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Your weight gain can have a tremendous impact on your baby’s birth weight. If you fail to gain enough weight, your baby could end up being very small. Babies with low birth weight (under 5½ lbs/2.5 kg) are at higher risk for illness and death than are babies of normal weight. Weight gains associated with the healthiest pregnancy outcomes are listed in Table 10.1. If you have a large body frame, aim for the upper end of each range, and if you have a smaller frame, aim for the lower end. If you are underweight or happen to be carrying more than one baby, it is very important that you gain a little extra weight. Adolescents also need to strive for higher weight gains, especially if they are still growing and/or are underweight. Women who are overweight do not need to gain “fat stores” for lactation, thus a slightly lower weight gain is generally considered safe. It is important to note that many people assume that they are overweight when in fact they are within their healthy weight range.

Check with your doctor or health care provider before you decide to limit your weight gain. You may unnecessarily compromise your nutrient intake and, consequently, the health of your baby.

Table 10.1 Weight Gain in Healthy Pregnancy

Factors Determining Weight Gain Goals Recommended Weight Gain

Normal Weight (BMI* 19–24.9) 25–35 lbs (11.5–16 kg)

Underweight (BMI less than 19) 28–40 lbs (12.5–18 kg)

Overweight (BMI more than 25) 15–25 lbs (7–11.5 kg)

Adolescent 30–45 lbs (14–20 kg)

Normal weight with twins 35–45 lbs (16–20 kg)

* Body mass index prior to pregnancy.

In order to gain the appropriate weight, you’ll need to increase your caloric intake. During the first trimester, strive for an extra 100 calories per day and during the next two trimesters, an extra 300 calories per day.

Tips for Great Gains

If you are having trouble gaining weight, don’t give up. With a little extra effort, you can get those calories high enough to produce a healthy weight gain.

• Eat regular meals and snacks.

• If you have trouble eating more, try drinking more. Shakes are a perfect choice. (See Quick Shake.) Do include the optional flax oil to improve your omega-3 intake. Even fresh

squeezed orange juice can provide a good supply of extra calories and nutrients.

• Increase your intake of low-bulk, high-fat plant foods. Eat more tofu, nuts, seeds and their butters, avocados, and soups or puddings made with soymilk.

• Use some concentrated oils. While oils have little nutritional value, they do help increase nutrient absorption and energy content of the diet.

• Use oil-based salad dressings and small amounts of oil in cooking.

• Enjoy nutritious baked items. Make nutrient-packed granolas, cookies, squares, muffins, and fruit crisps. Spike these foods with wheat germ, flaxseed, and soymilk powder for a real nutrition boost.

• Try our Sneaky Dad’s Pudding (Sneaky Dad’s Pudding)—we consider this a secret weapon which could almost come with a written guarantee!

Protein

You will undoubtedly be besieged with questions about how you can possibly get enough protein to support a baby’s growth on a vegan diet. Fear not; you probably already eat close to the

recommended intakes of protein for pregnancy. You need about 60–66 grams a day, an increase of about 10–20 grams above nonpregnant needs. (Recommended intakes for nutrients are provided in Table 10.2.) At least 60 grams of protein/day is recommended for the general population or for vegans who rely mainly on easy-to-digest plant foods, such as tofu and veggie “meats” as primary protein sources. Sixty-six grams/day (a 10% increase) is suggested for vegans who get much of their protein from harder-to-digest plant foods such as beans. This amount of protein comes very close to the average intakes of vegan women. However, if your diet is low in protein, you will need to make a concerted effort to include more protein-rich foods in your diet.

Those at greatest risk for insufficient protein intakes are people who don’t eat enough calories and/or those who include few high-protein plant foods in their diet (i.e. tofu, legumes, nuts, seeds, or meat substitutes). This can be a problem particularly for people who switch from a nonvegetarian diet to a vegan diet by eliminating the meat and dairy products and not replacing them with foods of

comparable nutritional value. Pasta and bread products are often staples in such diets.

To meet your needs for protein, add an extra serving from the beans and bean alternate group to your daily diet, bringing your total intake to 3 servings a day. A good rule of thumb is to include a

serving of beans and bean alternates with each meal. A serving of beans and bean alternates equals a cup of beans, ½ cup of tofu or tempeh, 1 veggie patty, 3 veggie deli slices, 2 cups of soymilk, ¼ cup nuts or seeds, or 3 Tbsp. nut butter.*

Iron

Iron needs are greater during pregnancy because of the increased formation of red blood cells for both the mother and her infant. These needs are at least partially compensated for by increased iron absorption (from 10–20% to as much as 50%) and decreased iron losses (menstruation ceases). Iron deficiency anemia is associated with both low birth weight and preterm delivery. The incidence of iron deficiency anemia increases during the third trimester of pregnancy; however, it is suggested that this is due to hemodilution (expansion of blood volume without a parallel increase in red blood cells) and does not negatively impact the baby’s birth weight or length of gestation.

Recommended iron intakes go up from 32 mg/day to 49 mg/day during this time, an amount that can be a challenge to obtain from either vegan or nonvegetarian diets. (Recall that the RDAs for iron are 1.8 times higher for vegetarians than for nonvegetarians.) There is currently little evidence to suggest that the risk for iron deficiency in pregnancy is any greater in vegans than it is in

nonvegetarians. However, vegan iron stores are lower, so theoretically, risk may be increased. To help ensure sufficient iron intake, supplemental iron at a rate of 30 mg/day (60–120 mg/day if anemic) starting at the second trimester of pregnancy is generally recommended. Little evidence exists to show that iron supplements actually improve pregnancy outcome, although there is some evidence that iron status after delivery is better in women who have been supplemented during pregnancy.

Even if you are using iron supplements, it’s still a good idea to include plenty of dietary sources too! Legumes, tofu, nuts, seeds, dried fruits, whole and enriched grains, and dark greens are great choices. (See Chapter 6 for further information on iron sources.) Eating these foods with a source of vitamin C will improve absorption considerably, and cooking in cast-iron will help increase iron content of the food. To help ensure good iron status during pregnancy, avoid tea and coffee with meals, as they are high in tannins which interfere with iron absorption.

Zinc

Severe zinc deficiency in pregnancy has been associated with spontaneous abortion and congenital malformations, while milder forms of zinc deficiency have been associated with low birth weight, growth retardation, and preterm delivery.

The recommended intake for zinc during pregnancy is 11 mg a day, an increase of 3 mg above nonpregnant needs. These recommendations assume an absorption rate of at least 20%. In a vegan diet, zinc absorption generally ranges from 15–20%, and there is little indication that zinc absorption improves during pregnancy. In addition, total zinc intakes of pregnant women, whether vegans or nonvegetarians, rarely meet the recommended intakes.

While some studies suggest that zinc supplementation may improve infant birth weight and lengthen the duration of pregnancy, results have been highly inconsistent. Several recent studies have failed to find any improvements in infant birth weight or pregnancy duration, however, some suggest that other indicators of infant development may be improved. Although zinc supplementation is not routinely recommended (unless over 60 mg of iron/day are taken), it may be prudent for pregnant

vegans to select a prenatal supplement that includes 10–15 mg of zinc. This supplement should also contain about 2 mg copper, as zinc can reduce copper absorption.

To maximize the zinc content of your diet, include plenty of whole foods such as legumes, nuts, seeds, and whole grains. Some fortified breakfast cereals and veggie meats are fortified with zinc (read labels). Also see Chapter 6 for more information on zinc.

Calcium

Calcium helps ensure proper formation of your baby’s bones and teeth, as well as their nerve, muscle, and blood functioning. Your body has huge calcium reserves (your bones!), so your baby will

certainly get enough. To avoid using up your precious reserves, it is important that you eat sufficient calcium-rich foods.

While women used to be advised to substantially increase their calcium intakes during

pregnancy, this is no longer considered necessary. The reasons are twofold: first, recommendations for calcium intake during adolescence and adulthood have been increased to 1,300 mg for those 14–

18 years of age and 1,000 mg for those 19–50 years of age. Thus, if women are meeting

recommended intakes, they enter pregnancy with great calcium stores. Second, during pregnancy, calcium absorption appears to be significantly increased. While there is some controversy as to whether vegans need as much calcium as nonvegetarians (due to lower protein intakes and lower sodium intakes), it is prudent for all pregnant women to meet the RDA until there is enough evidence to prove otherwise.

Getting enough calcium on a vegan diet need not be any more difficult than it is on a lacto-ovo vegetarian or nonvegetarian diet. You need 6–8 servings per day from the calcium-rich group. (See food guide.) The following food combinations each supply the equivalent of at least 6 servings from the calcium-rich group:

• 2 Tbsp. tahini, 1 Tbsp. blackstrap molasses, 1 cup calcium-fortified orange juice, and 1 cup fortified soymilk

• 2 cups fortified soymilk,⅓ cup almonds, and 1 cup cooked broccoli

• 1 cup baked beans, 5 large figs, 1 tofu/fortified soymilk shake, and 1 cup cooked bok choy

• ⅓ cup hijiki seaweed, 2 cups black bean soup, 4 cups raw kale salad, 1 cup fortified soymilk For those who have not previously consumed a calcium-rich diet or those who consume less than the recommended number of servings from the calcium-rich group, a calcium supplement may be warranted.

Calcium in most prenatal supplements ranges from about 100 to 250 mg, which is insufficient to meet the needs of those who are consuming few calcium-rich foods. If you need a calcium

supplement, select one that provides about 500–600 mg/day. In addition to the calcium from your food, this should be sufficient.

Vitamin D

Vitamin D is calcium’s partner, necessary to its absorption. Without sufficient vitamin D, infants can be born with rickets and tetany and mothers can develop osteomalacia (softening of the bones).

Recommended intakes of vitamin D are the same in pregnant and nonpregnant women—5 mcg per day (200 IU). For those living in colder climates (with no warm sunshine in the winter) or those who have little exposure to sunlight, an intake of 10 mcg per day (400 IU) is suggested.

There are two ways to get vitamin D: from sunshine or from food. Lightskinned women need about 10–15 minutes of warm sunshine on their face and forearms each day. Those with darker skin may need an hour a day or more. If you don’t get enough sunshine, vitamin D-fortified foods or a vitamin D supplement should be used. Vitamin D fortification of foods varies considerably from country to country; however, in many areas soymilk is now being fortified with vitamin D₂ (the nonanimal form of vitamin D).

Vitamin B

The importance of getting sufficient vitamin B₁₂ in pregnancy cannot be overstated. A lack of this nutrient during pregnancy means that your baby will be born with stores that are only about 10–25%

that of mothers with sufficient vitamin B₁₂ intakes. The stores of infants from adequately nourished mothers last about 6 months to a year, while the stores of infants from mothers with poor B₁₂ intake will be depleted in very short order. If you breast-feed your infant and still do not have a reliable source of vitamin B₁₂, your infant may end up with severe vitamin B₁₂ deficiency (weakness, loss of reflexes, failure to thrive, delayed development, muscle wasting, and irreversible brain damage). To add to the concern, recent research has demonstrated that high homocysteine levels during pregnancy may increase the risk for neural tube defects in infants. Homocysteine levels are elevated by a lack of both folate and vitamin B₁₂. Several prominent researchers have suggested that along with folate, B₁₂ should also be added to foods. This may help to decrease the risk of masking B₁₂ deficiencies with folate.

There is some uncertainty as to the impact of your vitamin B₁₂ stores on the vitamin B₁₂ status of your baby. Some studies suggest your stores are not available to the infant and that the key

determinant of your baby’s vitamin B₁₂ status is your current intake, while others have shown that your stores may also effect your baby’s B₁₂ status. One thing that is very clear is that no one should rely on their B₁₂ stores to provide the necessary B₁₂ for their infant.

Aim for at least 3 mcg/day of vitamin B₁₂ from fortified foods or supplements. (The RDA is 2.6 mcg/day.) The best dietary sources of vitamin B₁₂ for vegans are Red Star Vegetarian Support

Formula nutritional yeast (T-6635+), fortified nondairy beverages, cereals, and meat substitutes. (See Chapter 7 for more information on B₁₂ sources.) Seaweed and fermented soyfoods are not reliable vitamin B₁₂ sources.