DSOG Guideline Bulletin: Vegetarian and vegan diets during pregnancy

Main Article Content

Paul Axelsson
Tina Beermann
Heinke Hansen
Mette Moustgaard Jeppesen
Anna Kristensen
Saskia Marxen
Rasmus Olesen
Camilla Palm
Emilie Sejer
Frederikke Skoven
Thea Thetmark
Kristina Renault


Vegetarian and vegan diets are becoming increasingly common among Danish women of reproductive age. We reviewed the available literature via PubMed and concluded that varied and well-balanced vegetarian and vegan diets are safe and sufficient during pregnancy and lactation, provided that dietary supplements for folate, vitamin B12, and vitamin D are taken regularly. Additionally, it is important to ensure adequate intake of calcium, protein, and iron. Protein requirements may be higher for vegetarians and especially for vegans, though evidence is limited regarding the recommendation for increased protein intake if the diet is exclusively plant-based. Routine blood tests are not recommended unless there has been insufficient supplementation leading up to or during pregnancy, or if symptoms suggest a deficiency. We found no evidence to support supplementation with docosahexaenoic acid (DHA). There is no indication of an increased risk of malformations for pregnant Danish women on a vegetarian or vegan diet compared to omnivores. The risk of delivering small for gestational age and low birthweight infants (<2500 grams) may be increased, but the evidence is conflicting and of poor quality. Vegetarian and vegan diets may offer benefits, such as a lower risk of excessive gestational weight gain and women consuming the lowest amounts of meat have a significantly lower risk of gestational diabetes. Vegans may face a lower risk of having large for gestational age infants. Vegetarian and vegan lifestyles are also compatible with breastfeeding, and provided women take the recommended supplements, there is no difference in the micronutrient content of the breast milk of vegetarian/vegan women compared to that of omnivores. Children of vegans and vegetarians with limited or no consumption of milk products or eggs are recommended to breastfeed or receive baby formula for at least the first two years of life.

Article Details

How to Cite
DSOG Guideline Bulletin: Vegetarian and vegan diets during pregnancy. (2024). Danish Journal of Obstetrics and Gynaecology, 2(1), 51-61. https://doi.org/10.56182/ccd2xa40

How to Cite

DSOG Guideline Bulletin: Vegetarian and vegan diets during pregnancy. (2024). Danish Journal of Obstetrics and Gynaecology, 2(1), 51-61. https://doi.org/10.56182/ccd2xa40


Dansk Vegetar Forening - Statistik om Danmark [Internet]. Available from: https://vegetarisk.dk/statistik-om-danmark/

Baroni L, Rizzo G, Goggi S, Giampieri F, Battino M. Vegetarian diets during pregnancy: effects on the mother’s health. A systematic review. Food Funct. 2021;12(2):466–93.

Kesary Y, Avital K, Hiersch L. Maternal plant-based diet during gestation and pregnancy outcomes. Arch Gynecol Obstet. 2020 Oct;302(4):887–98.

Tan C, Zhao Y, Wang S. Is a vegetarian diet safe to follow during pregnancy? A systematic review and meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2019 Sep 8;59(16):2586–96.

Yisahak SF, Hinkle SN, Mumford SL, Li M, Andriessen VC, Grantz KL, et al. Vegetarian diets during pregnancy, and maternal and neonatal outcomes. Int J Epidemiol. 2021 Mar 3;50(1):165–78.

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 Apr 1;174(4):577.

Hedegaard S, Nohr EA, Olsen SF, Halldorsson TI, Renault KM. Adherence to different forms of plant-based diets and pregnancy outcomes in the Danish National Birth Cohort: a prospective observational study. Acta Obstet Gynecol Scand. 2024 Jan;

Cheng PJ, Chu DC, Chueh HY, See LC, Chang HC, Weng DRH. Elevated maternal midtrimester serum free beta-human chorionic gonadotropin levels in vegetarian pregnancies that cause increased false-positive Down syndrome screening results. Am J Obstet Gynecol. 2004 Feb;190(2):442–7.

Chen Z, Qian F, Liu G, Li M, Voortman T, Tobias DK, et al. Prepregnancy plant-based diets and the risk of gestational diabetes mellitus: a prospective cohort study of 14,926 women. Am J Clin Nutr. 2021 Dec 1;114(6):1997–2005.

Friis-Hansen L, Kristensen JK. Vitamin B12 (cobalamin). Sundhed.dk. [Internet]. 2023. Available from: https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/undersoegelser-og-proever/klinisk-biokemi/blodproever/vitamin-b12-cobalamin/

WHO, Food and Agriculture Organization of the United Nations. Human Vitamin and Mineral Requirements - Report of a joint FAO/WHO expert consultation. Chapter 5. 2002.

Simpson JL, Bailey LB, Pietrzik K, Shane B, Holzgreve W. Micronutrients and women of reproductive potential: required dietary intake and consequences of dietary deficiency or excess. Part I – Folate, Vitamin B12, Vitamin B6. J Matern Fetal Neonatal Med. 2010 Dec;23(12):1323–43.

Koebnick C, Gruendel S, Hoffmann I, Dagnelie PC, Heins UA, Wickramasinghe SN, et al. Long-Term Ovo-Lacto Vegetarian Diet Impairs Vitamin B-12 Status in Pregnant Women. J Nutr. 2004 Dec;134(12):3319–26.

Denissen KFM, Heil SG, Eussen SJPM, Heeskens JPJ, Thijs C, Mommers M, et al. Intakes of Vitamin B-12 from Dairy Food, Meat, and Fish and Shellfish Are Independently and Positively Associated with Vitamin B-12 Biomarker Status in Pregnant Dutch Women. J Nutr. 2019 Jan;149(1):131–8.

Avnon T, Anbar R, Lavie I, Ben-Mayor Bashi T, Paz Dubinsky E, Shaham S, et al. Does vegan diet influence umbilical cord vitamin B12, folate, and ferritin levels? Arch Gynecol Obstet. 2020 Jun;301(6):1417–22.

Graham SM, Arvela OM, Wise GA. Long-term neurologic consequences of nutritional vitamin B12 deficiency in infants. J Pediatr. 1992 Nov;121(5):710–4.

Sundhedsstyrelsen. Anbefalinger for svangreomsorgen. Vol. 4.udgave. 1. oplag, 2022.

Crowe FL, Steur M, Allen NE, Appleby PN, Travis RC, Key TJ. Plasma concentrations of 25-hydroxyvitamin D in meat eaters, fish eaters, vegetarians and vegans: results from the EPIC–Oxford study. Public Health Nutr. 2011 Feb;14(2):340–6.

Pawlak R, Berger J, Hines I. Iron Status of Vegetarian Adults: A Review of Literature. Am J Lifestyle Med. 2018 Nov;12(6):486–98.

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 Mar;131(3):733–9.

Reddy S, Sanders TA, Obeid O. The influence of maternal vegetarian diet on essential fatty acid status of the newborn. World Rev Nutr Diet. 1994;75:102–4.

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 Sep;59(3):209–20.

Haggarty P. Effect of placental function on fatty acid requirements during pregnancy. Eur J Clin Nutr. 2004 Dec;58(12):1559–70.

Blomhoff R, Andersen R, Arnesen EK, Christensen JJ, Eneroth H, Maijaliisa E, et al. Nordic Nutrition Recommendations 2023. Nordic Council of Ministers; 2023.

Halldorsson TI, Birgisdottir BE, Brantsæter AL, Meltzer HM, Haugen M, Thorsdottir I, et al. Old Question Revisited: Are High-Protein Diets Safe in Pregnancy? Nutrients. 2021 Jan 29;13(2):440.

World Health Organization. WHO | Breastfeeding [Internet]. [cited 2014 Jan 15]. Available from: http://www.who.int/topics/breastfeeding/en/

Sundhedsstyrelsen. Ernæring til spædbørn og småbørn - en håndbog for sundhedspersonale. Vol. 4. udgave, 1.oplag. 2019.

Světnička M, Sigal A, Selinger E, Heniková M, El-Lababidi E, Gojda J. Cross-Sectional Study of the Prevalence of Cobalamin Deficiency and Vitamin B12 Supplementation Habits among Vegetarian and Vegan Children in the Czech Republic. Nutrients. 2022 Jan 26;14(3):535.

Karcz K, Królak-Olejnik B. Vegan or vegetarian diet and breast milk composition – a systematic review. Crit Rev Food Sci Nutr. 2021 Apr 12;61(7):1081–98.

Specker B, Black A, Allen L, Morrow F. Vitamin B-12: low milk concentrations are related to low serum concentrations in vegetarian women and to methylmalonic aciduria in their infants. Am J Clin Nutr. 1990 Dec;52(6):1073–6.

Pawlak R, Vos P, Shahab-Ferdows S, Hampel D, Allen LH, Perrin MT. Vitamin B-12 content in breast milk of vegan, vegetarian, and nonvegetarian lactating women in the United States. Am J Clin Nutr. 2018 Sep;108(3):525–31.

Perrin MT, Pawlak R, Dean LL, Christis A, Friend L. A cross-sectional study of fatty acids and brain-derived neurotrophic factor (BDNF) in human milk from lactating women following vegan, vegetarian, and omnivore diets. Eur J Nutr. 2019 Sep;58(6):2401–10.