Many believe the keto diet to be an effective way to lose weight and benefit from countless positive diet changes from feeling more energetic to decreasing type two diabetes risk. However, for expectant mothers or women who are looking to get pregnant, they might be curious if the ketogenic diet will work with this cycle of life. In case you’re curious about this high-fat, low carb diet, the Body Reboot book goes into greater detail about the positive health benefits the diet provides. Whether ketosis is safe for pregnant women is a critical topic to discuss. That’s why we thought we’d cover this subject in more detail so you can make the best decisions regarding being in ketosis while pregnant.

For starters, Maria from Keto Adapted discusses a few misconceptions women may have about pregnancy and the keto diet. She says that many believe that the diet is harmful to a fetus, but she disagrees.

I get a ton of emails a few months after these consults telling me that they are ecstatic and are now pregnant but are wondering on what to eat now. As if this diet of REAL food would be harmful to a fetus. There are many reasons why to not add in certain foods like gluten and dairy. Many times when cravings get the best of pregnant clients and they consume these foods, the auto-immune response can result in a miscarriage. But even if the clients are committed about staying away from gluten and dairy, they often worry that too low of carbs is bad for the fetus. You will never find evidence of this, but you will read it all over the web. The information that clients read have a few flaws:

A huge mistake is when people and doctors compare benign dietary ketosis to diabetic ketoacidosis. You can produce ketones in a starvation state. So instead of using a well-formulated low carb diet, they starved pregnant rats to get them into ketosis. The flaw in that evidence should be obvious.

One woman named Amanda Colbert on Babygaga blog documented how she felt during her pregnancy while on the keto diet. The author was thrilled with how she felt while on her pregnancy. However, she still reminds mothers not to ignore their doctors, even though the decisions she made for herself helped her have a better pregnancy.

During my more recent pregnancy with my daughter, I made several changes. I ate a moderate-carb daily diet of 50 net grams of carbs or fewer. The nutritionist explained that I should be eating more carbs and I just nodded and smiled at her. I gained just half the weight I had gained when I was pregnant with Shep, which made this pregnancy somewhat easier on my body. Instead of drinking a huge dose of sugar water for the glucose tolerance test, I offered a compromise. I'd monitor my glucose by finger pricks so that my endocrinologist could get more data with which to make an evidence-based decision on my care and treatment. I staved off gestational diabetes for a whole month longer than I did with my son – but it got me again, that darn fetus beetus! But even this was different – I only needed insulin once per day (long-acting at night) and I needed less than half of what I required the first time around. My glucose levels were much more stable and mostly controlled by diet an exercise, with a boost of insulin for my fasting levels.

However, despite many women's positive experiences of being on the keto diet while pregnant, a 2013 study by BMC Pregnancy Childbirth found that the keto diet may potentially cause harm to a fetus:

An anatomical comparison of the SD and KD embryos revealed that at E13.5 the average KD embryo was volumetrically larger, possessed a relatively larger heart but smaller brain, and had a smaller pharynx, cervical spinal cord, hypothalamus, midbrain, and pons, compared with the average SD embryo. At E17.5 the KD embryo was found to be volumetrically smaller with a relatively smaller heart and thymus, but with enlarged cervical spine, thalamus, midbrain and pons.

A ketogenic diet during gestation results in alterations in embryonic organ growth. Such alterations may be associated with organ dysfunction and potentially behavioral changes in postnatal life.

Perfect Keto argues that being on the keto diet while being pregnant is safe, but it’s still important to be cautious. Keep in mind that the keto diet is often used to lose weight, and that isn’t a good idea while pregnant. It’s best to focus on eating whole foods, and they also recommend other tips below:

Although ketosis is natural and safe if done effectively, big changes happen in a woman’s body and extra precautions must be taken during this cycle of life. Here are some things to keep in mind for those who are pregnant, whether in ketosis or not:

Don’t aim for weight loss. We know the ketogenic diet is effective for weight loss, but for most pregnant women, pregnancy is not the time to pursue it. No matter what way of eating is being followed, getting enough calories and proper nutrition is most important.

Eat whole foods. Speaking of nutrition, it’s especially vital when you’re growing a baby. That being said, there are some foods with carbohydrates that are important for pregnant women to include in their diets: vegetables and fruits, nuts and seeds, legumes, and sometimes dairy.

Avoid refined grains, added sugars, and processed foods. The quality of carbohydrates is important to ensure the diet is nutrient-dense and both mom and baby are getting the good stuff they need to thrive.

Don’t do intermittent fasting. While intermittent fasting has a variety of benefits for the average person, it’s not appropriate during pregnancy when it’s most important to listen to your own hunger cues and ensure mother and baby are getting enough nutrients for growth.

The Diet Doctor supports Perfect Keto’s analysis that the keto diet may benefit pregnant women, and cites one doctor’s opinion and findings on the matter as well:

“It is completely safe for women to be eating a ketogenic diet in pregnancy. Women in ancient times were certainly ketotic during pregnancy,” says Dr. Michael Fox, fertility specialist at the Jacksonville Center for Reproductive Medicine, who has not only been recommending a low-carb ketogenic diet for 17 years to his infertile patients but also to all his patients who become pregnant. He has now had hundreds of patients “who have been completely ketotic throughout pregnancy without any untoward effects.”

He recommends women start the diet two to three months before trying to conceive so that the mom is fat adapted before entering pregnancy. He advises that, once pregnant, the mother enjoy frequent low-carb, high-fat eating every two hours from the time she wakes up — with no fasting. His provides a dietary handout of meal and snacking foods that lists items such as cream cheese or unsweetened nut butters on vegetables like celery, cucumber or cauliflower, as well as nuts, egg in all forms, meats, canned and fresh fish, cheeses, avocado, unflavoured pork rinds, butter, full-fat cream.

In his experience eating this way decreases the rates of miscarriage, preeclampsia, gestational diabetes and morning sickness. “Nausea is a reactive hypoglycemic reaction to the dramatically increased insulin resistance caused by pregnancy hormones,” he said.

In addition, Diet Doctor also mentions a few more authors who also highly recommend the keto diet while being pregnant.

Ketogenic expert, author, and Diet Doctor contributor Maria Emmerich, who has the popular ketogenic website Mind Body Health, has counselled hundreds of women on ketogenic eating during pregnancy, with great results. “As if this diet of real food would be harmful to the fetus?” she asks rhetorically. She points to evidence that the fetus is naturally in a frequent state of ketosis7 and that it is essential for laying down fatty structures like brains and nerve cells.

Another expert in low carb or ketogenic diets in pregnancy is US dietitian Lily Nichols, whose popular 2015 book Real Food For Gestational Diabetes has a whole chapter on the misconceptions surrounding ketosis in pregnancy. She has helped hundreds of pregnant women in her career as specialist in gestational diabetes (GD), also known as “carbohydrate intolerance of pregnancy.” Along with her book and website, she frequently blogs and appears as an expert guest on low-carb keto podcasts. GD is such an important issue in pregnancy, particularly for women who may have undiagnosed pre-diabetes prior to conception, that part two of this post focuses solely on that condition, and what to eat for it, featuring an in depth interview with Nichols.

At the time of writing this post, we're currently giving away free copies of the Body Reboot book because it's our mission to increase awareness and to help people lose weight and get healthy! If you help us cover the cost of shipping, we’ll send a copy to your door FREE. Go over to this page to see if there are any copies left.

Sources: Keto Adapted, Babygaga, NCBI: BMC Pregnancy Childbirth. 2013, Perfect Keto, Diet Doctor