News

March 10, 2021

IBD Pregnancy Nutrition

Eating well during pregnancy helps to provide you and your baby with the nutrients you need. It’s recommended that you consume a wide variety of foods throughout your pregnancy, including having different colours of fruits and vegetables. Try to have balanced meals, which can look like filling half of your plate with fruits and vegetables, a quarter with protein-rich foods, and a quarter with whole grains or starches. More information on balanced meals can be found in Canada’s Food Guide.


Energy Needs and Healthy Weight Gain

  • You do not need to consume more calories during the first trimester, as energy needs are not increased during this time.
  • On average, most women in singleton pregnancies need an extra 340 calories per day during the second trimester and an extra 450 calories per day during the third trimester. These additional energy needs can typically be met by incorporating an additional one or two snacks throughout the day. Energy needs will be higher for women carrying more than one baby.
  • Rather than counting calories daily, the sufficiency of energy intake can be measured by adequacy of weight gain and following your hunger cues. If you aren’t gaining enough weight, your medical provider may recommend you eat more.
  • Recommended weight gain throughout pregnancy depends on your pre-pregnancy weight.
  • Typically, little weight gain occurs in the first trimester and may be around 0.5-2.0 kg (1.1-4.4 lb). Gradual weight gain should occur during the second and third trimesters. Although there are recommended weight gain trajectories, many factors can influence weight gain, including gastrointestinal symptoms, appetite, fluid gain and your relationship with food. More specific recommendations on weight gain can be found at Health Canada.


Important Nutritional Considerations

Protein
  • Protein needs are not increased in the first trimester. The amount needed daily is around 1.0 g/kg.
  • Protein needs are increased in the second and third trimesters. Estimated needs are based on current weight during pregnancy and are approximately 1.1 g/kg.
  • Your protein needs can typically be met by incorporating protein-rich food at each meal and snack. Examples include seafood, dairy products, eggs, meat, poultry, tofu, legumes, and nuts and seeds.
  • Additional protein may be needed if you are physically active, are having a flare-up, have had resections of your small intestine, and/or have a high ostomy or fistula output. If this is the case, it’s recommended that you speak with a dietitian to discuss your individual needs.
DHA
  • DHA is a type of omega-3 fatty acid and is important for fetal brain and eye development. It’s an essential fatty acid, meaning your body doesn’t naturally produce it and you must get it from your diet and/or a supplement.
  • To get enough from your diet, you could consume 2 servings (150 g or 5 oz) of cooked fish per week. At least one of these servings should be a fatty fish, such as salmon, herring, mackerel or trout. To limit mercury, have no more than two servings of the following fish per month: shark, swordfish, fresh/frozen/canned tuna, marlin, orange roughy, and escolar.
  • While some plant-based foods, like ground flax and hemp seeds contain omega-3s, the type found in them has to be converted to DHA. This conversion is not always efficient and during pregnancy you should not rely on plant-based foods to provide you with enough DHA.
  • If you do not have two servings of fish per week, it’s recommended that you take an omega-3 supplement daily that has at least 200-300 mg DHA in it. Avoid fish liver oil supplements as they are too high in vitamin A. For vegans/vegetarians, algae-based omega-3 supplements are an option.
Fluid intake
  • More fluid is needed during pregnancy to support the growing blood volume and form the amniotic fluid and growing tissues.
  • Aim to consume between 10-12 cups of fluid per day. Water, milk, tea, coffee, broth soup, juice, and fruit drinks count towards fluid intake.
  • You may need additional fluid if you have a fever, are exercising, if you’re in hot weather, and/or if you have diarrhea.

Vitamins, Minerals and Supplements

If you are planning to conceive, it’s recommended that you start taking a prenatal multivitamin for at least 2-3 months before conception. You should continue taking the prenatal multivitamin throughout pregnancy and for 4-5 weeks postpartum or until breastfeeding ends. Below are considerations for select key vitamins and minerals needed during pregnancy. Your specific nutrient needs may be higher if you’re having a flare-up, have had resections of your small intestine, and/or have a high ostomy or fistula output. Also, if you’ve had blood work showing low levels of certain vitamins or minerals, you may need to increase your intake of them. It’s recommended that you speak with your health-care provider to discuss your individual needs.

Folate
  • Intake of folate is crucial as deficiency leads to an increased risk of neural tube defects in the baby and megaloblastic anemia in the mother.
  • Adequate intake is especially important in early pregnancy before most women even know they are pregnant, as this is when the neural tube closes.
  • Dietary folate is found naturally in dark green vegetables, legumes, liver, citrus fruits, and nuts and seeds. Folic acid is the synthetic version of folate that is found in fortified grain products and most supplements.
  • It is advised that any woman who is capable of becoming pregnant take at least 400 mcg of synthetic folic acid daily. Prenatal multivitamins contain folic acid or 5-methyltetrahydrofolate (the active form of folic acid).
  • You may need higher amounts of folic acid if you are at increased risk for neural tube defects. This would include those with active Crohn’s disease in their small intestine and/or those that have had resections of their small intestine. Refer to pages 541 and 542 in this article to learn about additional conditions that increase your risk and recommendations on dosing.
  • Many prenatal multivitamins contain doses of folic acid much higher than 400 mcg. Higher doses may have potential adverse effects, but published studies to date have shown inconsistent data and the links are associational, not causational. If you are at lower risk for neural tube defects, a precautionary approach given the inconclusive data would be to take a prenatal multivitamin that contains between 400-600 mcg of folic acid.
Iron
  • Iron needs are increased in pregnancy and the amount needed is 27 mg per day.
  • It’s recommended that pregnant women get at least 16-20 mg per day from a supplement and the rest from diet. Most prenatal multivitamins contain this amount. The exception is prenatal multivitamin gummies, which do not contain iron. It is best to take a prenatal that contains iron unless you cannot tolerate the form of iron in them. If this is the case, it may be recommended that you take a separate heme-iron supplement.
  • Iron levels are usually monitored during pregnancy and if your levels are low, you may need to take higher amounts of iron. You are at higher risk of having low iron levels if you have frequent blood loss in your stools, have active disease in your small intestine, have had resections of your small intestine, and/or follow a plant-based diet.
Calcium
  • Calcium needs are not increased during pregnancy, but it’s important to make sure you’re getting enough. Many prenatal multivitamins contain insufficient amounts compared to your needs.
  • The amount needed during pregnancy is 1000 mg per day.
  • The amount of calcium commonly found in foods and drinks can be found at Healthlink BC.
  • If you require an additional calcium supplement, calcium carbonate can be constipating whereas calcium citrate is non-constipating.
Vitamin D
  • The minimum daily requirement during pregnancy is 600 IU per day.
  • Given vitamin D is important for the immune system and for helping to control inflammation in the gut, it may be beneficial to aim for closer to 2000 IU per day.
  • Since diet alone usually provides minimal vitamin D and the dose of vitamin D in prenatal multivitamins is typically no more than 1000 IU, you may wish to take an additional vitamin D supplement.
Choline
  • Choline is a nutrient that is important for fetal brain development, placental health, and prevention of neural tube defects.
  • The amount needed during pregnancy is 450 mg per day.
  • It can be difficult to get enough from your diet unless you consume eggs and/or liver regularly. The amount of choline commonly found in foods can be found at Food Sources of Choline.
  • Prenatal multivitamins typically contain no choline or very low amounts of choline. If you can’t get enough from your prenatal multivitamin and your diet, it’s recommended that you take an additional supplement.
Iodine
  • The amount needed during pregnancy is 220 mcg per day.
  • If your prenatal multivitamin doesn’t contain at least 150 mcg of iodine, it’s important to ensure you’re getting enough from dietary sources and/or an additional supplement.
  • An easy way to increase your iodine intake is by using iodized table salt for cooking. Natural sea salt, kosher salt, and pickling salt are naturally low in iodine. Dairy and seafood are examples of iodine-rich sources. The amount of iodine commonly found in foods can be found at Food Sources of Iodine.

The majority of herbal supplements have not been studied in pregnancy and it’s therefore recommended to avoid them. This is often indicated in the cautions and warnings section of the supplement label. While this includes many probiotics, if you were taking a probiotic before pregnancy that you were benefitting from, it’s generally safe to continue taking it during your pregnancy. However, taking high doses of individual vitamins and minerals can be harmful, so it’s best to check with your healthcare provider if you’re taking additional supplements apart from those mentioned above. See the next section for specific considerations related to vitamin A. Health Canada’s Dietary Reference Intake tables provide the Tolerable Upper Intake Level (UL) during pregnancy for select vitamins and minerals where there is adequate research.


Safety Considerations

Food Safety
  • There are many food safety precautions to be aware of during pregnancy, including certain types of foods that should be avoided. Details can be found at Health Canada.
Caffeine
  • Health Canada advises to consume <300 mg per day, but more recent research has caused the American College of Obstetrics and Gynecology to set their recommendation as <200 mg per day.
  • The average caffeine content of foods and drinks can be found at Health Canada.
Herbal Tea
  • 2-3 cups of tea per day made from the following are generally safe during pregnancy: ginger, orange peel, lemon balm, peppermint, rose hip, echinacea, red raspberry leaf (in second and third trimesters).
  • Avoid other types of tea such as chamomile, licorice, fennel, and sage.
Alcohol
  • Safe levels are not known so it’s recommended to avoid it completely during pregnancy.
  • Ideally, you should also be avoiding it when trying to conceive.
Vitamin A
  • Stick to the amount found in prenatal multivitamins as excess supplementation may lead to birth defects.
  • While getting vitamin A from foods is safe, avoid having liver more than once per week during the first trimester.
  • Avoid fish liver oil supplements as they are high in vitamin A.
Non-Nutritive Sweeteners (e.g., aspartame, acesulfame potassium, stevia, polyols, saccharin, neotame and thaumatin)
  • These are safe to consume in moderation.


Managing Gastrointestinal Symptoms

Constipation
  • It’s relatively common in pregnancy and is primarily related to increased progesterone levels, which cause relaxation of the muscles in the bowel leading to slower transit time.
  • To help manage, have adequate fluids and fibre and regularly move your body.
  • If your prenatal multivitamin seems to be making your constipation worse, you may benefit from taking an iron-free prenatal multivitamin and a heme iron supplement instead.
Heartburn
  • This can be triggered by relaxation of the esophageal sphincter from increased hormone levels and pressure from the baby.
  • To help manage, have small frequent meals, have fluids away from meals, avoid wearing tight clothing, remain upright for 2-3 hours after meals and avoid eating a few hours before bed.
  • Some foods that may make heartburn worse include peppermint, chocolate, deep fried/fatty foods, citrus, tomato products, spicy foods, garlic and onions.
Nausea
  • It’s most common in the first trimester and usually eases up starting in the second trimester.
  • To help manage, have something to eat first thing in the morning, have small frequent meals to avoid becoming overly hungry, have fluids away from meals, snack on salty and/or carbohydrate rich foods (e.g., crackers, toast, smoothies, fruits etc.), and try having more cold foods and fluids. Also try to include a protein and fat source at meals to help stabilize blood sugars, as fluctuations can make nausea worse.
  • Supplements that may help with nausea include:
    • Ginger tea (made with tea bag or freshly grated ginger), ginger candies, or ginger capsules (limit to 1000 mg per day).
    • Vitamin B6 in doses of 25 mg taken up to 3X per day.

 

References
  1. Canada, H. (2012, February 16). Government of Canada. Canada.ca. https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/food-additives/caffeine-foods/foods.html.
  2. Canada, H. (2010, January 14). Government of Canada. Canada.ca. https://www.canada.ca/en/health-canada/services/publications/food-nutrition/prenatal-nutrition-guidelines-health-professionals-background-canada-food-guide-2009.html.
  3. Dietitians of Canada. Pregnancy: Summary of Recommendations and Evidence. In: Practice-based Evidence in Nutrition [PEN]. 2020 April 13. Available from: https://www-pennutrition-com/KnowledgePathway.aspx?kpid=3043&trid=3104&trcatid=42
  4. Nichols, L. (2018). Real food for pregnancy: the science and wisdom of optimal prenatal nutrition. Lily Nichols.
  5. Position of the American Dietetic Association: Use of Nutritive and Nonnutritive Sweeteners. (2004). Journal of the American Dietetic Association, 104(2), 255–275. https://doi.org/10.1016/j.jada.2003.12.001
  6. Sahakian, V., Rouse, D., Sipes, S., Rose, N., & Niebyl, J. (1992). Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: A randomized, double-blind placebo-controlled study. International Journal of Gynecology & Obstetrics, 38(2), 151–151. https://doi.org/10.1016/0020-7292(92)90077-v

 

Gina Almasan, RD