Diet in Pregnancy and Breastfeeding with a GI Condition

Simple routines ease symptoms and protect you and your baby.

• Plan pregnancy with your doctor if you have IBD, coeliac disease or liver disease, ideally while the disease is quiet, and start folic acid before you conceive.
• Do not stop IBD, liver or other prescribed medicines because you are pregnant or breastfeeding; stopping can cause a flare that is more harmful than the medicine.
• Keep antenatal visits and blood tests, and tell the team about all supplements and herbal products.
• Do not smoke (including shisha and vapes) or drink alcohol.
• Wash hands, keep raw and cooked foods apart, and refrigerate leftovers quickly.
• Gentle activity such as walking helps constipation, reflux and mood unless your doctor has advised otherwise.

Aim for a varied diet, not “eating for two”. Needs for extra calories rise mainly in the second and third trimesters and during breastfeeding, and are modest.

• Nausea and hyperemesis: eat small, frequent, dry or bland snacks (for example crackers or bread before getting up), cold foods rather than hot smelly ones, sip fluids between meals, and try ginger if it helps. Avoid fatty, spicy foods and triggers. If you cannot keep fluids down, seek medical care rather than waiting.
• Reflux: eat smaller meals, avoid eating in the 2 to 3 hours before lying down, raise the head of the bed, and reduce fried, spicy and very fatty foods, chocolate, and large amounts of tea, coffee and cola. Ask the doctor which antacids or other medicines are suitable.
• Constipation: increase fibre gradually (vegetables, fruit, legumes, wholegrain bread and oats), drink fluids regularly, and walk daily. Iron tablets can worsen constipation; tell your doctor rather than stopping them. Ask before using any laxative.
• Iron, folate and vitamin D: take a folic acid supplement before conception and in early pregnancy, and the prenatal vitamins, iron and vitamin D your doctor recommends after blood tests. Low vitamin D is common among women in Saudi Arabia despite the sunshine, so it is worth checking. In IBD, coeliac disease or after bowel surgery, iron, folate, B12 and vitamin D deficiency is more likely and higher doses or intravenous iron may be needed; this is the doctor’s decision.
• Foods to avoid for infection risk: unpasteurised (raw) milk, including raw camel and goat milk, and cheeses made from it; soft mould-ripened and blue cheeses unless cooked; pâté; ready-to-eat deli meat, smoked fish and prepared salads unless heated until steaming hot; raw or undercooked meat, poultry, eggs (including home-made mayonnaise) and shellfish; raw sprouts; unwashed fruit and vegetables. Choose pasteurised dairy and cook meat and eggs fully.
• Liver and vitamin A: avoid liver and liver products (including fried liver) and cod liver oil or high-dose vitamin A supplements, because too much preformed vitamin A can harm the baby.
• Fish: eat fish 2 to 3 times a week, including oily fish such as sardines, but choose lower-mercury kinds, and avoid shark, swordfish, marlin and king mackerel. Ask your doctor or dietitian how local large reef and predator fish fit this advice. Avoid raw fish and sushi.
• Caffeine: keep the total from all sources (tea, coffee, Arabic coffee, cola, energy drinks, chocolate) under about 200 mg a day, which is roughly one to two small cups of coffee. Avoid energy drinks.
• Herbal products: many herbs and traditional blends have little or no safety data in pregnancy, and some (for example high amounts of fenugreek, aloe, senna, liquorice, or strong herbal laxatives) may act on the womb or the bowel. Do not use herbal or “detox” remedies without asking your doctor or pharmacist.
• IBD in pregnancy: no special diet is proven; eat a balanced diet and avoid unnecessary restriction. Coeliac disease: stay strictly gluten-free and check iron and folate. Liver disease or cirrhosis in pregnancy needs a joint specialist plan (salt, protein and varices). Cholestasis: no diet treats it; do not cut out food groups, and the doctor may check vitamin K if stools are pale or fat absorption is poor.
• Breastfeeding: you need extra energy (a few hundred calories more a day, usually from regular snacks), plenty of fluids to thirst, and the same food-safety care. Keep taking vitamins as advised. Most mothers do not need to avoid any food; do not cut out dairy or other foods unless a clinician has confirmed the baby has an allergy, and then do it with a dietitian. Limit caffeine, avoid alcohol, and choose lower-mercury fish. Ask your paediatrician about vitamin D drops for the baby.
• Ramadan in pregnancy or breastfeeding: there is no randomised trial, and observational studies give mixed results, so evidence cannot show that fasting is either safe or harmful for every woman. Islam gives a concession to pregnant and breastfeeding women who fear harm to themselves or the baby. Speak to your obstetrician before Ramadan. Fasting is usually discouraged with hyperemesis, diabetes in pregnancy, twins, anaemia, poor growth of the baby, cholestasis, IBD flares, cirrhosis or other liver disease, and low weight. If you do fast, break the fast for dizziness, dehydration, vomiting, reduced baby movements, or reduced milk supply. See also the article on Ramadan with a GI or liver condition.

Never start, stop or change any medicine without asking your obstetrician and gastroenterologist. No doses are given here.

• For nausea, doctors use a stepwise approach; the first-line medicine in most guidelines is a vitamin B6-based treatment, with other anti-sickness medicines added if needed.
• For reflux and constipation, some antacids, acid reducers and fibre-based or osmotic laxatives are commonly used in pregnancy, but ask first.
• Most IBD maintenance medicines are continued in pregnancy and are compatible with breastfeeding, but a few (for example methotrexate) must be stopped before conception; this is decided by your team.
• Ursodeoxycholic acid may be prescribed for cholestasis of pregnancy.
• Avoid anti-inflammatory painkillers such as ibuprofen in pregnancy unless a doctor advises, and do not use herbal laxatives.

Procedures are avoided in pregnancy unless needed, but they can be done safely when the benefit is clear.

• Endoscopy can be done in pregnancy for bleeding, severe symptoms or suspected flares, using careful sedation and monitoring.
• Ultrasound is the preferred imaging in pregnancy for the liver and gallbladder.
• Hospital admission for fluids, thiamine and anti-sickness treatment may be needed in severe vomiting.
• Timing and mode of delivery are planned by the obstetric and liver or IBD teams when there is cholestasis, cirrhosis or active IBD.