Pregnancy in IBS: Nutrients, FODMAPs, and Symptom Management

Disclaimer: It is not typically recommended to start a low FODMAP elimination diet during pregnancy due to the restrictive nature of the diet. If you absolutely need to consider initiating the low FODMAP diet, it should be done under medical/dietitian supervision. However, people with IBS who are following a modified low FODMAP diet prior to pregnancy may benefit from the information in this article. All recommendations are based on my experience as a dietitian.

Pregnancy and IBS symptoms

So you’re pregnant with IBS. You may be wondering what to expect when it comes to your symptoms. Will they change? Will they get worse? Or maybe even improve?

The truth is, some women with IBS notice an improvement in symptoms during pregnancy while others notice worse symptoms. While there is not a concrete answer to which category you may fall into, there is a pattern. For those with diarrhea-predominant IBS, bowel habits may improve, as the pregnancy hormone progesterone slows down intestinal transit time and can, therefore, improve stool consistency and urgency.^1,2

Because of this slowed transit time, as well as added pressure on the bowel, those with IBS-C often notice that constipation is further exacerbated. For those dealing with constipation in pregnancy, consider the following:^1,2

• Consume lots of high-fiber foods. If following a modified low FODMAP diet, try things like blueberries, oats, bananas, canned lentils, chia seeds, or ground flax seeds.
• Drink lots of fluids, especially water.
• Get moving! Physical activity helps to stimulate contractions in the bowel and therefore promotes more regular bowel movements.
• Consider supplements. Some pregnant women benefit from adding fiber supplements to help soften stool, especially if they have trouble getting enough dietary fiber. In addition, prenatal supplements often contain high amounts of iron, which has a known side effect of constipation. However, iron is very important for your baby, so talk to your doctor or dietitian before adding or removing supplements. It is best to ensure these products are appropriate for you and your growing baby!

Nutrition tips for dealing with nausea and vomiting

On top of other IBS symptoms, you may now be experiencing the added joy of morning sickness. Let’s be honest, it should be called "all-the-time sickness," as it doesn’t seem to be isolated to a specific time for many women.²

Ginger

This age-old remedy helps to stimulate movement in the gut and is also a low FODMAP food. Try a bit of ginger tea or some ginger candies. Be careful of ginger ale, however, as many brands contain high fructose corn syrup, which is high FODMAP. The carbonation can also be a bit irritating when dealing with a sensitive stomach.

Lemons

This low FODMAP food has been shown to help pregnant women with morning sickness. One study actually found that simply smelling lemons can improve symptoms for some women! Try drinking lemon water or diffusing lemon essential oils in your home.³

Peppermint

Many people use peppermint to calm the gut during times of distress. However, not all peppermint is created equal! Avoid high FODMAP mints and gum that contain polyols such as sorbitol and xylitol. Instead, drink peppermint tea or include mint in recipes, like low FODMAP tabbouleh or take enterically coated peppermint capsules from your local pharmacy.

Carbohydrates and starchy foods

Similar to when you have the flu, eating bland and starchy foods may settle the stomach. The research to support this isn’t great, but anecdotally it helps a lot of expectant moms!

If you avoid wheat for your IBS, choose non-wheat carbohydrates like rice cakes, rice crackers, gluten-free bread and crackers, oats, or rice. Many people can also tolerate sourdough bread, as the high FODMAP wheat is broken down during production. Many people aren’t aware, but 5 soda crackers are also low FODMAP!

Feeding your growing baby with low FODMAP foods

A developing baby needs lots of nutrients and fuel to become strong and healthy. Although you are likely already taking a prenatal multivitamin, the foods you choose will also play a big role in the development of your little babe.

However, many women with IBS also need to consider limiting high FODMAP foods in order to manage their symptoms. But don’t worry, there are still lots of great IBS-friendly foods that can help you meet your nutrient requirements! Below, I review 3 key nutrients for pregnancy and which low FODMAP foods contain them.

Folate

Consuming adequate folate is important for reducing risk of neural tube defects in pregnancy. Some low FODMAP foods with folate include: edamame, spinach, lettuce, potato, canned lentils, and sunflower seeds.⁴

Iron

You need more blood during pregnancy to pass nutrients from mother to baby. Therefore, more iron is required to make up the additional red blood cells during pregnancy. Iron can be found in low FODMAP foods such as, meat, fish, poultry, oats, salad greens, firm tofu, tempeh, seeds, almonds, and nut butters.⁵

Calcium

Expectant moms require high amounts of calcium for a few reasons. Not only are you building a new skeleton inside your uterus, but you’re also starting to produce breast milk. Both of these things require lots of calcium! Find calcium in lactose-free dairy, hard cheese, salad greens, tofu, fish, seafood, fortified almond milk, and fortified rice milk.⁶

At our practice, we’re big advocates of checking in with your dietitian each trimester, as things change quickly during pregnancy and so too can your digestive symptoms. Working with your dietitian can ensure the advice is tailored to you!