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Milk and milk alternatives during pregnancy

MS, RD, LDN, CBS

Janel holds a Master’s in Nutrition Communication from Tufts University. As the recipient of the 2010 Massachusetts Young Dietitian of the Year award, she believes in making healthy eating simple, sustainable, and delicious.

What to Know

  • Cow’s milk and milk alternatives as part of a healthy pregnancy diet
  • Pros and cons of different types of milk

While water is the best fluid for all of us most of the time, in moderation cow’s milk and milk alternatives – whether on their own or used as an ingredient – can be a healthful source of some of the nutrients you need to support your growing baby and for your own good health.

prenatal nutrition isn’t easy. We can help.

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.

While water is the best fluid for most of us, in moderation cow’s milk and milk alternatives can be a healthful source of some of the nutrients you need to support your growing baby and your own health.

U.S. Food and Drug Administration

What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding

FDA strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and marijuana in any form during pregnancy or while breastfeeding.

Cannabis and Cannabis-derived products have become increasingly available in recent years, with new and different types of products appearing all the time. These products raise questions and concerns for many consumers. And if you are pregnant or breastfeeding, you might have even more questions about whether these products are safe for you.

FDA strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and marijuana in any form during pregnancy or while breastfeeding.

What are cannabis, marijuana, hemp, THC and CBD?

Cannabis is a plant of the Cannabaceae family and contains more than eighty biologically active chemical compounds. The most commonly known compounds are THC and CBD. One type of cannabis plant is marijuana, which contains varying levels of THC, the compound that produces the “high” that is often associated with marijuana. Another type of cannabis plant is hemp. Hemp plants contain extremely low amounts of THC. CBD, which does not produce a “high,” can be derived from either marijuana or hemp.

We are now seeing CBD-containing products everywhere. CBD can be found in many different products, like drugs, foods, products marketed as dietary supplements, and cosmetics. These products often make questionable health promises about CBD.

FDA wants you to know there may be serious risks to using cannabis products, including those containing CBD, if you are pregnant or breastfeeding.

What do we know about the effects of marijuana use during pregnancy and while breastfeeding?

There are many potential negative health effects from using marijuana and other products containing THC during pregnancy and while breastfeeding. In fact, the U.S. Surgeon General recently advised consumers that marijuana use during pregnancy may affect fetal brain development, because THC can enter the fetal brain from the mother’s bloodstream. The Surgeon General also advised that marijuana may increase the risk of a newborn with low birth weight. Research also suggests increased risk for premature birth and potentially stillbirth 1 .

While breastfeeding, it is important to know that breastmilk can contain THC for up to six days after use. This THC may affect a newborn’s brain development and result in hyperactivity, poor cognitive function, and other long-term consequences.

Additionally, marijuana smoke contains many of the same harmful components as tobacco smoke. Neither marijuana nor tobacco products should be smoked around a baby or children.

What do we know about the effects of CBD use during pregnancy and while breastfeeding?

There is no comprehensive research studying the effects of CBD on the developing fetus, pregnant mother, or breastfed baby. FDA is continuing to collect and study the data on the possible harmful effects of CBD during pregnancy and while breastfeeding. However, based on what we do know, there is significant cause for concern.

High doses of CBD in pregnant test animals have caused problems with the reproductive system of developing male fetuses 2 . In addition, based on what we already know about CBD, we expect that some amount of CBD will be transferred to babies through breast milk.

We also know that there is a potential for CBD products to be contaminated with substances that may pose a risk to the fetus or breastfed baby, including THC. We have also heard reports of CBD potentially containing other contaminants (e.g., pesticides, heavy metals, bacteria, and fungus); we are investigating this.

Moreover, CBD has known risks for people in general. Based on clinical studies in humans, risks can include the following:

  • liver toxicity (damage)
  • extreme sleepiness
  • harmful interactions with other drugs

FDA is studying the effects of CBD use from different angles, such as: (1) the use of CBD-containing products, like food, cosmetics, or supplements, over a person’s entire life; and (2) the effects of using these various products in combination. There are many unanswered questions about the science, safety, and quality of products containing CBD.

We especially want to learn more about the effects of CBD during pregnancy and while breastfeeding, including, for example, whether and to what extent the presence of CBD in human milk harms the breastfed baby or the mother’s milk production.

Has FDA approved any CBD products and are there any benefits?

FDA has not approved any CBD products except for one prescription drug to treat rare, severe forms of seizure disorders in children. It is still unclear whether CBD has any other benefits.

Other than the one approved prescription drug, CBD products have not been evaluated or approved by FDA for use as drug products. This means that we do not know:

  • if they are safe and effective to treat a particular disease
  • what, if any, dosage may be considered safe
  • how they could interact with other drugs or foods
  • whether they have dangerous side effects or other safety concerns

The clinical studies that supported the approval of the one available CBD drug product identified risks related to the use of CBD, including liver toxicity (damage), extreme sleepiness, and harmful interactions with other drugs.

What about hemp seeds?

FDA recently completed an evaluation of some hemp seed-derived food ingredients and had no objections to the use of these ingredients in foods. THC and CBD are found mainly in hemp flowers, leaves, and stems, not in hemp seeds. Hemp seeds can pick up miniscule amounts of THC and CBD from contact with other plant parts, but these amounts are low enough to not raise concerns for any group, including pregnant or breastfeeding mothers.

What should you remember about using cannabis or cannabis-derived products?

If you are considering using cannabis, or any products containing THC or CBD, you should be aware of the following:

  • FDA strongly advises that during pregnancy and while breastfeeding, you avoid using CBD, THC, or marijuana in any form.
  • Although many of these products are being sold, FDA has not approved these products, other than one prescription CBD drug product and two prescription drug products containing dronabinol, a synthetic version of THC (which are approved to treat certain side effects of HIV-AIDS or chemotherapy). All three of these prescription products have associated risks and side effects.
  • Always talk with your doctor, nurse, or pharmacist before taking any medicines, vitamins, or herbs while pregnant or breastfeeding.

Do not put yourself or your baby at risk by using cannabis products while pregnant or breastfeeding. Check out these links to learn more about cannabis, marijuana, CBD, and THC, and about taking medicines while you are pregnant.

FDA strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and marijuana in any form during pregnancy or while breastfeeding.