Associations have been reported between suboptimal maternal vitamin E intake during pregnancy and childhood asthma. This pilot study conducted in 2008/2009 investigated the feasibility and acceptability of a food-based randomized controlled trial in pregnant women to optimize dietary vitamin E intake to 15 mg/day. A food-based intervention using "food exchanges" to individually optimize dietary vitamin E intake to 15 mg/day was developed and included in an advice booklet. Forty-three pregnant women with a personal/partner history of asthma were recruited at 12 weeks gestation and randomized to food-based intervention or a control group until 20 weeks gestation. A registered dietitian assessed the vitamin E intake of 22 women and provided tailored advice on food-based exchanges to optimize their intake to 15 mg/day. The 21 control women were not given dietary advice. The food-based intervention was completed by 19 women and increased mean vitamin E intake: food diary data, 7.13 mg/day (95% confidence interval: 5.63 to 18.6) to 17.4 mg/day (95% confidence interval: 14.4 to 20.5) (P<0.001). This pilot study demonstrates the feasibility and acceptability of a food-exchange-based intervention to optimize dietary vitamin E intake during pregnancy. Additional work is required to determine whether this intervention, if sustained for the rest of pregnancy, reduces the likelihood of childhood asthma. The methodology used in the design of this novel food-based intervention could be transferred to other nutrients.