Updated on March 24, 2023
Article Summary:
- Although patients with ulcerative colitis often have concerns about the safety of conventional ulcerative colitis therapies during pregnancy, research suggests there are a number of safe and natural alternatives to help manage symptoms.
- Diets can limit flare-ups and address symptoms when they do occur, but some patients struggle with adherence due to the restrictive nature of such strategies.
- Quercetin supplementation can complement specialized diets and offer nutritional support.*
Developing an effective strategy for managing ulcerative colitis (UC) is an ongoing challenge. During flare-ups, patients find themselves desperate for interventions that can dampen debilitating symptoms. During remission, many UC patients constantly worry about the possibility of a relapse. However, for UC patients who are pregnant, dealing with active and/or latent UC symptoms becomes an even greater challenge because therapy options are more limited.
During pregnancy, a surgical intervention is essentially out of the question, even for a woman who has recently been diagnosed with UC, because studies show that surgery raises fetal mortality rate. Although most pharmaceutical therapies are considered safe for pregnant women, there are significant exceptions: methotrexate and thalidomide are contraindicated for pregnant women and designated as Pregnancy Category X medications. There are also several classes of drugs in Pregnancy Category C, including mesalamine and corticosteroids, which means that animal studies suggest possible negative consequences for pregnant mothers. Given the lack of clear, comprehensive evidence on most drugs, both patients and practitioners remain concerned about using these pharmacotherapeutics during pregnancy.
As a result of these limitations, many patients and practitioners are considering nutrition-based management strategies to help manage UC symptoms without putting the health of the mother or the fetus at risk. Effective strategies can include a combination of special diets (such as carrageenan elimination and gluten elimination) and nutritional supplements that can both help maintain the body’s natural inflammatory response and support optimal nutrient levels during pregnancy.
The Importance of Controlling Ulcerative Colitis During Pregnancy
Scientists have recognized for decades that managing UC symptoms is especially important for women during pregnancy. In 1980, a study on more than 250 British women indicated that UC directly affects birth outcomes; women with active UC had a slightly lower chance of producing a live, healthy baby than women who were in remission, and the risk was considerably higher for the patients with the most severe symptoms. These findings were supported by a nationwide Danish study published in 2011. For patients diagnosed with UC in the first six months of pregnancy—and therefore were likely to be experiencing active symptoms—there was a significantly higher risk of preterm birth.
In 2018, researchers at Tokyo Women’s Medical University conducted a retrospective study on the role of UC on pregnancy outcomes in middle-aged women. Once again, abnormal pregnancy—defined as abnormal delivery and/or low birthweight—was more likely in patients with active UC (30.1 percent, as compared with 17 percent for women in the remission group). These results support the hypothesis that UC activity is directly related to pregnancy progression and patient outcomes. Given the concerns about pharmacological therapy for UC during pregnancy, there is great potential value in targeted dietary changes for pregnant UC patients.
Reducing the Intake of Inflammation-Inducing Food Additives: The No-Carrageenan Diet
Some UC patients worry that specialized diets can make it difficult to get adequate nutrition during pregnancy. This is a particular concern for UC patients because nutrient malabsorption is a common symptom. One solution is to eliminate pro-inflammatory food additives that contribute no significant nutritional value, such as carrageenan. Based on in vitro and animal studies implicating this common food additive in multiple inflammatory processes, researchers at the University of Illinois explored whether lowering carrageenan intake would aid in the management of UC.
In a randomized, double-blind, placebo-controlled study in 2017, patients were instructed to adopt a no-carrageenan diet. Half were then given a carrageenan-containing supplement, while the other half were given a placebo. Patients who took the carrageenan supplement had higher levels of inflammatory biomarkers and a statistically higher risk of remission. The researchers concluded that carrageenan restriction can lower the risk of early relapse—a major goal for UC patients who are in remission at the beginning of their pregnancy. Moreover, cutting out carrageenan can potentially ameliorate symptoms in UC patients when the disease does flare up during pregnancy.
Considering a Gluten-Free Diet During Pregnancy
Gluten-free diets might also be a safe way for pregnant patients to address UC symptoms. Because a combination of preliminary research and anecdotal evidence suggests that gluten can trigger inflammation, exacerbating the most common symptoms of UC, elimination can be an effective management strategy. Indeed, in one study of more than 1,600 patients who had been diagnosed with an inflammatory bowel disease (such as UC) and celiac disease, 38.3 percent reported that a gluten-free diet led to fewer or less severe UC flare-ups.
But many gluten-containing foods, like whole wheat bread and whole grain cereal, are fortified with essential B vitamins, including folate, which are particularly important nutrients for women during pregnancy. As a result, removing gluten from a patient’s diet can eliminate important sources of B vitamins. Consistent with this concern, studies on mostly-female patients on gluten-free diets indicate the diet might raise the likelihood of folate deficiency. Therefore, pregnant UC patients who choose a gluten-free diet should make sure that they add a highly bioavailable folate supplement to their diet. A gluten-free pregnancy diet should also emphasize the intake of high-folate fruits and vegetables like leafy greens, lentils, avocado, and papaya.
Ulcerative Colitis and Pregnancy: Diet Strategies that Support Optimal Health
Another nutritional supplement for pregnant UC patients to consider is quercetin. Quercetin is an all-natural polyphenol derived from plant extracts, and its antioxidant properties have made it a prominent candidate for all patients looking for UC management alternatives. This plant-based nutritional supplement is especially appealing for pregnant women because it poses no major safety concerns. Furthermore, a 2011 study in the journal Toxicology indicates that quercetin has benefits for both the mother and the child beyond helping to maintain a normal inflammatory response in UC patients.* Mouse models show that a quercetin supplement can raise iron levels in the mother, which is important because iron-deficiency anemia is more common among UC patients than the rest of the population.* The study also indicated that exposure to a quercetin supplement can enhance the infant’s future capacity for iron homeostasis (that is, the infant’s ability to maintain healthy iron levels).* These results suggest that quercetin can simultaneously help UC patients manage symptoms, as well as addressing nutrient deficiency-related concerns during pregnancy.
It is essential for UC patients to effectively manage their symptoms during pregnancy, and dietary changes offer a safe, evidence-based option. By eliminating certain dietary components (like food additives and gluten) and raising their intake of others (like B vitamins and quercetin) through supplementation, pregnant UC patients can address their symptoms while ensuring they receive the nutrients they need to support their own health and that of their baby.*
The power of Tesseract supplements lies in enhancing palatability, maximizing bioavailability and absorption, and micro-dosing of multiple nutrients in a single, highly effective capsule. Visit our website for more information about how Tesseract’s products can help support your gastrointestinal health.*
Works Cited
Bhattacharyya S, Shumard T, Xie H, Dodda A, Varady KA et al. 2017. Nutrition and Healthy Aging. 4(2):181-92.
Habal FM, Ravindran NC. 2008. World Journal of Gastroenterology. 14(9):1326-32.
Hashash JG, Kane S. 2015. Gastroenterology & Hepatology. 11(2).
Herfarth HH, Martin CF, Sandler RS, Kappelman MD, Long, MD. 2014. Inflammatory Bowel Diseases. 20(7):1194-7.
Ito A, Iizuka B, Omori T, Nakamura S, Tokushige K. 2018. Internal Medicine. 57(2):159-64.
Norgard BM. 2011. Danish Medical Bulletin. 58(12):B4630.
Poturoglu S, Ormeci AC, Duman EE. 2016. World Journal of Gastrointestinal Pharmacology and Therapeutics. 7(4):490-502.
Stein J, Dignass AU. 2013. Annals of Gastroenterology. 26(2).
Valente FX, Campos TN, de Sousa Moraes LF, Hermsdorf HHM, Cardoso LM et al. 2015. Nutrition Journal. 14:110.
Vanhees K, Godschalk RW, Sanders A, van Waalwijk van Doorn-Khosrovani SB, van Schooten FJ. 2011. Toxicology. 290(2-3):350-8.
Willoughby CP, Truelove SC. 1980. Gut. 21(6):469-74.
