Nutrients to Consider When Preparing for Pregnancy in IBD

Nutrients to Consider When Preparing for Pregnancy in IBD

Many of our clients come to us to discuss preparing for pregnancy in IBD, and for good reason! The pre-pregnancy window is a great opportunity to improve nutrient status, especially because early pregnancy is typically met with side effects like nausea and food aversions, making it difficult to meet nutrient requirements (2). 

The World Health Organization highlights the fact that nutritional deficiencies before and during pregnancy can have dramatic impacts on birth outcomes and the child’s development, as well as inadequate or excess maternal weight gain.  

General healthy eating interventions can also be helpful during pre-pregnancy to prevent preeclampsia or gestational diabetes, two common conditions in pregnancy. For those with IBD, pre-pregnancy can be filled with anxiety and uncertainties, but with proper support it can be a joyful one as well!     

Today we will discuss specific nutrients of concern when preparing for pregnancy in IBD. 

Folate  

Folate or folic acid is most beneficial 2-3 months before pregnancy and during the first trimester while the fetus’ neural tube is being developed (5). Many may not even know they are pregnant at this point, which is why many countries have fortified foods like grain products to ensure some folate is being supplied to conceiving mothers. 

Because folate is absorbed in the small intestine, a commonly affected site in IBD, it is a nutrient of concern for pregnancy in IBD (6). Supplementing with a highly absorbable form of folate prior to pregnancy, such as a methylated folate, has been shown to reduce the risk of neural tube defects and can also positively affect IBD symptoms (5). 

Food sources of folate are not very stable and are easily broken down in the cooking process. At least 400 mcg of folate is recommended to reduce the risk of neural tube defects, however those with IBD may require more (5). It’s important to discuss dosage with your healthcare team because too much folate can pose a risk as well. 

Choline

Choline is another important nutrient that plays a vital role in brain development and the prevention of neural tube defects. Choline has a growing body of evidence behind it, yet is not routinely found in prenatal supplements. It can be found in foods like egg yolks, soy, and broccoli, however the amount required for the prenatal period would be difficult to obtain from food alone. This is especially true for someone with IBD, who may have additional challenges related to absorption of nutrients from food. 

The recommendations for choline in pregnancy are currently 450 mcg per day and many women are not achieving this goal (3). Increasing dietary choline options as well as potentially supplementing may be a beneficial strategy for those preparing for pregnancy in IBD.

 Iron

Iron is an important nutrient for both IBD and pregnancy. Iron status should be regularly monitored in anyone with IBD and especially in those with IBD preparing for or are already pregnant. Extra iron is necessary in preparation for and during pregnancy because more red blood cells are required for the fetus, placenta, and maternal red cell mass. 

Iron deficiency anemia is common in IBD and the pre-pregnancy time frame should be used to correct the deficiency as fully as possible to help with fetal development and the health of the mother. Iron deficiency in pregnancy is associated with impaired fetal development, preterm delivery, and low birth weight, as evidenced by the World Health Organization’s initiative for Good Maternal Nutrition. 

Iron supplementation can be difficult to manage, so it’s important to work closely with your healthcare team to correct anemia in a way that is tolerable. We typically suggest an iron bisglycinate version because it is more easily absorbed with less side effects (4). 

Vitamins B6 & B12

B vitamins are important to body functions because they are responsible for acting as a catalyst for energy production. Vitamin B6 is also important for blood cell formation, brain function, and can help prevent nausea in pregnancy (7). Between 10-25 mg, three times per day can be used to alleviate nausea in pregnancy. 

A consistent source of Vitamin B12 is a good idea in those preparing for pregnancy with IBD because B12 requirements increase slightly in pregnancy (1). B12 is also likely needed in higher amounts in those eating primarily a plant-based diet and those with absorption difficulties, like many with IBD. Similar to folate, B12 is also absorbed in the small intestine, making it difficult for some with IBD to maintain appropriate levels. 

Nutrients to Consider for Pregnancy in IBD: Key takeaways 

There are several nutrients to consider when preparing for pregnancy in IBD. IBD creates significant challenges in maintaining healthy nutrient status in the body and appropriate precautions and collaboration with the healthcare team is needed to prepare yourself and your family for a healthy pregnancy in IBD. 

We have worked with many clients pre-pregnancy, during pregnancy, and after to establish and maintain a healthy environment for the fetus to grow, develop, and thrive. If you are looking for support while preparing for pregnancy in IBD, book a consultation here! 

References: 

1. Allen LH. Vitamin B12 metabolism and status during pregnancy, lactation and infancy. Adv Exp Med Biol. 1994;352:173-86. doi: 10.1007/978-1-4899-2575-6_14. PMID: 7832046. (7)
2. Cetin I, Berti C, Calabrese S. Role of micronutrients in the periconceptional period. Hum Reprod Update. 2010 Jan-Feb;16(1):80-95. doi: 10.1093/humupd/dmp025. PMID: 19567449. (1)
3. Korsmo HW, Jiang X, Caudill MA. Choline: Exploring the Growing Science on Its Benefits for Moms and Babies. Nutrients. 2019 Aug 7;11(8):1823. doi: 10.3390/nu11081823. PMID: 31394787; PMCID: PMC6722688. (4)
4. Layrisse M, García-Casal MN, Solano L, Barón MA, Arguello F, Llovera D, Ramírez J, Leets I, Tropper E. Iron bioavailability in humans from breakfasts enriched with iron bis-glycine chelate, phytates and polyphenols. J Nutr. 2000 Sep;130(9):2195-9. doi: 10.1093/jn/130.9.2195. Erratum in: J Nutr 2000 Dec;130(12):3106. PMID: 10958812. (5)
5. Locksmith GJ, Duff P. Preventing neural tube defects: the importance of periconceptional folic acid supplements. Obstet Gynecol. 1998 Jun;91(6):1027-34. doi: 10.1016/s0029-7844(98)00060-x. PMID: 9611019. (2)
6. Pan Y, Liu Y, Guo H, Jabir MS, Liu X, Cui W, Li D. Associations between Folate and Vitamin B12 Levels and Inflammatory Bowel Disease: A Meta-Analysis. Nutrients. 2017 Apr 13;9(4):382. doi: 10.3390/nu9040382. PMID: 28406440; PMCID: PMC5409721. (3)
7. Shrim A, Boskovic R, Maltepe C, Navios Y, Garcia-Bournissen F, Koren G. Pregnancy outcome following use of large doses of vitamin B6 in the first trimester. J Obstet Gynaecol. 2006 Nov;26(8):749-51. doi: 10.1080/01443610600955826. PMID: 17130022. (6)