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

BackgroundAlthough vegan-vegetarian diets are increasingly popular, no recent systematic reviews on vegan-vegetarian diets in pregnancy exist. ObjectivesTo review the literature on vegan-vegetarian diets and pregnancy outcomes. Search strategyPubMed, Embase, and the Cochrane library were searched from inception to September2013 for pregnancy and vegan or vegetarian Medical Subject Headings (MeSH) and free-text terms. Selection criteriaVegan or vegetarian diets in healthy pregnant women. We excluded case reports and papers analysing vegan-vegetarian diets in poverty and malnutrition. Searching, paper selection, and data extraction were performed in duplicate. Data collection and analysisThe high heterogeneity of the studies led to a narrative review. Main resultsWe obtained 262 full texts from 2329 references; 22 selected papers reporting maternal-fetal outcomes (13) and dietary deficiencies (nine) met the inclusion criteria. None of the studies reported an increase in severe adverse outcomes or in major malformations, except one report of increased hypospadias in infants of vegetarian mothers. Five studies reported vegetarian mothers had lower birthweight babies, yet two studies reported higher birthweights. The duration of pregnancy was available in six studies and was similar between vegan-vegetarians and omnivores. The nine heterogeneous studies on microelements and vitamins suggest vegan-vegetarian women may be at risk of vitaminB12 and iron deficiencies. Author's conclusionsThe evidence on vegan-vegetarian diets in pregnancy is heterogeneous and scant. The lack of randomised studies prevents us from distinguishing the effects of diet from confounding factors. Within these limits, vegan-vegetarian diets may be considered safe in pregnancy, provided that attention is paid to vitamin and trace element requirements.