Is spinach good during pregnancy?

Yes, as one vegetable among many, and it does not do the job of a folic acid tablet. The proven protection against neural tube defects comes from folic acid: a Cochrane review of five trials with 6,708 births found daily folic acid supplements gave a risk ratio of 0.31 (95% CI 0.17 to 0.58), on high-quality evidence. Spinach is among the foods highest in folate, according to the US National Institutes of Health, and no trial has tested whether eating it matches the tablet. Nobody has run a trial of spinach itself in pregnancy.

Established. Folic acid before and in early pregnancy prevents most neural tube defects. US experts advise every woman who could become pregnant to take 400 mcg of folic acid a day from supplements, fortified foods or both, in addition to the folate from a varied diet. Spinach belongs in that varied diet and does not replace the 400 mcg.

What the trials found

The folic acid evidence is the strongest on this page, and it is about tablets. In the Cochrane review, folic acid alone or with other vitamins and minerals cut neural tube defects to about a third of the rate seen without it. Spinach was not tested in any of those trials.

One randomized trial fed leafy greens to women before and during pregnancy. In slums in Mumbai, women were given a daily snack of green leafy vegetables, fruit and milk or a low-micronutrient snack of potato and onion. Among 1,008 women who had a glucose test, gestational diabetes fell from 12.4 to 7.3 percent, an odds ratio of 0.56 (95% CI 0.36 to 0.86). Only half the eligible women had that test, the snack was a mix of foods, and the women started from a low intake. In 1,360 newborns from the same trial, birth weight did not rise overall, a gain of 0.92 oz (26 g) with a confidence interval running from 15 g less to 68 g more (P = 0.22).

The rest is observational. A meta-analysis of 13 cohort studies linked a vegetable dietary pattern to a lower risk of gestational diabetes, a risk ratio of 0.86 (0.76 to 0.98), with spinach not counted separately. Among 872 Nigerian pregnant women who already had moderate or severe anemia, those who ate green leafy vegetables daily had lower odds of iron deficiency anemia than those who never did, an odds ratio of 0.26 (0.09 to 0.73). That was a cross-sectional survey of self-reported intake of local greens, which shows a pattern and cannot show cause.

Myth. Spinach is not the iron food it is made out to be. The NIH notes that spinach is a good plant source of iron with low bioavailability, because it contains absorption inhibitors such as polyphenols. In pregnancy, when iron needs rise, spinach is a poor thing to rely on for iron.

Who should be careful

A common worry is that leafy greens carry heavy metals. In 2,169 pregnant British women in the ALSPAC cohort, those who ate leafy green and green vegetables four or more times a week had lower odds of blood cadmium above the median, an odds ratio of 0.72 (0.56 to 0.92). That is observational, and a study of lead in Mexican adolescents found the opposite sign, though not in pregnant women.

Not for everyone. If you take warfarin, spinach is a food to keep steady rather than to swing up and down. A systematic review of 149 reports on warfarin interactions names spinach among the foods that need awareness. In pregnancy warfarin is usually replaced by heparin, so this matters only for the few women who stay on it, and the amount is a question for the doctor managing it.

The cards on this page say nothing about washing raw spinach or about listeria and other germs on raw greens in pregnancy. We found no trusted source on that point that named spinach.

What expert bodies say

The US Food and Nutrition Board advises all women and adolescents who are capable of becoming pregnant to take 400 mcg of folic acid daily from supplements, fortified foods or both, in addition to food folate from a varied diet. The NIH Office of Dietary Supplements lists spinach, liver, asparagus and brussels sprouts among the foods with the highest folate levels, and notes that the iron in spinach is poorly absorbed.

How we searched

What would change this answer

• A trial testing whether food folate from spinach and other greens protects against neural tube defects as well as folic acid does. Until then, the tablet stays.
• A repeat of the Mumbai gestational diabetes result in another population, with every woman tested and greens separated from fruit and milk.
• Studies that count spinach separately. Every result here is about leafy greens, vegetables or folate in general.

More on the vegetable itself: Spinach.

Sources

1. ev-sppr-01 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized and quasi-randomized trials with GRADE · n = 6,708 births
   The results of the first comparison involving 6708 births with information on NTDs and other infant outcomes, show a protective effect of daily folic acid supplementation (alone or in combination with other vitamins and minerals) in preventing NTDs compared with no interventions/placebo or vitamins and minerals without folic acid (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.17 to 0.58); five studies; 6708 births; high quality evidence).
   
   Who: women of any age and parity, periconceptional folate alone or with other micronutrients vs none, placebo or micronutrients without folate
   Effect: neural tube defects RR 0.31 (95% CI 0.17 to 0.58; 5 trials; high quality); recurrence RR 0.34 (0.18 to 0.64; 4 trials, 1,846 births); no effect on miscarriage RR 1.10 (0.94 to 1.28)
   Certainty: Supplement trials, not spinach. Relevance: spinach is a folate food, but the proven protection comes from folic acid tablets or fortified foods.
   Cochrane Database Syst Rev, 2015 · checked 2026-10-07 · we read the abstract
2. ev-sppr-02 · Position of an expert body · agency fact sheet · n = —
   Spinach, liver, asparagus, and brussels sprouts are among the foods with the highest folate levels.
   
   Who: general population food sources
   Effect: spinach among the top food sources of folate
   Certainty: T2, level E. Amount per serving is in the ODS table, not carded as a quote.
   NIH Office of Dietary Supplements, Folate Fact Sheet for Health Professionals · checked 2026-10-07 · we read the section
3. ev-sppr-03 · Position of an expert body · agency fact sheet citing Food and Nutrition Board and USPSTF · n = —
   The FNB advises all women and adolescents who are capable of becoming pregnant to “consume 400 mcg of folic acid daily from supplements, fortified foods, or both in addition to consuming food folate from a varied diet” [2].
   
   Who: women and adolescents capable of becoming pregnant
   Effect: 400 mcg/day folic acid plus food folate; USPSTF 400 to 800 mcg from 1 month before conception through the first 2 to 3 months
   Certainty: T2, level E. Food folate such as spinach is in addition to, not instead of, folic acid.
   NIH Office of Dietary Supplements, Folate Fact Sheet for Health Professionals · checked 2026-10-07 · we read the section
4. ev-sppr-04 · Randomized controlled trial(s) · nonblinded individually randomized controlled trial (Project SARAS) · n = 1,008
   In an intention-to-treat analysis, the prevalence of GDM was reduced in the treatment group (7.3% compared with 12.4% in controls; OR: 0.56; 95% CI: 0.36, 0.86; P = 0.008).
   
   Who: women living in Mumbai slums, snack from before conception through pregnancy vs low-micronutrient snack (potato, onion); OGTT at 28 to 32 weeks
   Effect: GDM 7.3% vs 12.4%, OR 0.56 (95% CI 0.36 to 0.86), P = 0.008, intention to treat
   Certainty: Snack mixed leafy greens with fruit and milk, so not spinach alone; only 50% of eligible women had an OGTT; low-intake setting. ISRCTN62811278.
   J Nutr, 2016 · checked 2026-10-07 · we read the abstract
5. ev-sppr-05 · Randomized controlled trial(s) · nonblinded individually randomized controlled trial (Mumbai Maternal Nutrition Project) · n = 1,360 newborns
   In an intention-to-treat analysis, there was no overall increase in birth weight in the treatment group (+26 g; 95% CI: -15, 68 g; P = 0.22).
   
   Who: women in Mumbai slums, daily snack of green leafy vegetables, fruit and milk from 90 days or more before pregnancy until delivery
   Effect: birth weight +26 g (95% CI -15 to 68), P = 0.22; per protocol +48 g (1 to 96); low birth weight ITT OR 0.83 (0.66 to 1.05)
   Certainty: Primary outcome null; benefit only in per-protocol and non-underweight subgroups.
   Am J Clin Nutr, 2014 · checked 2026-10-07 · we read the abstract
6. ev-sppr-06 · Observational data · systematic review and meta-analysis of cohort studies · n = 13 studies
   This meta-analysis revealed that "prudent" (RR = 0.78, CI = 0.63-0.96), "vegetable" (RR = 0.86, CI = 0.76-0.98), and "Mediterranean" (RR = 0.71, CI = 0.56-0.91) dietary patterns with high levels of whole grain, fruits, vegetables, and low fat dairy intake decreased the risk of GDM.
   
   Who: pregnant women in 13 cohort studies
   Effect: vegetable pattern RR 0.86 (95% CI 0.76 to 0.98); prudent RR 0.78 (0.63 to 0.96); Mediterranean RR 0.71 (0.56 to 0.91); western RR 1.27 (1.03 to 1.56)
   Certainty: Meta-analysis of cohorts, so C. Pattern-level, spinach not isolated.
   Clin Nutr ESPEN, 2020 · checked 2026-10-07 · we read the abstract
7. ev-sppr-07 · Observational data · cross-sectional study · n = 872
   The odds for IDA reduces from aOR: 0.36 (95%CI: 0.13 - 0.98) among pregnant women who consume green leafy vegetables every 2-3 weeks, to 0.26 (95%CI: 0.09 - 0.73) among daily consumers, compared to those who do not eat it.
   
   Who: pregnant women at 20 to 32 weeks with hemoglobin below 10 g/dL in Lagos and Kano, Nigeria
   Effect: IDA aOR 0.36 (95% CI 0.13 to 0.98) every 2 to 3 weeks; 0.26 (0.09 to 0.73) daily, vs none
   Certainty: Cross-sectional, self-reported intake; OR, not risk; local leafy greens, not spinach specifically.
   BMC Pregnancy Childbirth, 2024 · checked 2026-10-07 · we read the abstract
8. ev-sppr-08 · Position of an expert body · agency fact sheet · n = —
   Some plant-based foods that are good sources of iron, such as spinach, have low iron bioavailability because they contain iron-absorption inhibitors, such as polyphenols [23,24].
   
   Who: general population
   Effect: spinach iron poorly absorbed; inhibitors such as polyphenols
   Certainty: T2, level E. Spinach should not be counted on as the main iron source in pregnancy.
   NIH Office of Dietary Supplements, Iron Fact Sheet for Health Professionals · checked 2026-10-07 · we read the section
9. ev-sppr-09 · Observational data · observational cohort analysis · n = 2,169
   There were similarly reduced likelihoods for all leafy green and green vegetables (0.72 (0.56-0.92) when consumed ≥4 times/week vs ≤1 to ≥3 times/week) and with all meats (0.66 (0.46-0.95) when consumed ≥4 times/week vs ≤ once in 2 weeks).
   
   Who: pregnant women in the ALSPAC cohort, UK, with whole blood cadmium
   Effect: blood Cd at or above 0.26 ug/L: OR 0.72 (95% CI 0.56 to 0.92) for leafy green and green vegetables at least 4 times a week
   Certainty: Observational; addresses the worry that leafy greens load heavy metals. Opposite sign seen in a Mexican adolescent cohort for lead (40480419), not pregnant women.
   Nutrients, 2020 · checked 2026-10-07 · we read the abstract
10. ev-sppr-10 · Observational data · systematic review of interaction reports · n = 149 articles
    These include Chinese wolfberry, chamomile tea, cannabis, cranberry, chitosan, green tea, Ginkgo biloba, ginger, spinach, St. John's Wort, sushi and smoking tobacco.
    
    Who: 149 articles describing 78 herbs, foods or supplements reported to interact with warfarin
    Effect: 45 of 78 items potentiated warfarin, 23 inhibited it; spinach named among items needing awareness
    Certainty: Relevant in pregnancy only for the few on anticoagulants (mechanical valves); warfarin is usually replaced by heparin in pregnancy. Consistency of intake matters more than avoidance.
    Br J Clin Pharmacol, 2021 · checked 2026-10-07 · we read the abstract