If you have a food allergy, you may be concerned about how to make the most of your diet during pregnancy, to help keep both you and your baby healthy. Due to hormonal changes, allergic reactions and symptoms can change during pregnancy. Some women find that pregnancy reduces their symptoms; others find they increase. This guide will explain how you can still meet your nutritional requirements during pregnancy whilst avoiding those offending foods.

Coeliac disease

Pre-conception and pregnancy is a great time to review your gluten-free diet, to make sure you are eating a good balance of foods and remain healthy. It is particularly important to stick to the diet during pregnancy. Even if you only get mild symptoms on eating gluten (found in wheat, barley, rye and oats), it can have serious complications for the body, e.g. preventing enough calcium and iron from being absorbed. You also risk having a low birth-weight baby if you don’t follow the diet properly. The following tips will help you keep a balanced diet during pregnancy:

  • Include starchy carbohydrate with every meal, e.g. potato, rice, gluten-free pasta, gluten-free cereals.
  • Include protein-rich foods 2-3 times a day, e.g. meats, fish, beans, lentils. Try to include red meat at lease once a week and oily fish (e.g. salmon, mackerel, pilchards) once a week. This will help you meet the extra iron requirements for coeliac disease.
  • Include 5 portions of fruit and vegetables a day. Try to make at least one of these is a vitamin C-rich fruit eaten with a meal, e.g. orange, clementine, grapefruit, berries. This is because vitamin C helps increase iron absorption, and iron intake is really important in both coeliac disease and pregnancy.
  • Calcium intake is really important. Calcium requirements for coeliacs are 1500 mg per day – over double that for non-coeliacs. The increased requirements are due to the potential for decreased absorption.To obtain enough calcium, you need to eat around four portions of dairy products each day, e.g. yoghurt, cheese, milk with cereal, milky drink. Other good sources of calcium include tinned fish (with bones), bread, scrambled egg, tofu, beans and pulses. High calcium main meals include pizza, lasagne, macaroni cheese, cheese omelette, quiche and mousakka (all made with gluten-free ingredients).
  • Try to limit snacks high in sugar and fat. Shop-bought gluten-free biscuits and baked products tend to be higher in sugar and calories then standard products. Instead, choose healthier snacks e.g. gluten-free crackers, fruit, veggie sticks, plain popcorn.
  • Review any opportunities for cross contamination, e.g. toasters, tubs of spread, wooden spoons transferred between cooking pots.

If you’ve been formally diagnosed with coeliac disease, dermatitis herpetiformis of gluten sensitive enteropathy, you are entitled to a number of products on prescription every month. Use your prescription allowances to obtain starchy foods like pasta, bread and crackers, rather than cakes and biscuits. If your healthcare Trust have limits on prescription amounts, you may be able to access more foods during the last 3 months of pregnancy(where calorie requirements are 200kcal higher) and during breastfeeding. Your GP or dietitian will be able to give you more information on foods available on prescription.

Milk / dairy allergy

If you are avoiding cow’s milk / dairy products because of cow’s milk allergy or lactose intolerance, it’s important to replace the milk/dairy products with other calcium-containing alternatives. Calcium requirements in pregnancy do not increase, but it is important to ensure you have 2-3 portions of dairy alternatives each day to meet requirements.

Good non-dairy alternatives to milk include soya, rice and almond milk (check the label to make sure they have added calcium). Other sources of calcium include soya yoghurts, calcium-enriched tofu, kidney beans, soya beans, chickpeas, tempeh, soya mince, tinned fish (with bones), nuts, figs and green leafy vegetables.

Fish / seafood allergy

The benefits of including oily fish in the diet once a week are well-documented, due to their omega-3 fatty acid content. It’s important that you eat enough foods containing omega-3 fatty acids to help support your baby’s growth and developing brain. Try to include plant-based sources of omega-3 fatty acids, e.g. linseeds/flaxseeds, nuts and seeds, avocados and green leafy vegetables. Linseeds add ‘bite’ to food and can be added to foods like cereal, soup, yoghurt, bread mixes and salads. You may wish to consider taking an algae docosahexanoic acid (DHA) supplement during pregnancy and breastfeeding (providing 200mg a day).

Egg allergy

It’s important to include 2-3 portions of protein-rich food each day. Eggs are a good source of protein and iron. If you’re avoiding eggs, be sure to include alternative sources of protein, such as meat, fish, poultry, beans, lentils, chickpeas, Quorn or tofu.

Oral allergy syndrome (OAS)

If you’re avoiding certain fruits and veggies, it’s important to consider your vitamin C intake. Vitamin C requirements are raised during the last trimester of pregnancy. Most people with OAS are able to eat well-cooked fruit, as cooking destroys the allergens. However, cooking also reduces the amount of vitamin C in foods. Steaming fruits using minimal water is the best option, and include a wide variety of different fruits. Fruits high in vitamin C include citrus fruits, berries, pineapple and other tropical fruits.

If your fruit and vegetable intake is low, or you cannot tolerate cooked fruits, you may wish to consider taking a supplement containing vitamin C. Suitable options include a pregnancy multi-vitamin supplement or Healthy Start Vitamins. It’s best to avoid single vitamin supplements as they can contain high doses which could be dangerous in pregnancy.

Other allergies, e.g. nut, soya, wheat allergy

If you’re allergic to nuts, soya or any other foods, continue to avoid the offending foods during pregnancy. Take particular care to avoid cross-contamination. If you’re avoiding nuts or soya, be sure to include other sources of protein in your diets, e.g. meat, fish, poultry, beans and lentils. If you’re avoiding wheat, make sure you include a good variety of suitable starchy carbohydrates, like rice, potato, oats or wheat-free pasta.

General tips for all allergy sufferers

  • Let your midwife know about your allergy at your booking appointment so it can be documented.
  • If your symptoms increase during pregnancy, pay your GP a visit to get some advice.
  • When calling your chosen place of birth when you go into labour, be sure to mention your allergy so the unit can arrange suitable meals.
  • Ask your GP to refer you to a dietitian if you have multiple food allergies or increased symptoms and are struggling to maintain a balanced diet in pregnancy.
  • If you suffer from an allergy, your baby will be more likely to develop an allergy. The Department of Health recommends that you exclusively breastfeed your baby for the first six months to help reduce the risk. Whilst you’re pregnant, think about how you wish to feed your baby, and obtain all the information on breastfeeding you need to make an informed choice.

    Great Britain: Committee on Medical Aspects of Food Policy and Great Britain: Department of Health (1991) Dietary reference values for food energy and nutrients for the United Kingdom. Stationery Office Books.

    Greenberg JA, Bell SJ and Ausdal WV (2008) Omega-3 fatty acid supplementation during pregnancy. Rev Obstet Gynecol. 1(4):162-169.

    McCance RA and Widdowson EM (2002) McCance and Widdowson's The Composition of Foods Sixth Summary Edition. Royal Society of Chemistry.