney disease in pregnancy. BMJ 2008; 336: 211-5.
27. Piccoli GB, Ferraresi M, Deagostini MC, Vigotti FN, Consiglio V, Scognamiglio S, et al. Vegetarian low-protein diets supplemented with keto analogues: a niche for the few or an option for many? Nephrol Dial Transplant 2013; 28: 2295-305.
28. Piccoli GB, Leone F, Attini R, Parisi S, Fassio F, Deagostini MC, et al. Association of low-protein supplemented diets with fetal growth in pregnant women with CKD. Clin J Am Soc Nephrol 2014; 9: 864-73.
29. Piccoli GB, Attini R, Vasario E, Gaglioti P, Piccoli E, Consiglio V, et al. Vegetarian supplemented low-protein diets. A safe option for pregnant CKD patients: report of 12 pregnancies in 11 patients. Nephrol Dial Transplant 2011; 26: 196-205.
30. Nissen T, Wynn R,. The clinical case report: a review of its merits and limitations. BMC Res Notes 2014; 7: 264.
31. Wen X, Justicia-Linde F, Kong K, Zhang C, Chen W, Epstein L, et al. Associations of diet and physical activity with the three components of gestational weight gain. Am J Epidemiol 2013; 11 (Suppl): S1-181. (abstract).
32. Robic T, Benedik E, Bratanic B, Fidler Mis N, Rogelj I, Golja P,. Body composition in (NON) vegetarian pregnant women and their neonates. Clin Nutr Suppl 2012; 7: 108.
33. Alwan NA, Greenwood DC, Simpson NAB, McArdle HJ, Godfrey KM, Cade JE,. Dietary iron intake during early pregnancy and birth outcomes in a cohort of British women. Hum Reprod 2011; 26: 911-9.
34. Stuebe AM, Oken E, Gillman MW,. Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain. Am J Obstet Gynecol 2009; 201: 58.e1-8.
35. North K, Golding J, The Alspac Study Team. A maternal vegetarian diet in pregnancy is associated with hypospadias. BJU Int 2000; 85: 107-13.
36. Lakin V, Haggarty P, Abramovich DR, Ashton J, Moffat CF, McNeill G, et al. Dietary intake and tissue concentration of fatty acids in omnivore, vegetarian and diabetic pregnancy. Prostaglandins Leukot Essent Fatty Acids 1998; 59: 209-20.
37. Drake R, Reddy S, Davies J,. Nutrient intake during pregnancy and pregnancy outcome of lacto-ovo-vegetarians, fish-eaters and non-vegetarians. Veg Nutr 1998; 2: 45-52.
38. Fonnebo V,. The healthy Seventh-day Adventist lifestyle: what is the Norwegian experience? Am J Clin Nutr 1994; 59 (Suppl): 1124S-9S.
39. Reddy S, Sanders TAB, Obeid O,. The influence of maternal vegetarian diet on essential fatty acid status of the newborn. Eur J Clin Nutr 1994; 48: 358-68.
40. Ward R, Abraham R, McFadyen IR, Haines AD, North WRS, Patel M, et al. Assessment of trace metal intake and status in a Gujerati pregnant Asian population and their influence on the outcome of pregnancy. Br J Obstet Gynaecol 1988; 95: 676-82.
41. Carter JP, Furman T, Hutcheson HR,. Preeclampsia and reproductive performance in a community of vegans. South Med J 1987; 80: 692-7.
42. Campbell-Brown M, Ward RJ, Haines AP, North WRS, Abraham R, McFadyen IR, et al. Zinc and copper in Asian pregnancies-is there evidence for a nutritional deficiency? Br J Obstet Gynaecol 1985; 92: 875-85.
43. Thomas J, Ellis FR,. The health of vegans during pregnancy. Abstract. Proc Nutr Soc 1977; 36: 46A.
44. Koebnick C, Leitzmann R, Garcia AL, Heins UA, Heuer T, Golf S, et al. Long-term effect of a plant-based diet on magnesium status during pregnancy. Eur J Clin Nutr 2005; 59: 219-25.
45. Koebnick C, Hoffmann I, Dagnelie PC, Heins UA, Wickramasinghe SN, Ratnayaka ID, et al. Long-term ovo-lacto vegetarian diet impairs vitamin B-12 status in pregnant women. J Nutr 2004; 134: 3319-26.
46. Sharma JB, Soni D, Murthy NS, Malhotra M,. Effect of dietary habits on prevalence of anemia in pregnant women of Delhi. J Obstet Gynaecol Res 2003; 29: 73-8.
47. 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: 733-9.
48. Sharma DC, Kiran R, Ramnath V, Khushiani K, Singh PP,. Iron deficiency and anemia in vegetarian mothers and their newborns. Indian. J Clin Biochem 1994; 9: 100-2.
49. Stammers JP, Hull D, Abraham R, McFadyen IR,. High arachidonic acid levels in the cord blood of infants of mothers on vegetarian diets. Br J Nutr 1989; 61: 89-97.
50. Abraham R,. Trace element intake by Asians during pregnancy. Proc Nutr Soc 1982; 41: 261-5.
51. Jathar VS, Inamdar-Deshmukh AB,. Erythrocyte vitamin B12 activity in lactovegetarian pregnant Indian women. Acta Haematol 1981; 65: 153-6.
52. King JC, Stein T, Doyle M,. Effect of vegetarianism on the zinc status of pregnant women. Am J Clin Nutr 1981; 34: 1049-55.
53. Tofail F, Persson LA, El Arifeen S, Hamadani JD, Mehrin F, Ridout D, et al. Effects of prenatal food and micronutrient supplementation on infant development: a randomized trial from the Maternal and Infant Nutrition Interventions, Matlab (MINIMat) study. Am J Clin Nutr 2008; 87: 704-11.
54. Ganpule A, Yajnik CS, Fall CHD, Rao S, Fisher DJ, Kanade A, et al. Bone mass in Indian children-relationships to maternal nutritional status and diet during pregnancy: the Pune Maternal Nutrition Study. J Clin Endocrinol Metab 2006; 91: 2994-3001.
55. Hui AL, Ludwig SM, Gardiner P, Sevenhuysen G, Murray R, Morris M, et al. Community-based exercise and dietary intervention during pregnancy: a pilot study. Can J Diabetes 2006; 30: 169-75.
56. Widga AC, Lewis NM,. Defined, in-home, prenatal nutrition intervention for low-income women. J Am Diet Assoc 1999; 99: 1058-62.
57. Ceesay SM, Prentice AM, Cole TJ, Foord F, Weaver LT, Poskitt EME, et al. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomized controlled trial. BMJ 1997; 315: 786-90.
58. Abitbol MM, Taylor-Randall UB, Barton PT, Thompson E,. Effect of modern obstetrics on mothers from Third-World Countries. J Matern Fetal Neonatal Med 1997; 6: 276-80.
59. Fikree FF, Midhet F, Souza RMD, Hussain R, Berendes HW,. Risk factors for intrauterine growth retardation: results of a community-based study from Karachi. J Pak Med Assoc 1994; 44: 30-4.
60. Sharma DC, Pendse V, Sahay K, Soni BL,. The changing pattern of maternal and neonatal anemia at Udaipur during 2 decades in relation to poverty, parity, prematurity and vegetarianism. Asia Oceania J Obstet Gynaecol 1991; 17: 13-7.
61. Mardones-Santander F, Rosso P, Stekel A, Ahumada E, Llaguno S, Pizarro F, et al. Effect of a milk-based supplement on maternal nutritional status and fetal growth in underweight Chilean women. Am J Clin Nutr 1998; 47: 413-9.
62. Ross SM, Nel E, Naeye RL,. Differing effects of low and high bulk maternal dietary supplements during pregnancy. Early Hum Dev 1985; 10: 295-302.
63. Viegas OAC, Scott PH, Cole TJ, Eaton P, Needham PG, Wharton BA,. Dietary protein energy supplementation of pregnant Asian mothers at Sorrento, Birmingham. II: selective during third trimester only. BMJ 1982; 285: 592-5.
64. McDonald EC, Pollitt E, Mueller W, Hsueh AM, Sherwin R,. The Bacon Chow study: maternal nutritional supplementation and birth weight of offspring. Am J Clin Nutr 1981; 34: 2133-44.
65. Singh PN, Arthur KN, Orlich M, James W, Purty A, Job JS, et al. Global epidemiology of obesity, vegetarian dietary patterns, and noncommunicable disease in Asian Indians. Am J Clin Nutr 2014; 100 (Suppl 1): S359-64.
66. Bourne LT, Lambert EV, Steyn K,. Where does the black population of South Africa stand on the nutrition transition? Public Health Nutr 2002; 5: 157-62.