Davit Orujyan, Edward Lee, Daniela Sharp, Sandeep Lankireddy, Mitchell Goldstein, MD, MBA, CML 

Dear Editor: 

We read “The Transcript of Jane Velez-Mitchell’s Interview with Neonatology Today” with great interest (Hillyer, K. NT Behind the Scenes: Jane Velez-Mitchell of the Unchained TV Network Discusses Pig Little Lies. Neonatology Today. 2022;17(10):33-46.). This interview, conducted by Dr. Kimberly Hillyer, focused on animal activism, vegetarian/veganism, and health through Velez-Mitchell’s new reality show, “Pig Little Lies,” on “Unchained TV.” The interview concluded that widespread vegetarian/veganism could help remedy global issues like climate change, hunger, and animal abuse. Vegetarianism/veganism is also reported to improve people’s health by lowering cholesterol levels and decreasing occurrences of heart disease, cancer, and other systemic diseases. We, too, are passionate about bettering health worldwide and are inspired by challenging the status quo. However, there was no mention of how veganism is related to neonatology or perinatal health, even when there are known benefits. Because we see possible advantages of this diet in neonatal and perinatal health, we encourage a more focused approach that would enhance the journal, perhaps related to the specific effects of a plant-based diet in pregnancy and postpartum. 

We agree that current animal agricultural practices are concerning and demand change. A plant-based diet can cause pregnant women to be deficient in many vitamins and minerals, such as iron, vitamin D, calcium, iodine, omega-3, and vitamin B12 (1, 2). Fortunately, in modern society, it is possible to maintain a well-balanced vegetarian/vegan diet with the correct supplemental additions. A balanced diet could lower risk factors such as preeclampsia, ultimately improving maternal and infant outcomes (2). Interestingly, Abbasi et al. conducted a case-control study comparing the dietary patterns of 510 pregnant females which the participants were divided into three different groups consisting of the Western diet (high in red meat and processed meat), the Iranian diet (high in eggs, and legumes), and Healthy diet (high in fruits, low-fat dairy, dried fruits, nuts, vegetables, fruit juice, liquid oil, and tomatoes). They found a statistically significant difference in which the Western diet had a 5.99 times greater increase in preeclampsia odds than the Healthy diet (3). 

Some parents may also have concerns regarding breast milk composition when nursing their infant on a plant-based diet. However, suppose the mother understands keeping a balanced diet by supplementing certain fatty acids, vitamin B12, and other minerals. In that case, there should similarly be no issues. Breast milk will have the nutritional value necessary to sustain a growing infant (4). In addition to the above, further literary research could depict how a vegetarian/vegan diet could even be beneficial in decreasing the occurrence of some pediatric conditions. As Pistollato et al. described, the maternal intake of certain vegetarian/vegan foods in 763 Japanese mother-child pairs shows this relationship between vegetarian/vegan diets and decreased incidence of pediatric wheezing, asthma, and eczema in ages 16-24 months (5). 

In conclusion, we believe that adapting further interviews to neonatal and perinatal health will enhance the impact a transcript can have in “Neonatology Today.” We look forward to future developments in the field of diet and health. 

References: 

1. Craig WJ, Mangels AR, Fresán U, Marsh K, Miles FL, Saunders AV, et al. The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals. Nutrients. 2021;13(11). Epub 20211119. doi: 10.3390/nu13114144. PubMed PMID: 34836399; PubMed Central PMCID: PMCPMC8623061. 
2. ‘Sebastiani G, Herranz Barbero A, Borras-Novell C, Alsina Casanova M, Aldecoa-Bilbao V, Andreu-Fernandez V, et al. The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Nutrients. 2019;11(3). Epub 2019/03/09. doi: 10.3390/nu11030557. PubMed PMID: 30845641; PubMed Central PMCID: PMCPMC6470702. 
3. Abbasi R, Bakhshimoghaddam F, Alizadeh M. Major dietary patterns in relation to preeclampsia among Iranian pregnant women: a case-control study. J Matern Fetal Neonatal Med. 2021;34(21):3529-36. Epub 20191117. doi: 10.1080/14767058.2019.1686474. PubMed PMID: 31736380. 
4. Karcz K, Królak-Olejnik B. Vegan or vegetarian diet and breast milk composition – a systematic review. Crit Rev Food Sci Nutr. 2021;61(7):1081-98. Epub 20200422. doi: 10.1080/10408398.2020.1753650. PubMed PMID: 32319307. 
5. Pistollato F, Sumalla Cano S, Elio I, Masias Vergara M, Giampieri F, Battino M. Plant-Based and Plant-Rich Diet Patterns during Gestation: Beneficial Effects and Possible Shortcomings. Adv Nutr. 2015;6(5):581-91. Epub 20150915. doi: 10.3945/an.115.009126. PubMed PMID: 26374180; PubMed Central PMCID: PMCPMC4561836. 

Sincerely, 

Davit Orujyan, Edward Lee, Daniela Sharp, Sandeep Lankireddy 

Western University of Health Sciences, Pomona, CA 

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Dear Davit Orujyan, Edward Lee, Daniela Sharp, and Sandeep Lankireddy: 

Thank you for taking the time to review this manuscript. Indeed, the effect of a well-balanced plant-based diet has improved adult patients’ health. Sophisticated protein needs and other growth benefits are best provided to newborns through their mother’s breastmilk. However, there are certain conditions, including milk protein allergies and metabolic disorders, which preclude the use of human milk. In this case, it can be argued that the advancement of Vegan and Vegetarianism lifestyles has improved protein science and potentially offered options for these most at-risk newborns. Even though breastmilk is decidedly not a Vegan product, most Vegan parents do recognize the superiority, albeit no longer necessarily a requirement of breastmilk in their newborn’s diet. Still, especially with Vegan parents, proper dietary supplementation (1) must occur in the mom for the breastmilk to contain the necessary nutrition. (2) Where this is not achievable or acceptable, soy and elemental formulations are available. 

Although there may be benefits in the long term, term outcomes for the children of parents who have a Vegetarian or Vegan diet, the risks of undernutrition in Vegan patients may outweigh the benefits. In these situations, again, formula supplementation may be preferable. There have been discussions of post-expression supplementation in Vegan moms to ensure adequate nutrition. (3) This practice needs to be approached on a case-by-case basis, as it may be more appropriate to improve the mom’s nutrition which would then concomitantly provide enhanced or appropriate nutrition to the newborn. 

All of these considerations notwithstanding, eliminating mom’s milk from the newborn’s diet will have another potentially far-reaching effect in so far as the lack of an immunologic component from the newborn’s diet. Certain infections, including seasonal viral infections like RSV, can be mitigated by the transfer of maternal antibodies. (4) With the risk of severe infection and yet unknown or evolved viruses, mom’s own milk is the best defense against these potential infections. 

The association of various immune-mediated diseases with maternal consumption of animal proteins has significant support in the literature and deserves attention. However, the concern regarding possible nutritional deficiencies may outweigh the benefit, especially when adequate prenatal care cannot be assured and monitoring for nutritional deficiencies is beyond the scope of those providing prenatal care. (3, 5) 

References: 

1. Sklar R. Nutritional vitamin B12 deficiency in a breast-fed infant of a vegan-diet mother. Clin Pediatr (Phila). 1986;25(4):219- 21. Epub 1986/04/01. doi: 10.1177/000992288602500409. PubMed PMID: 3948463. 
2. Sebastiani G, Herranz Barbero A, Borras-Novell C, Alsina Casanova M, Aldecoa-Bilbao V, Andreu-Fernandez V, et al. The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Nutrients. 2019;11(3). Epub 2019/03/09. doi: 10.3390/nu11030557. PubMed PMID: 30845641; PubMed Central PMCID: PMCPMC6470702. 
3. Pawlak R. To vegan or not to vegan when pregnant, lactating or feeding young children. Eur J Clin Nutr. 2017;71(11):1259- 62. Epub 2017/07/27. doi: 10.1038/ejcn.2017.111. PubMed PMID: 28745335. 
4. Abu-Raya B, Reicherz F, Lavoie PM. Correlates of Protection Against Respiratory Syncytial Virus Infection in Infancy. Clin Rev Allergy Immunol. 2022. Epub 2022/06/12. doi: 10.1007/s12016-022-08948-8. PubMed PMID: 35689745. 
5. Muller P. Vegan Diet in Young Children. Nestle Nutr Inst Workshop Ser. 2020;93:103-10. Epub 2020/01/29. doi: 10.1159/000503348. PubMed PMID: 31991425.