Milk and milk alternatives during pregnancy

Nutritional Guide

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In addition to needing extra calories and protein during pregnancy, moms-to-be also require additional calcium, vitamin A and vitamin D daily (among other nutrients).

Regardless of whether you drink cow’s milk, eat dairy, or neither (due to any number of dietary, digestive or simple taste preference reasons), pregnancy is an especially important time to eat nutritious foods that are high in protein, calcium, and vitamins A and D in order to reach your daily requirements as much as possible through whole foods.

Read on for the skinny on the pros and cons of cow’s milk and milk alternatives:

Cow’s Milk

Cow’s milk is available in fat-free or skim (80 calories, 0 grams of fat per 8 ounce serving), low-fat or 1% (110 calories, 2.5 grams of fat per 8 ounce serving), reduced fat or 2% (120 calories, 5 grams of fat per 8 ounce serving) and whole full-fat milk (150 calories, 8 grams of fat per 8 ounce serving) varieties.

One 8 ounce serving of cow’s milk provides roughly 8 grams of protein, 25% of calcium needs naturally, 10% of vitamin A, and when fortified, 25% of vitamin D.

It’s best to choose skim or low-fat varieties for yourself and anyone in your family over 2 years of age to limit your saturated fat intake. (It’s ok for children between the ages of 1 and 2 to drink whole milk in order to meet their unique nutrient needs).

All cow’s milk is naturally rich in protein, fat and calcium, while full-fat, whole milk is also naturally rich in vitamin A (because during the process of skimming fat to create reduced fat varieties, the vitamin A content is removed. However, some vitamin A is added back to these lower fat versions in a process mandated by law). And most commercial milk is fortified with vitamin D.

Note that the naturally occurring sugar in cow’s milk (lactose) can cause digestion trouble for some in the form of gastrointestinal distress like bloating, diarrhea and gas, otherwise known as lactose intolerance. If you are lactose intolerant you can opt for lactose-free milk.

If you’re allergic to dairy, vegan or just don’t like the taste of cow’s milk, a variety of milk alternatives are on the market. Some are plant-based like soy, rice, almond, hemp or cashew “milk” while others are animal-based, like goat milk.

Animal-based milk alternatives

Goat’s milk is a popular animal-based milk alternative. While it contains even more calcium, B6, vitamin A and potassium than cow’s milk, it has more calories and saturated fat than cow’s milk and it also contains less B12. So if goat’s milk is your drink of choice, it’s important to include foods or a supplement with B12 to make up the difference. Finding goat’s milk that is fortified with B12 will also make it an adequate cow’s milk alternative. Like cow’s milk, goat’s milk is not compatible with a vegan diet.

Plant-based milk alternatives

Milk-alternative beverages made from soy, rice, almond, hemp and cashew milks are rising in popularity. These milk alternatives are naturally lactose-free (and therefore likely better digested by those who experience discomfort from cow’s milk-based products), their fat content is primarily unsaturated (which may help reduce “bad” cholesterol and raise “good” cholesterol in your body) and they are compatible with a vegetarian diet (and as long as fortification is from a plant-based source, a vegan diet too).

Plant-based milk alternatives do provide much less calcium than cow’s milk, but many are fortified with calcium, protein, vitamin A and vitamin D to provide amounts similar to, and sometimes even greater than, cow’s milk. (Without fortification, plant-based milk alternatives will contain only 0-1% of the daily value of these important nutrients.)

You can determine whether a product has been fortified by checking the ingredient list and nutrition facts panel (see the What to Do section for guidance). Currently, food companies must list the percent daily value for calcium and vitamin A and may voluntarily list vitamin D. When the new proposed food labels are in effect, calcium and Vitamin D will be listed, and Vitamin A content will be optional information.

Beware that healthy nutrients aren’t always the only things added to milk alternatives during processing. Sugars and sweeteners can also sneak in, adding nutritionally void, excess calories. Sugar, or one of its many derivatives (check out Minimizing added sugars for the full list), will appear in the ingredients list.

Here is a snapshot of the calories, fat and protein content for a few types of plant-based milk alternatives, before fortification:

  • Soy milk contains more protein (9 grams per 8 ounces) than most plant-based milk alternatives and comes in a variety of non-fat, low-fat and flavored options like vanilla, chocolate and even green tea. It contains the most calories of plant-based milk alternatives, ranging from 90-130 per 8 ounce glass depending on the fat content.
  • Hemp milk contains many of the same nutrients found in cow’s milk but at lower levels. For example, the protein and fat content of hemp milk is lower than cow’s milk (but still higher than other non-dairy milk options). There are about 80 calories per 8 ounces.
  • Rice, almond and cashew milk tend to be the lowest in protein, fat, and calories (45, 40 and 25 calories per 8 ounce glass, respectively), vitamins and minerals.

Keep in mind that ingredients and nutrition facts vary among brands.

What to Do

Focus on eating your calories, not drinking them

While cow’s milk and milk alternatives can be part of a healthy diet, it is best to incorporate them with your favorite foods, for example cold cereal, oatmeal, frittatas and whole grain baked goods. Drink milk in moderation, while focusing on eating a varied, well-balanced diet.

When drinking cow’s milk, choose skim or other low-fat varieties

When choosing plant-based milk alternatives, opt for unsweetened varieties

Beware of “Original” flavors of plant-based milk, as these products often have sugar added. Look instead for “Unsweetened” claims. Check that the ingredients list does not list sugar, or one of its many derivatives, and that the nutrition facts panel includes no more than 0-1 grams of sugar and no added sugar on the new style nutrition facts panels

Remember that cow’s milk and goat’s milk contain naturally occurring sugar (in the form of lactose) which will appear as grams of sugar on the current nutrition facts panel but will have zero grams added sugar in the upcoming new nutrition facts panels

Check ingredients labels and nutrition facts panel for fortification information

Supplemental calcium will appear on ingredients lists as tricalcium phosphate or calcium carbonate, vitamin A as vitamin palmitate and vitamin D as D2/ergocalciferol (plant-based) or D3/calciferol (animal-based). Remember that food companies are currently required to include the percent daily value for calcium and vitamin A and may voluntarily do so for vitamin D. If a company is using the new style of labels (all companies will be required to in the future), Vitamin D and calcium will be listed, whereas Vitamin A may or may not be there. Without fortification, plant-based milk alternatives will contain only 0-1% daily value of these nutrients. With fortification, they could contain up to 40%.

Emphasize foods rich in calcium and vitamin D

Emphasizing foods rich in these nutrients is especially important if your milk or milk alternative has not been fortified like some farm-fresh milks and certain milk alternatives. Eat plenty of fish (sardines with the bones and salmon, in particular), lean meats, eggs, legumes and dark green leafy vegetables.

If you are a vegan or a vegetarian who doesn’t eat eggs or dairy, supplementation will be important, and a Happy Mama Mentor can help you evaluate your needs and options.

Make sure your milks are pasteurized

Pregnant women are advised to avoid unpasteurized raw milk and milk products. Plus, the safety of store-bought, fresh-pressed milk alternatives is unclear so it’s best to choose pasteurized versions.

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