In December 2018, the prosperous vegan parents of a toddler, whose diet-related vitamin D deficiency caused her to develop rickets, were arrested in Australia (Chapman, 2018). This follows a UK case in 2014, where the Seventh Day Adventist parents of a 5-month-old baby who died from rickets (his mother was a vegan and his parents' religious views limited medical care) were imprisoned (Brannan et al, 2014).
NHS (2018) advice suggests that ‘vegetarian and vegan mums-to-be need to make sure they get enough iron and vitamin B12, which are mainly found in meat and fish, and vitamin D.’ Perhaps this advice needs to be reinforced, given the apparent popularity of veganism, which is increasingly informed by political and environmental considerations. For example, Martinelli and Berkmaniené (2018: 502) have traced the rise of veganism from ‘inoffensive vegetarians’ to ‘legions of hippies, hipsters, animal advocates […] coinciding with food's central position in social, political and cultural debate’.
What do vegans eat? Vegan food is largely plant-derived: no meat, milk, or eggs, with added mineral and vitamin supplements. Tyree et al (2012) emphasised the vulnerability of a developing fetus to nutritional deficiencies and excesses, plus the importance of devising proper nutritional support for pregnant women.
When Bath et al (2014) considered the iodine intake and status of UK women of childbearing age, they pointed out the importance of an adequate iodine status to fetal neurological development; reported that a proportion of UK women may be entering pregnancy with low iodine stores; and showed that milk, eggs and dairy were positively associated with iodine status. In a recent analysis of micronutrient intakes, Derbyshire (2018) not only reported that veganism could have an adverse impact on vitamin D, calcium, vitamin B12, iodine and selenium intakes; but also that reduced micronutrient intakes, particularly of zinc and vitamin D, were present in women who consumed less than 40 g of red meat per day.
In a review of 22 papers on vegan and vegetarian diets in pregnancy (Piccoli et al, 2015), only one study reported increased hypospadias (a congenital condition in males, where the urethra opens on the underside of the penis) among infants of vegetarian mothers; five studies reported vegetarian mothers with lower birthweight babies; and two studies reported higher birthweights. Although nine studies of micronutrients and vitamins suggested that vegan/vegetarian women might be at risk of vitamin B12 and iron deficiencies, Piccoli et al (2015: 623) concluded that the evidence on vegan/vegetarian diets in pregnancy was limited, marked by a lack of randomised controlled studies: ‘Within these limits, vegan/vegetarian diets may be considered safe in pregnancy, provided that attention is paid to vitamin and trace element requirements.’
This caveat implies that, in contrast to a balanced omnivorous diet, a vegan diet in pregnancy may court an element of risk. This places a primary responsibility with the mother to ensure that her diet is nutritionally suitable for herself and her child. Penney and Miller (2008: 37) noted that the quality of a woman's breast milk after birth was determined by her nutritional status: ‘Vegetarian and vegan diets may present with unique nutrient deficiencies that can be addressed during prenatal nutritional counselling.’ This suggests that a midwife may be pivotal in checking that the prenatal health of a pregnant mother is properly assessed.
Choosing a diet based on lifestyle, religion and/or other beliefs is one thing, but if the hazards illustrated by Chapman (2018) and Brannan et al (2014) are to be avoided, both the pregnant woman and her clinicians have a responsibility to ensure that her nutritional status is optimal.