Can I Do the Keto Diet When Pregnant?

The Science of Pregnancy and Ketones

Let’s preface this section by considering that baby and mom naturally enter metabolic ketosis regularly throughout pregnancy, especially nearing birth.

Also, mom’s breast milk provides a rich and diverse profile of nutrients and healthy fats, a perfect fuel source for any growing baby.

Exclusively, breastfed babies are shown to be able to sustain a continuous and healthy state of metabolic ketosis well after birth thanks to the fatty and ketone-producing nature of human breast milk—an essential component in the development of all baby’s body systems (e.g., cognitive, neurological, respiratory, etc.).

However, similar to how it’s inadvisable to begin a rigorous exercise regimen when pregnant if previously living a sedentary life, the same is true with adopting a drastically different diet when newly pregnant, or at any point during gestation.

It’s much gentler on the body to avoid drastic changes that cause stress to mom and baby; instead, maintain balanced eating and exercise habits before pregnancy to set the stage for an ideal carrying and postpartum experience.

The neuroprotective benefits of being in ketosis and how it positively impacts the brain development of an unborn baby cannot be overlooked.

A ketotic metabolic state is ideal for the proper growth and development of the baby’s brain. Ketone bodies are passed through the placenta to the unborn fetus to maintain an embryonic state of ketosis in baby naturally.

In later stages of gestation, they support a baby's development in addition to the endogenous ketones produced by the fetus.

Furthermore, ketosis has a balancing effect on the body which is particularly significant as it relates to women’s health, especially surrounding pregnancy. Ketosis helps regulate hormones in the body that directly affect mood and the body’s ability to absorb nutrients and efficiently utilize fat as fuel.

Lastly, ketones and ketosis have a neuroprotective effect on the thyroid which is essential for regulating healthy body weight and metabolism.

Optimal thyroid health is particularly important for pregnant women because a growing fetus relies on the mother’s thyroid hormones in utero. For that reason, thyroid hormones play an essential and central role in the baby’s healthy brain development.

Getting Pregnant in Ketosis

This is the ideal scenario: being in ketosis and fat-adapted before conceiving provides the gentlest transition on the body.

Although both are beautiful states of being, pregnancy, and ketosis that is, both also pose a level of stress and trauma to the body—so it’s best not to embark on both simultaneously.

As is generally advisable before pregnancy, consider increasing vitamin intake and dedicating more time to physical fitness and mindfulness to create an atmosphere ready to welcome a new life; these are all central elements of a holistic prenatal protocol.

It’s essential to integrate several vitamins and minerals into your regimen before getting pregnant to facilitate a healthy experience for you and baby. Here’s a brief breakdown of the ideal vitamins to take pre-pregnancy and their unique benefit:

Healthy fats and folic acid are highly recommended for any prenatal protocol along with a host of B-group vitamins (e.g., B1, B2, B3, B6, and B12, et al.).

Also, it’s advisable to take sufficient amounts of calcium, iron, and vitamins C, D, and E. Keeping an eye on getting an adequate amount of protein will also be beneficial in that it provides muscle-building support for mom and baby.

We’d strongly advise consuming quality, grass-fed meats for their protein and fat content, both of which support mom before pregnancy and then contribute to the healthy development of the baby during pregnancy.

Folic Acid

A powerful member of the B-group of vitamins, B9, folic acid, also known as folate, is essential before and during pregnancy. It has found to help reduce the risk of certain neural tube congenital disabilities, such as anencephaly and spina bifida when taken by women trying to conceive and during pregnancy.

B1, B2, B3, B6, and B12

This suite of essential vitamins is particularly crucial when pregnant or planning to conceive. Along with folic acid (B9), many benefits are derived from the remaining B vitamins which are associated with the support of healthy eggs and sperm—crucial to anyone planning to start a family.

Calcium

As the building block of bones and teeth, calcium is essential to reproductive health too. In addition to this mineral fortifying the skeletal and oral health of an unborn baby, calcium is also known to facilitate the sperm reaching the egg during conception. Pretty powerful!

Healthy Fats

Avocados, nuts, and healthy oils like coconut-based medium-chain triglycerides (MCTs) are all excellent sources of fat that are ideal on a ketogenic diet—before, during and postpartum—particularly to facilitate the full lactation of fatty breast milk to support ketosis in a newborn.

Plus, remember polyunsaturated fats and oils which contain essential fatty acids (EFAs) such as omega-3, are vital for the function of healthy reproductive organs.

Healthy fats—monounsaturated, polyunsaturated, and certain saturated fats—also help regulate hormone levels, improve sperm quality and enhance the body’s ability to absorb the fat-soluble vitamins D and E, both of which support fertility.

Iron

Regardless of whether you have your immediate sights on motherhood, iron is a vital mineral for all but particularly for women, who more often suffer from a deficiency in this energy-boosting micronutrient.

Also, iron is crucial for the formation of oxygen-carrying red blood cells which, if deficient, can negatively impact fertility.

Vitamin D

Vitamin D is beneficial on its own but also has a symbiotic effect related to the body’s ability to absorb calcium—which again is a crucial building block of teeth and bones—and without this vitamin, the development of an unborn fetus may be compromised.

Also, it’s advisable to supplement with Vitamin D during pregnancy in general, but specifically during the winter months where natural sun exposure, as a source of the fat-soluble prohormone, is usually limited.

If you have limited exposure to sunshine or are overweight (have a BMI over 30), it's advised for a healthy, pregnant woman to take a daily 10mcg supplement; but consult with your doctor to determine your customized needs.

Zinc

This potent mineral is vital for essential tissue growth and repair. It's particularly critical for men’s reproductive health and the proliferation of healthy sperm to support a couple’s desire to begin or expand their family.

Protein

Amino acids are essential building blocks for body tissue and are a must during pregnancy.

Protein is primarily responsible for the building and repair of all cells and tissues in the body. It is especially crucial toward the second and third trimesters of pregnancy when a baby is growing fastest and in need of an increased transfer of necessary nutrients from mom.

In general, the suggested range of protein intake for a healthy pregnant woman fits within a range from 40g to 70g a day, with each woman’s ideal intake primarily dependent on her weight.

Also, there is little need to worry about deficiencies in this area as there are many keto-friendly foods a pregnant woman can enjoy to hit this macronutrient target. Eggs, dairy, leafy greens, and cruciferous vegetables, lean meats, and fish are all excellent options.

Vitamins C and E

A lot of information related to antioxidants focus on their anti-aging effect, but vitamins C and E, in particular, reduce the risk of damage to the reproductive eggs of women in the childbearing age.

Antioxidants also have a significant impact on men’s reproductive health. Sufficient amounts of antioxidants help protect the viability of sperm and make them increasingly mobile—so it’s easier for them to do their job and swim upstream during fertilization.

Safety of Ketosis During Pregnancy

Ketosis occurs when we significantly reduce carbohydrate intake in our diet and force the body to use an alternative energy source via food consumed, fat!

A pregnant woman’s body will generally, at the very least, dip into ketosis at some point during each night when in a fasted state—or the period between the evening meal and the meal was eaten the following day, to break the fast.

From glucose and blood pressure regulation to the prevention of certain cancers, and fostering a metabolic state that promotes fertility, a ketogenic diet is an excellent option during pregnancy.

The version best suited for pregnancy will look slightly different than what one might consume on a traditional, strict ketogenic diet.

But no worries, the moderate-carb ketogenic diet is every bit as delicious as it’s more restrictive iteration, and a safe protocol during pregnancy.

Rest assured, we'll get into more detail below about what to eat on a moderate ketogenic diet to help you start planning for success.

Besides, the neurodevelopmental and neuroprotective nature of ketones and ketosis are crucial during pregnancy. Just another vote in favor of following a modified ketogenic diet during and post-pregnancy.

Remember, although more heralded for its efficiency in facilitating rapid fat loss in recent years, the diet was established as a formidable protocol in the 1920s for its therapeutic benefits.  

Children with epilepsy and later those with other neurodegenerative disorders like autism, Alzheimer’s disease, and dementia have benefited.

Another distinct advantage of increased ketone bodies relates to enhanced and optimal brain development and function. Ketosis promotes the support of all of the above for both mom and her developing baby during pregnancy.

Misconceptions about Ketosis During Pregnancy

Some have asserted that a low-carb, ketogenic diet is dangerous or somehow inappropriate during pregnancy—cautioning moms, due to a bit of confusion, that a varied, ketogenic diet is somehow linked to ketoacidosis—but that perspective is misguided.

Consider that both fetus and expectant mom will, again, usually enter a state of nutritional ketosis with increased frequency during the latter part of the pregnancy. Those babies exclusively breastfed can sustain an ideal ketotic state well after birth, semi-independent of mom's ketones.

Our brains thrive on quality fats and need them to facilitate proper growth and development. Also, there is no metabolic need for us to consume carbohydrates in the presence of an abundance of fat and protein-based foods to satiate and provide energy for fuel.

If anything, an increase in calories, maybe even a higher ratio of fat intake, should be sufficient to help mom and her growing baby get the nutrition needed for a healthy ketogenic protocol, while pregnant.

Avoiding Gestational Diabetes on Keto

Some circles have submitted the theory that diabetes and increased insulin levels, along with a sudden inability of the body to efficiently metabolize glucose in the form of insulin resistance, are somehow inextricably tied.

However, emerging research is uncovering that those expressing diabetic symptoms during pregnancy were likely pre-diabetic but undiagnosed before pregnancy.

Some experts assert that gestational diabetes seen during pregnancy is likely a result of the oxidative stresses of pregnancy exposing a pre-existent, borderline issue that mom already had with glucose regulation.

This point is significant: elevated blood sugar levels, even if mildly elevated, should warrant concern and further investigation if suddenly onset during pregnancy, as it is only a symptom of a more profound imbalance.

Again, even slightly elevated glucose levels present in pregnant women has been shown to impact their health and that of their unborn child directly.

Furthermore, a baby developing in a glucose-elevated environment, in utero, is considered more likely to fall subject to developmental and metabolic issues as a result.

Keeping insulin levels in check during pregnancy is essential for preventing gestational diabetes.  

The ketogenic diet’s compounding benefit of nutritional ketosis makes it an ideal protocol during pregnancy.

As long as mom is not underweight, or otherwise suffering from some form of malnourishment, keto is a perfectly healthy dietary option.

The ketogenic diet can thwart obesity, mitigate high blood pressure, and reduce the risk of gestational hypertension and preeclampsia—which is a dangerous pregnancy complication related to high blood pressure that causes seizures, and sometimes death, in pregnant women.

It’s worth the effort to bust a few misguided myths and explore the alterations a woman of childbearing age should consider, in preparation of conceiving a child and planning to implement a modified form of the ketogenic diet.

Now, several myths are circulating in the health community concerning pregnancy and ketosis.

The following are a few fallacies we’d like to refute them serves no one, and in some cases can produce adverse health effects:

Myth #1: Blood sugar levels are naturally higher in pregnancy.

There’s a considerable amount of misinformation circulating about how pregnancy impacts blood sugar levels, with some suggesting that elevated blood sugar levels and fertility are synonymous.

However, a recent study focused on the difference in the blood sugar levels in women experiencing a healthy, pregnancy and non-pregnant women. It confirmed that glucose levels in pregnant women trend about 20% lower than their non-pregnant counterparts—that’s right, 20% lower!

Our bodies seem to prefer a limited amount of glucose in the blood during pregnancy; and since we know the body always functions with self-preservation in mind, this fact is worth noting.

Myth #2: Elevated glucose levels are expected when you are expecting.

This myth is hazardous because elevated glucose levels in mom can have lasting effects on both mom and her unborn child.

The benchmark Hyperglycemia and Adverse Pregnancy Outcomes study (HAPO), a study that monitored 23,316 women with gestational diabetes and their infants, found that even mildly elevated fasting blood sugar levels can harm a developing fetus.

Even slightly elevated maternal insulin levels were tied to high insulin levels in infants, which increases the risk of macrosomia.

The takeaway, a woman’s blood sugar levels during pregnancy matter and managing glucose during this time is essential for the health of mom and baby. If your sugar is spiking during pregnancy, it’s likely time to make some dietary and lifestyle tweaks.

Focus on eating low-glycemic foods, be more active to get the blood flowing—maybe take regular brisk walks through your neighborhood. If needed, rely on insulin or medication as a latter alternative to food-based and lifestyle-related blood glucose regulation protocols during pregnancy.

Myth #3: Gestational diabetes magically appears at the end of pregnancy.

While insulin resistance tends to rise in the latter stage of pregnancy as a standard process of adaptation, to divert as many nutrients as possible to mom’s rapidly growing baby, gestational diabetes is rarely a condition that comes out of nowhere.

Again, GD is more likely the exposure of a pre-existing condition of insulin resistance now exacerbated by the physiological and hormonal stresses of pregnancy.  

Myth #4: The glucose test is the only indicator.

While those shown to have gestational diabetes are defined as a “high-risk pregnancy” and may have concerns about outcomes of elevated glucose during pregnancy, like possibly needing to take insulin or needing a c-section during delivery due to macrosomia.

It is best to work with your doctor to bring your glucose levels down safely, and to chat about your delivery options. Many women may seek out a midwife with experience in creating a less stressful birth experience and can help you find doctors with a more holistic outlook.

If you are diagnosed with gestational diabetes, it does not mean things will end, or your baby will have any problems. It’s a great motivator to make clean, nutritious food choices to boost your and your baby’s health.

There is a metabolic ebb and flow, and this remains true during pregnancy. Focus on low-glycemic vegetables and berries, a variety of polyunsaturated and monounsaturated fats, along with omega-3s to achieve the most nutrient-dense diet possible.

Also, keep a focus on moderating sugar intake and consuming vital micro and macronutrients as a daily goal. And, be sure to check in with your doctor regularly. We’re confident with consistent self-care and check-ins; you’ll have a wonderful pregnancy experience.

Myth #5: I’m lean, I can’t possibly have gestational diabetes.

Being overweight can impact glucose regulation and insulin resistance because of the influence of releasing fat-stored hormones in the body, but the inverse doesn’t apply concerning thinness being an indicator of metabolic health.

Research has shown up to 50% of women with gestational diabetes don’t have any of the classic risk factors, like a family history of diabetes or being overweight before becoming pregnant.

For the sake of due diligence, it’s wise to request an A1c test in the first trimester of pregnancy, especially given the risk related to the birthing experience and beyond that, even mildly elevated glucose levels in mom may create problems for mom and baby.

Myth #6: Diet doesn’t change the risk of gestational diabetes.

I don’t understand how this one is even a thing. Of course, diet matters! Getting adequate amounts of vital minerals and vitamins is essential and rarely more so than during pregnancy.

Granted, one may be predisposed to having gestational diabetes. However, even if that’s the case, nutrition is always a great contributor to the likelihood of developing GD in an otherwise healthy pregnant woman.

Recent studies have even shown that pregnant and non-pregnant women who opt for low-glycemic over high-glycemic vegetables and eat limited amounts of fruits, aid in the prevention of gestational diabetes at considerably higher rates.

Low-GI foods help facilitate a healthy rate of fetoplacental growth and maternal weight gain.

Myth #7: Women with gestational diabetes have big babies.

Fortunately, this is not a hard-and-fast truth. While macrosomia, having a larger baby linked to GD, is a legitimate concern due to the health risks associated with having a larger baby (e.g., being more likely to require a c-section, giving birth to a baby predisposed to have insulin resistance, etc.), not every expectant mom with GD will deliver a larger baby.

The good news is, the likelihood of macrosomia is more prevalent in the presence of glucose in the body and glucose intake is something mom can control.

Some studies have shown that pregnant women have a particularly hard time metabolizing high-glycemic fruits and HG, starchy, foods in general.

Remember, the body wants to maintain about a 20% lower glucose level than would be the case if a woman weren’t pregnant, as we mentioned earlier.

Keep the carbs you consume as nutrient-dense as possible, focus on eating quality proteins and fats, and commit to mind your micronutrient intake. This will ensure to round out a robust dietary program, ideal for mom and baby.

Myth #8: Pregnant women need to eat at least 175g of carbohydrates per day.

There’s absolutely no nutritional reason for a pregnant woman to eat this many carbs a day, none! And, it's especially nonsensical and counterproductive to eat so many carbs a day if diagnosed as insulin intolerant.

By eating so many carbs, you stoke the proverbial fire of gestational diabetes and feed the potentially dangerous disorder.

A healthy pregnant woman can eat a nutrient-rich, low-glycemic diet and cut the carbs as mentioned earlier, at least by half of the suggested amount above, while still consuming enough micronutrients to support the health of herself and her developing baby.

Furthermore, and perhaps not much of a surprise, researchers have shown that eating a lower-glycemic diet reduces the chance of a pregnant woman needing to use insulin during pregnancy as a result of GD by half (Diabetes Care, 2009).

Myth #9: You’ll need insulin.

Fortunately, there are levels to this and the first approach to manage insulin resistance during pregnancy is dietary; there's no need to turn to insulin to regulate blood sugar automatically.

Discuss a food-based approach with your doctor to help manage glucose levels during pregnancy and stay active.

Again, keeping glucose levels moderate during pregnancy can have lasting benefits on mom and baby, so it’s worth the effort to lean on lower-glycemic foods to keep you and baby well nourished, before ever considering insulin or medication.

Myth #10: Ketosis is unsafe, like ketoacidosis.

Last but certainly not least of the myths to dispel: ketosis and ketoacidosis are the same. The truth is that ketosis and ketoacidosis are entirely different and here's how:

Nutritional ketosis is a healthy metabolic state with many benefits, where the body converts from running on glucose to using fat as fuel in the absence of carbohydrates in the diet. However, unlike the dangerous state of ketoacidosis, ketosis is known to facilitate the proper growth and development of an unborn child and provide much-needed fuel to the baby boy or girl's expectant mom.

However, again, diabetic ketoacidosis (DKA) is a perilous physiological state; it often develops in people with diabetes or those with insulin resistance.

Diabetic ketoacidosis is harmful to anyone's health, but it poses a particular risk to a pregnant woman. DKA can cause blood sugar levels three times higher than usual—something to avoid in consideration of how this may increase a woman's risk of developing or worsening glucose regulation issues during pregnancy, and the ramifications that may have on mom and baby.

Also, ketoacidosis floods the body  with excess exogenous ketones which lend to a highly acidic embryonic environment and can have adverse effects on mom and her developing baby—see, these two states sound similar but are opposites.

Can I Do the Keto Diet When Pregnant?

At this point, I think it’s clear that we’re going to go with “yes"!

The ketogenic lifestyle, one that promotes glucose-regulating endogenous ketones, keeps the body in an optimal state.

When predominantly fat-adapted, mom is afforded some metabolic flexibility so she can reap the benefits of ketone-based energy while consuming slightly elevated levels of carbs each day to support the healthy development of her baby.

More than a focus on weight and fat loss, as is often the case with many on the ketogenic diet, mothers-to-be should use the ketogenic diet more as a tool to regulate their hormones and blood sugar to avoid some commonly experienced and adverse reactions during pregnancy.

So, you may be wondering about the specific parameters required to start or maintain the ketogenic diet while pregnant; well, keep reading because we’ve got you covered below:

Low-Carb Diets and Pregnancy

To follow the ketogenic diet in a manner that’s balanced as to support the growing needs of mom and baby, you’ll want to follow some basic guidelines.

Make sure you’re eating enough calories and don’t be afraid to increase the carbohydrate and fat percentages in your overall macros, especially as your body adjusts in the first trimester of pregnancy.

Healthy fats help to support the development and optimization of cognitive functions for baby.

Supplementing folic acid (B9) is often highly recommended for pregnant women, as well, but there are many excellent food-based sources that you can easily incorporate into your diet, like eggs, broccoli, Brussels sprouts, and asparagus.

The ketogenic diet encourages a focus on macronutrient composition, but micronutrients are boss when following the diet during pregnancy.

Opt for nutrient-dense foods with a low-glycemic index to maximize the vitamins and nutrients passed into the baby’s bloodstream through the umbilical cord.  

Give preference to organic, dark leafy greens, mineral-rich and protein-packed algae like spirulina, and grass-fed, marbled cuts of meat—focus on quality and eating the spectrum of nutrients needed to support a healthy pregnancy.

Although intermittent fasting (IF) is generally recommended on a ketogenic diet, this is not the case during pregnancy.

When eating for two, or more as may be the case, it is essential to fuel your body as well as the babies with a consistent flow of necessary nutrients. It’s best to eat small, low-carb, high-fat meals throughout the day—and to break the overnight fast soon after waking.

High-Carb Diets and Pregnancy

Increasing carb intake moderately during pregnancy can be helpful, but the reality is that we don’t need to consume loads of carbohydrates to survive or thrive.

Now let me clarify, the body requires glucose to live, and that’s a fact, but the carb macronutrient is unnecessary. While high-carb foods may contain essential vitamins and nutrients, there is always a low-carb food source that could get the job done at least equally well.

Still, it’s acceptable to eat a buttered sweet potato and extend the boundaries of your diet for reasons of preference and to broaden your food options while growing baby.

Pregnancy and Gestational Diabetes

It’s humbling to consider that at least one in seven pregnancies, to as many as one in five, is affected by gestational diabetes.

Some women who experience GD, again, likely had undiagnosed pre-diabetes before conceiving that was exacerbated by all the physiological changes and increased demands imposed on mom’s body during pregnancy.

Elevated blood levels, even if slightly raised, directly impact the baby as excess glucose in mom’s bloodstream is transferred to the fetus, which can cause insulin and glucose resistance in the unborn child.

Also, a state of hyperglycemia—chronically elevated blood sugar levels—in mom is quite dangerous for her offspring because it is associated with a higher risk of miscarriage, high blood pressure, congenital disabilities, birth trauma, macrosomia, and even stillbirth.

Furthermore, the health risks to baby and mom remain elevated after childbirth as a result of glucose regulation issues experienced during pregnancy.

The metabolic damage caused by GD during gestation often results in a much higher risk of mom or baby eventually developing type 2 diabetes, cardiovascular disease, or other metabolic conditions.

The Benefits of Low-Carb Diets and Pregnancy

Fertility Health

The first benefit to note is gained before you conceive. Individuals of childbearing age who adopt a low-carb, ketogenic diet in preparation of pregnancy increase fertility and the probability of conception—and this benefit concerning fertility health is equally applicable to men and women.

Glucose Regulation

Our body’s ability to regulate glucose and insulin has many health benefits apart from those gained if pregnant. Glucose regulation when pregnant is paramount as insulin resistance in mom is directly passed to the baby which can significantly increase a baby’s probability of developing diabetes and other metabolic issues later in life.

Healthy Fats

In the absence of carbs, our bodies naturally need an alternative energy source, and this is especially true during pregnancy when the baby is siphoning nutrition from mom to develop and grow properly.

Mom consuming increased amounts of healthy fats is excellent for the development of everything from the baby’s brain, to its neurological system, and muscle tissue.

Increased Energy

Pregnancy is an exciting and miraculous time, but it can be utterly exhausting. Hosting a life is no small task, and a developing baby requires considerable amounts of vitamins, nutrients, and energy—and the baby is entirely reliant on mom for it all.

Increased fat in the presence of reduced carbs boosts natural ketones in the body which the body and baby can then readily use as a premium form of energy.

Hormone Regulation

Hormone health is always a topic that’s particularly important, as women’s hormones fluctuate and can directly impact everything from mood to the body’s ability to process insulin.

We see some evidence of the common hormonal challenges faced by pregnant women first-hand: crying during sappy commercials or snapping at a spouse when they're hangry.

Their hyper-specific food order is delayed—but the swings are real—and it's all par for the course.

A low-carb, ketogenic diet by definition will help stabilize hormones as it causes glucose to remain consistent and avoid the spikes that could make you harder to be around for nine months.

How to Adjust Macros and Micros for a Healthy Pregnancy

Reset your carb macro ceiling to 50 grams per day. Many people can maintain elevated levels of healthy ketones at this carb limit, and the increased carbs, calories and energy are helpful to mom and baby who is now sharing all their nutrients.

Consult your doctor for more customized caloric limits, especially if you have a pre-existing medical condition.

A general caloric guideline for pregnant women in the US, per the USDA, advises women to consume an additional 300 calories a day in the second and third trimesters of pregnancy, nothing drastic, and certainly not reflective of the indulgence that the “eating for two” adage may promote.

Focus on eating antioxidant-rich leafy greens, organic eggs, quality grass-fed meats, and organic dairy every day as a general rule, and you’ll be on your way to optimizing nutrition for yourself and your unborn child.

With this as the focus, you’ll find there are unlimited options to add to your keto diet to keep you and baby energized and in optimal health for the duration of your pregnancy, and beyond.  

Macros

Unlike micronutrients that the USDA has set clear requirements for regarding what’s best for women and men, everybody's macronutrient needs on the ketogenic diet, or any dietary protocol, will vary based on some personal factors.

Your current weight and pre-existing nutritive deficiencies will directly impact your needed caloric and macronutrient intake.

Classic keto advises a macro breakdown consisting of about 5% fat, 15% protein, and 80% fat, but, again, it can be beneficial for pregnant women to raise their carb limit and structure their macro composition, so carbs represent up to about 20% of daily food intake.

Increasing protein intake to around 20% and structuring the remaining calories with healthy fats is an excellent approach to keep mom and baby healthy and keto during pregnancy.

Just as is the case apart from pregnancy, the ideal macronutrient composition is different for everyone.

Consult your medical team for specific support to determine your individual needs to create a dietary plan that provides the most nutrient-dense environment for your developing baby.

Micros

Although so much conversation in the keto community surrounds macronutrients (e.g., fat, protein, and carbohydrates), monitoring and incorporating essential vitamins and minerals is more critical than ever immediately before, during, and following pregnancy.

Quality fats, vitamins, and minerals all play a significant role in the development, growth, and function of a fetus; all are essential for a baby’s proper development. From the forming of the brain to the development of muscle tissue, a growing baby requires ample nutritional support to avoid gestational deformities (e.g., spina bifida, etc.).

And proper nutrition also helps to maintain mom’s nutritional integrity as she facilitates an appropriate environment for the development of the fetus.

Micronutrient health during pregnancy is vital as the health and condition of the most precious being in your world is at stake. You’ll want to consult with your doctor to identify pre-existent nutrient deficiencies to determine the amounts of essential micros to consume.

Here’s a bit more on essential keto micronutrients for pregnancy:

Iron

An iron deficiency is particularly problematic during pregnancy, as a deficiency that results in anemia can increase mom’s risk of hemorrhaging during delivery, as well as possibly increasing the risk of mortality in childbirth for both mom and her unborn child.

Ideal food-based sources of iron include broccoli, leafy greens like spinach, and nuts and seeds.

Folic Acid

Deficiencies in this micro can have devastating results related to the healthy development of a fetus, mainly because folic acid is used by the body to make the extra blood needed during pregnancy.

An insufficient amount of folic acid during pregnancy can result in blood disorders (e.g., anemia, hemophilia, and rare genetic diseases, etc.), congenital malformation, and may also cause other complications during pregnancy.

Ideal food-based sources of folic acid include leafy green vegetables like spinach and kale.

Zinc

Insufficient levels of zinc are associated with complications during pregnancy and delivery.

Also, a deficiency in zinc may directly contribute to growth retardation, congenital abnormalities and delayed neurobehavioral and immunological development in the fetus.

Ideal food-based sources of zinc include dairy, eggs, meat, nuts, and seeds.

Iodine

Cretinism, or iodine deficiency syndrome, is a congenital disorder and can severely stunt the physical and mental development of a growing fetus.

Iodine directly supports the production of thyroid hormones and its absence may result in impaired stimulation of the thyroid hormone in mom, and by proxy, baby. This can likely cause hypothyroidism in the baby and may cause a baby to be less active or sleep more.

Left untreated, congenital hypothyroidism can also lead to intellectual disability, delayed physical growth, preterm delivery, or miscarriage.

Ideal food-based sources of iodine include eggs, seafood, poultry, nuts, and seeds.

Magnesium

This mineral is essential as it relaxes muscles and may prevent premature contractions during pregnancy. Magnesium is also known to help build strong bones and teeth in your baby.

Additionally, muscle cramping during pregnancy is quite common, so magnesium helps to calm the muscles as well.

Ideal food-based sources of magnesium include mackerel, spinach, peanuts, and almonds.

Selenium

A trace mineral responsible for several bodily functions, selenium is particularly helpful related to the support of thyroid health and is said to reduce the risk of miscarriage.

Ideal food-based sources of selenium include whole milk, turkey, shellfish, pork, and beef.

Copper

This essential element is central to the development of a baby’s heart, blood vessels, and skeletal and nervous systems as copper are needed to form red blood cells.

Once mom’s blood supply increases as required, copper goes to work to help build crucial biological systems within her growing baby.

Ideal food-based sources of copper include cacao, dark leafy greens, oysters and other shellfish.

Calcium

In addition to reducing the risk of hypertension and preeclampsia, calcium helps a baby grow a healthy heart, nerves, and muscles.

Calcium is also responsible for the development of an average heart rate for baby, along with assisting with baby’s blood-clotting abilities.

Ideal food-based sources of calcium include sardines, whole milk, pink salmon (with bones and liquid), and kale.

It’s also important to note, per the World Health Organization (WHO): most recent evidence shows that giving pregnant women multiple micronutrient supplements may reduce the risk of low birth weight, compared with iron and folic acid supplementation alone.

Ketosis in Late Stage Pregnancies

Pregnant women naturally enter ketosis at different times with ease, and both mom and baby generally enter nutritional ketosis more often as the time for delivery draws near.

Also, in further support of nutritional ketosis being an ideal metabolic state during pregnancy: the default composition of breastmilk, our first food, being produced as mom's body prepares to nurture her newborn child, seems like another pretty significant biological endorsement for the metabolic state.

The human body is incredibly intuitive, and survival is always its central goal.

That our bodies naturally enter ketosis during and increasingly nearing childbirth appears to indicate that ketosis is a preferred metabolic state to foster health, growth, development and proper physiological function.

Also, think about the first trimester of pregnancy which is usually a time where expectant moms experience nausea (morning sickness) and periods of reduced appetite. These are spans where there's a lack of food eaten.

It's these naturally-occurring and sometimes extended periods, particularly in the presence of limited carbohydrates on a modified ketogenic diet, that by their very virtue promote ketosis.

Also, pregnant women enter a fasted, ketotic state—as do we all—every evening between the last meal of the day and breakfast, something suggested even in the name of the first meal of the day, breakfast.

Furthermore, women’s bodies during pregnancy may even favor the metabolic state of ketosis as ketone levels following an overnight period of fasting appear to be three times higher in pregnant women than those who are not with child.

Although our bodies can run on glucose (sugar) efficiently for short bursts, the body craves ketones and fat-based energy as its a cleaner and more sustainable fuel for the human body.

Everything from the healthy development, growth, and function of our brain and body rely on the presence of healthy fats as a primary building block.

Lastly, emerging research indicates that fetuses generate ketones in utero independent of mom which may explain the increased ketones shown in pregnant women, especially nearing the end of pregnancy, as baby starts to produce some of its endogenous ketones.

Again, the body is naturally geared toward self-preservation, so it’s hard to believe our bodies make so much effort to enter ketosis during pregnancy unless it supports human life and development, or at the very least provides a preservative effect.

Precautions:

We’ve established that ketosis is a natural and beneficial metabolic state, but there are still some factors to consider when pregnant and eating a low-carb, ketogenic diet:

Put Goals of Fat Loss on Hold

Women will naturally gain some weight, of course, during pregnancy and the weight gain is necessary for the healthy growth of the baby. Enjoy the process and know that the few extra LBs are working to nurture your unborn child.    

Ditch Intermittent Fasting

Despite the many health benefits generally associated with intermittent fasting, forego all forms of fasting during pregnancy as consistent and robust nutrient intake is required to support the proper development of the fetus fully.

Eat Whole Foods

This piece of advice is particularly important. Focus on eating the most nutrient-dense, low-glycemic, foods possible.

Keep the focus on eating foods that provide the most significant nutritional punch, and you can rest assured that you are doing the absolute best for yourself and your baby.

Avoid Grains, Sugar, and Processed Foods

A simple rule is to shop the perimeter aisles of the supermarket to ensure that mom and baby get sufficient nutrition.

Stick to antioxidant-rich leafy greens, low-glycemic fruits, and avoid grains and added sugars that can spike insulin levels and compromise mom and baby’s well-being, as many women are often more sensitive to insulin during pregnancy.  

Summary

On all accounts, it seems safe for women to eat a diet lower in carbs during pregnancy as long as mom’s food is rich in nutrients and provides the range of macronutrients and micronutrients to support the health and development of baby and mom.

Fetuses, like all humans, require both glucose and ketones to survive, so a delicate balance is essential.

Furthermore, in addition to dietary composition, it’s vital to ensure mom has normal blood sugar levels during pregnancy to avoid the common and harmful state of gestational diabetes which can have lasting and adverse effects on both mother and child.  

Pregnancy is an amazing and transformative life experience, and our nutrition during that time is foundational and vital.

Along with the many things changing in a woman’s body while preparing for the arrival of the baby, a mindset change around food and our relationship with it is essential.

Focus heavily on vitamins and minerals when planning meals to ensure adequate nutrition.

Although food and eating are virtually inextricably tied to socializing and cultural traditions in western and almost all cultures, now is the time to reset our perspective on food—making a shift from viewing it as a form of comfort to recognizing it as a life-generating form of fuel.

Resources

1. https://www.ncbi.nlm.nih.gov/pubmed/11509110
2. http://library.umac.mo/ebooks/b28357899.pdf
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193777/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685567/
5. https://ghr.nlm.nih.gov/condition/congenital-hypothyroidism
6. https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/symptoms-causes/syc-20372579
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372867/