Endometriosis and pregnancy – a guide for expectant mothers

Endometriosis It negatively impacts fertility, increases the risk of difficulty conceiving, and increases the risk of complications during pregnancy. Yes, it's true, but don't worry! Stress, anxiety, and chaotic behavior are the last things you need during this special time. Diagnosis This isn't a death sentence, and it doesn't mean you'll never get pregnant, and if you do, something bad will definitely happen. It's just a sign that you need to approach this consciously, calmly, with a good plan and with specialists you trust. This article is a comprehensive guide for all endocrine patients who are pregnant or preparing for pregnancy and want to take the best possible care of themselves and their baby. I'll show you how to do it step by step, calmly, without stress or unnecessary pressure.   

How does endometriosis affect pregnancy? 

Let's start with a few facts. Endometriosis has a very complex and multifactorial impact on fertility and pregnancy. Chronic inflammation and the presence of endometrial foci and adhesions within the reproductive organs can negatively impact egg viability and quality, sperm survival, fertilization, and embryo implantation. The condition can also increase the risk of pregnancy complications, such as low birth weight, miscarriages, and preterm labor. What does this mean for you? You need to approach this topic calmly, with great mindfulness and patience. I know it's easier said than done, but if you're reading this article now, it's a sign that you want to take conscious care of yourself and your baby, so the first step is already behind you. 

Endometriosis and pregnancy – what to remember?

A healthy lifestyle, specialist care and regular survey These are the foundations of a healthy pregnancy. Daily habits regarding diet, physical activity, sleep, and regeneration influence hormonal balance and systemic inflammation, helping to compensate for any nutritional deficiencies and preventing them from developing. They also influence your well-being, ensuring your body is better prepared for the intense changes occurring in each trimester, and providing the best environment for your little one's development. However, remember that you can't do everything perfectly, no matter how hard you try. Pregnancy lasts nine months, has its own rules, and is often unpredictable. Take care of your daily habits, but also give yourself space for mistakes, worse moments, surprises and try to let go of excessive controlIn a moment, I'll present you with the most important recommendations and tips that, once implemented, will have a positive impact on your health. But don't stress if you can't do everything right away. Tailor them to your current, individual needs. 

Pregnancy and endometriosis – regular check-ups

I will start with a point that may seem obvious, but I would like to emphasize it very much. It is extremely important that during your pregnancy you are under the care of specialists you trust and who have experience in managing pregnancies in women diagnosed with endometriosis.This time is an emotional rollercoaster for many women. New questions, doubts, and fears arise every day. The opportunity to consult with people who make you feel cared for, heard, and safe is worth its weight in gold. Remember, too, that the internet and social media are full of information and advice, but not all of it will be beneficial or safe for you. Discuss any concerns with specialists, and don't skip scheduled appointments and tests. Regular checkups ensure that you and your baby are doing well and allow you to detect any problems early, so you can better manage them. During pregnancy, it's important to be under the care of:

• A gynecologist specializing in pregnancy management with endometriosis,

• Clinical dietitian specializing in working with pregnant women and endometriosis diet therapy,

• Urogynecological physiotherapist,

• Midwife,

• If necessary, also a psychologist or psychotherapist.

These specialists form an interdisciplinary team and are able to provide you with comprehensive care. If you haven't yet found the right person to work with, check out our list of recommended doctors and check out the offer dietary consultations i psychological consultations.

Pregnancy and endometriosis – what tests should be performed?

The range of tests performed during pregnancy in women with endometriosis does not differ significantly from those recommended for healthy women. Typically, laboratory tests are performed at least five times, and ultrasound imaging at least three times throughout the pregnancy. Laboratory tests include:

• Morphology,

• General urine test,

• Fasting glucose level.

Additionally, early in pregnancy, tests for infectious diseases and Rh factor testing are also performed. Between weeks 24 and 26 of pregnancy, you'll be referred for an oral glucose tolerance test to rule out gestational diabetes. As a clinical dietitian, I often recommend other tests to my pregnant patients diagnosed with endometriosis, such as: 

• Ferritin level to assess the level of iron in the body,

• Vitamin B12 level,

• Folic acid level,

• Homocysteine ​​level. 

The frequency and scope of tests are always individually tailored to your health and that of your baby, so follow your doctor's recommendations and don't be alarmed if you hear that another woman has had more or fewer tests. Each of you may be in a completely different situation. 

Pregnancy and endometriosis – how to plan your diet?

Diet Anti-inflammatory therapy is one of the key elements of the comprehensive treatment of endometriosis, but it takes on particular importance during pregnancy. Proper nutrition reduces the risk of pregnancy complications and promotes your baby's health even before it arrives. Detailed information and practical tips on an anti-inflammatory diet for endometriosis can be found in our ebook EndoDieta. Below, I present to you the most important recommendations that I would like you to try to take care of every day during pregnancy:

• Compose your meals according to the concept of the so-called "healthy plate". Half of your plate should be vegetables and/or fruit, one-quarter of your plate should be protein, and the last quarter should be carbohydrates. This minimizes the risk of nutritional deficiencies and abnormal blood glucose fluctuations. 
• Protein is the basic building block of our bodyMake sure it's included in your meals throughout your pregnancy. The best sources of this macronutrient are lean meats, fish, eggs, unprocessed dairy products, and legumes. In emergency situations, when you have no appetite or are experiencing nausea, you can reach for a good quality protein supplement, but on a daily basis, try to include natural sources of protein in every meal. 
• Don't forget about the addition of fat. As women, we often overlook it for fear of its high caloric value. However, healthy dietary fats are precursors to steroid hormones. They are the source of estrogen and progesterone, among other hormones, which are essential for fertility and maintaining pregnancy. Olive oil, nuts, seeds, and fatty fish are your allies. 
• Take care of fiber, which regulates intestinal function and helps remove harmful and unnecessary substances from our body. Research shows that women who consume adequate amounts of fiber (approximately 20-30 g) have a lower risk of certain pregnancy complications, such as preterm labor, preeclampsia, and persistent constipation in the third trimester. Its sources include primarily vegetables, legumes, fruits, oat flakes and bran, nuts, and whole grain cereals. 
• Remember that during pregnancy, your body is changing – after all, it is creating a completely new life and preparing to bring it into the world. Do not follow any restrictive, low-calorie diets to reduce pregnancy weight gain.You and your baby need energy! In the first trimester, energy needs increase by about 80 kcal per day, in the second trimester by about 300 kcal per day, and in the third by as much as 500 kcal per day. Diets of 1000-1200 kcal are not a good idea. This is how much your little one will eat when they turn one! If you're not sure whether your diet is energy-balanced, talk to a dietitian. 

Pregnancy and endometriosis – what to avoid in your diet?

You already know the most important dietary recommendations for pregnancy and that an anti-inflammatory diet is important for endometriosis. However, pregnancy requires a few additional adjustments, as not all foods are safe during this period. What should you watch out for?

• Raw meat Uncooked meat is a potential reservoir of pathogenic bacteria, including Salmonella, Listeria, and Campylobacter. Infection with these pathogens during pregnancy poses a serious threat to a woman's safety and can cause miscarriage, premature birth, and disruptions to the child's neurodevelopment. When pregnant, choose only well-cooked, well-done, or baked meat. Avoid steak tartare and rare steaks.
• Raw fish – Like raw meat, uncooked fish can be a source of microbial contamination. Avoid sushi, fish tartare, and cold-smoked fish during pregnancy. 
• Some species of fish Fish can accumulate large amounts of heavy metals, including mercury, so not all species are recommended during pregnancy. According to official recommendations, tuna, king mackerel, pangasius, tilapia, and shark should be avoided during this period. Choose safer species such as farmed salmon, cod, gilthead seabream, or trout. 
• Raw eggs – Raw and undercooked eggs can be a source of Salmonella. Infections with this bacteria can cause food poisoning, diarrhea, and even miscarriage and preterm labor. Choose hard-boiled eggs and well-done scrambled eggs. Avoid eggs with runny yolks (boiled or fried), as well as sauces and desserts (e.g., tiramisu) with raw yolks. 
• Unpasteurized dairy products – Raw milk and unpasteurized dairy products can be a source of Listeria monocytogenes bacteria, which crosses the placenta. Infection during pregnancy can damage the baby's nervous system, cause meningitis, miscarriage, and premature birth. Importantly, infection may not result in any symptoms At mom's. The good news is that dairy products available in stores are always pasteurized, and this is regulated by law. So you don't have to worry about products purchased in popular, large chain stores. However, be wary of organic products, from local farmers, or "straight from the cow." 
• Coffee Drinking coffee during pregnancy is a controversial topic. It's primarily about caffeine. Official recommendations state that 200 mg of caffeine per day is safe during pregnancy, but newer studies show that even smaller doses may pose a risk of pregnancy complications. Many experts believe there is no safe dose of caffeine during pregnancy and it should be avoided. So, try to limit your coffee consumption, and if you enjoy the taste, choose a decaf version. However, remember that regular and decaf coffee negatively affect iron absorption. Endometriosis and pregnancy increase the risk of iron deficiency, so if you decide to drink coffee, wait at least one hour between meals. 
• Green tea and matcha These beverages are gaining popularity, and many people choose them as an alternative to coffee. A significant advantage of green tea and matcha is their high content of polyphenols and antioxidants (especially EGCG). They have a very strong anti-inflammatory effect and are a valuable component of endometriosis diet therapy. Some studies have shown the high effectiveness of EGCG supplementation in reducing inflammation, reducing pain, and supporting the treatment of uterine fibroids. Unfortunately, such a high polyphenol content is a disadvantage during pregnancy. There are indications that a high intake of polyphenols impairs fetal heart development and can cause premature closure of the ductus arteriosus. This is particularly dangerous in the third trimester. Therefore, green tea and matcha are not recommended during pregnancy and should be avoided. 
• Some herbs – Herbs have many health-promoting properties and can support endometriosis dietary therapy. I described this issue in detail in the article "Herbs for endometriosisHowever, not all plant-based ingredients are safe or recommended during pregnancy. The active substances they contain can cross the placenta. Often, their impact on fetal development is unknown, as, for obvious reasons, research on pregnant women is extremely limited. However, we do know that some ingredients can negatively impact fetal development, as well as intensify uterine contractions and increase the risk of miscarriage. These include licorice, senna, aloe, St. John's wort, buckthorn, and wormwood. 

Pregnancy and endometriosis – supplementation

A healthy, well-balanced diet is essential, but supplementation is essential during pregnancy. A basic set of supplements for endometriosis during pregnancy should include: 

• Foils Vitamin B9 is essential for the proper development of the nervous system, DNA structure, and cell division. During pregnancy, folate supplementation should be at least 800 µg, but women at risk of miscarriage may require a higher dose. Be sure to discuss this with your doctor. When choosing a supplement, pay attention to the dose and chemical form. Some products contain folic acid in the form of pteroylmagglutamic acid. This is a synthetic and inactive form, and long-term supplementation can lead to complications during pregnancy. In 2024, the Polish Society of Gynecologists and Obstetricians issued its latest recommendations, according to which the only acceptable form of folic acid during pregnancy is active folates (e.g., metafolin, 5-MTHF).
• Vitamin D – affects the development of the nervous, skeletal, and immune systems. The minimum daily dose is 2000 IU, but it's worth having your vitamin D levels checked and adjusting your dosage to your body's needs.
• Omega-3 – This ingredient is essential in the supplementation of women with endometriosis and all pregnant women. In the context of endometriosis, it has a strong anti-inflammatory effect. However, it becomes even more important during pregnancy. Why? DHA, an omega-3, builds the cell membranes of your baby's neurons. Moreover, omega-3 fatty acids reduce the risk of preterm birth and even postpartum depression. The dose should be individually adjusted, taking into account the intake of omega-3 fatty acids from the diet (primarily from marine fish), but it should not be lower than 250 mg of DHA per day. 
• Iodine – is essential for proper thyroid function and nervous system development. The recommended dose during pregnancy is 150-200 µg per day.  

Additionally, depending on individual needs, test results, nutritional status and diet, it is worth considering additional supplements:

• Choline – it positively affects the development of the child's nervous system and cognitive functions. It also increases the transport of omega-3 fatty acids across the placenta. According to some statistics, more than half of pregnant women do not get enough omega-3 fatty acids through their diet, so it's worth considering supplementation with your doctor and dietitian. What are the sources of choline? You can find it primarily in eggs, dairy products, meat, fish, legumes, nuts, and sprouts.
• Vitamin B12 – It is essential in preventing anemia and influences the development of the nervous system and neurobehavioral functions. Women on plant-based diets are most susceptible to vitamin B12 deficiency. If, for any reason, you limit animal products, B12 supplementation during pregnancy may be necessary. 
• Iron Routine iron supplementation during pregnancy is not recommended, but it's worth including this mineral in your supplementation regimen if you have anemia or are at high risk of anemia. Unfortunately, iron supplementation is not without its effects on the body. Large doses can increase inflammation and oxidative stress and should be avoided, especially during the first trimester. Ensure adequate iron intake through your diet, and only take supplements when necessary and always under the supervision of a specialist.
• Magnesium - Magnesium has multifaceted effects. It supports nervous system function, neuromuscular transmission, and intestinal function. It's not a mandatory supplement during pregnancy, but it can be helpful for persistent calf cramps, constipation, sleep problems, or excessive stress. It's worth emphasizing, however, that not all magnesium is created equal, and each chemical form has slightly different effects. Magnesium citrate is best for constipation, magnesium threonate for sleep problems and stress, and if you're struggling with cramps, you can choose magnesium malate, for example. However, avoid magnesium oxide, as its absorption is extremely low. 

If you suffer from endometriosis, you may have already been taking many anti-inflammatory supplements. There are many substances that can be excellent dietary supplements for endometriosis, but many are prohibited during pregnancy due to the high risk of complications during pregnancy. Supplements used for endometriosis that should be discontinued during pregnancy include: 

• Curcumin,

• Resveratrol, 

• Sulforaphane,

• EGCG. 

Pregnancy and endometriosis – urogynecological physiotherapy

Physiotherapy Urogynecological care is invaluable support in the context of endometriosis and pregnancy. By working with a physiotherapist, you can better prepare your mind and body for labor and alleviate many pregnancy ailments. Back pain, pubic symphysis pain, and excessive gluteal tension are very common problems that can impact your comfort and daily functioning. You're not doomed to them, and sometimes even a single physiotherapy visit can bring relief. 

Also remember that urogynecological physiotherapy is important not only before a vaginal delivery but also before a cesarean section. If you're preparing for a C-section, your physiotherapist will explain what to look out for and how to mobilize the scar during the first few days after the surgery. This is crucial because a C-section is a very extensive procedure that increases the risk of adhesions. There have even been reports of endometrial lesions developing in the C-section scar, so don't ignore this issue and remember that it's worth preparing for every birth. 

Pregnancy and endometriosis – physical activity

Endometriosis is not a contraindication to exercise during pregnancy. Quite the opposite! The World Health Organization and other expert associations clearly recommend that all pregnant and postpartum women without medical contraindications should engage in regular physical activity. minimum 150 minutes of activity per week, preferably one that combines aerobic and muscle strengthening exercises. 

Aerobic exercise is any movement that slightly increases your heart rate and breathing. It's not about pushing your body and pushing your limits every day. However, your body needs to feel like it's doing something. Examples of aerobic exercise include brisk walking or jogging, cycling, and swimming. It's worth combining it with moderate resistance training, stretching, yoga, or Pilates. This will improve your endurance and muscle strength, as well as your flexibility and mobility. There's no single best activity, and any movement is better than none because:

• Reduces the risk of excessive weight gain,
• Reduces the risk of gestational diabetes, 
• Reduces the risk of postpartum depression,
• Prepares the body for childbirth.

However, many changes occur in your body during pregnancy, including your center of gravity, and not all exercises may be as accessible to you as they were before pregnancy. Therefore, it's worth consulting with a physiotherapist or a women's trainer, who will tailor exercises to your needs and abilities and show you how to perform them correctly. 

Pregnancy and endometriosis – sleep and regeneration

Preparing for pregnancy should focus not only on the physical aspect but also on the mental one. It's completely understandable that you might feel overwhelmed and anxious about whether everything will go according to plan. Take care of your peace and well-being just as you take care of your supplements, diet, exercise, and tests. Don't underestimate the importance of sleep. The recommendation to "get enough sleep" sounds boring and clichéd, but believe me, ensuring adequate sleep duration and quality is one of the best things you can do for yourself during pregnancy. 

During pregnancy, it's best to sleep on your left side to promote proper blood circulation. If you're having trouble finding a comfortable position, experiencing hip pain, or experiencing swelling, try placing a large pillow between your legs. Try to establish a routine by going to bed and waking up at approximately the same time each day. Our bodies love regularity, and during a time as demanding as pregnancy, it needs it even more. Also, implement the 3C rule in your bedroom—quiet, dark, and cool. These are optimal conditions for good sleep and optimal nighttime regeneration. 

Summary

Pregnancy for women diagnosed with endometriosis requires a great deal of awareness, mindfulness, and understanding. If I could give you just one piece of advice, it would be to create your own team of specialists whom you trust and under whose care you feel safe. This can make pregnancy a truly beautiful time, despite its frequent unpredictability. Remember to eat a healthy diet, take supplements, be active, and get enough sleep, but don't let yourself go crazy. Don't blame yourself for mistakes or errors; give yourself space for imperfect days. Your mental well-being is just as important as your physical health. 

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