Nutrition Before &
During Pregnancy

Adjusting your IBD diet for baby

Good nutrition before and during pregnancy improves your chances of having a healthy baby. But getting all the nutrition you both need can be challenging with IBD. This is especially true with active IBD since bowel inflammation and diarrhea can prevent proper absorption or the loss of nutrients. It can also reduce your appetite and make certain foods harder to digest.

Healthy nutrition for the duration of your pregnancy actually starts before you become pregnant. Talk with your gastroenterologist or doctor several months before trying to conceive. This gives your doctor time to perform diagnostic tests and find any nutritional deficiencies you may need to correct before you become pregnant.

Potential IBD nutritional deficiencies during pregnancy

Folic acid

Folic acid (also known as "folate" or "vitamin b9") is very important to the growth of your baby, and deficiencies during pregnancy can lead to major neural tube birth defects. Certain IBD medications, such as methotrexate or sulfasalazine, can increase the risk of folic acid deficiency.

You should begin taking 600-800 micrograms (the dosage found in most prenatal vitamins) of folate daily as soon as you are contemplating pregnancy and throughout your pregnancy. If you have a folate deficiency or are on sulfasalazine, you should take a higher supplementation of folate, around 1000-2000 micrograms (1-2 milligrams) per day as recommended by your doctor.

Vitamin D

Vitamin D deficiency is also common among IBD patients and is associated with decreased fertility and an increased risk of miscarriage. Prescription-strength doses of Vitamin D, typically 50,000 International Units weekly for 8-12 weeks, may be recommended depending on your level of deficiency. It's important to know what kind of Vitamin D you are using to supplement your diet, because Vitamin D3 may absorb more efficiently than Vitamin D2 does.

Iron

Many women require iron supplementation during pregnancy, and it is even more common for pregnant women with IBD. This is because pregnant women on average require twice the amount of daily iron as non-pregnant women do. And women with IBD may require even more due to iron loss through gastrointestinal bleeding.

Unfortunately, many women with IBD have difficulty with iron supplements as they can cause abdominal pain or constipation. If this is problematic during your pregnancy, you may want to talk to your doctor about a liquid form of iron, such as Spatone^®, or intravenous iron.

You should talk to your doctor about which form of iron supplementation (if any) is right for you.

Pregnancy supplements

You should work with your doctor to determine whether you will need to take dietary supplements during your pregnancy, but taking a daily prenatal vitamin is generally recommended. These vitamins contain most of the essential vitamins and minerals you and your baby will need during pregnancy. However, women with IBD often require a little extra support, specifically when it comes to folic acid, vitamin D and iron.

What to eat during pregnancy

Since protein, iron, calcium and folic acid intake are needed for a healthy pregnancy, you may want to adjust your inflammatory bowel disease diet while expecting. We've provided a list of good diet-based nutrient sources in the table below.

Pregnancy-approved nutrient sources

Nutrient	Dietary Sources
Protein	Red meats, poultry, fish, tofu, eggs, lentils & quinoa
Iron	Red meat, poultry, fish, spinach, leafy greens & beans* *Tip - Increase iron absorption by consuming iron with vitamin-C rich foods such as oranges or fruit juice. Also avoid consuming plant-based iron sources at the same time as dairy since calcium can inhibit iron absorption.
Calcium	Milk, yogurt or cheese or calcium-fortified cereals & juices
Folate	Cereals, breads, legumes, leafy greens & citrus fruits

Healthy weight during pregnancy

As an expecting mother, you'll need to eat more than you did before you became pregnant to make sure your baby gets all the nutrition he or she needs. However, the common saying, "eating for two" is not quite correct. Most women only need to increase caloric intake by 200-300 calories a day during the first two trimesters and by 500 calories during the third trimester.

However, if you are underweight or have active IBD, you may need to increase your daily caloric intake by an additional 10% to 20%. This is because underweight mothers have an increased risk for underweight or preterm babies. Therefore, it's important to talk to your doctor and work with a dietician, preferably one with IBD experience, when planning for pregnancy.

What shouldn't I eat?

When expecting, you may be more susceptible to serious foodborne infections, including listeria and salmonella. Therefore, you should avoid the following foods throughout your pregnancy:

• All raw or undercooked meat, eggs and seafood (including sushi)
• Unpasteurized milk or foods that contain unpasteurized milk (common in restaurant desserts)
• Luncheon meats, smoked seafood and pâtés (meat pastes)