Pregnant Mare and Laminitis

Shannon Ferrill

Hello, I’m looking for help with my mare. She was bred May 8, 2022. As she has gotten heavier she has shown a lot of signs of discomfort, X-rays were done and vet said to stop feed and just give alfalfa hay. She is also on Equinox daily. We were doing bute before. She also has pads and shoes on front feet. We are scheduled for another X-ray this Thursday and trimming /foot care etc. also plan to fit for soft boots. I’m very new at all this and need help please. Thank you

Shannon Hudson, in TX, 2023

Lesley Fraser

Hello Shannon

Welcome to the group!  As this is your first post it triggers our lengthy Welcome Letter, which contains all sorts of ECIR-related information.  It's a very useful document and it's worth keeping it to hand as you work your way through the care details for your mare.  What might not seem important now may well turn out to be further down the line.

If you haven't been able to do this so far, making a start on your Case History will be very helpful - if you have any problems doing it just post a message and let us know where you're stuck.  To start your case history have a read through the Wiki , and you'll also need to join the ECIR Case History sub-group too

Has your mare (what's her name, by the way, and how old is she?) had blood tests for ACTH (for Cushings), IR (for insulin levels) and glucose?  If so, the lab report results can go in your case history file - if the vet hasn't passed the lab print-outs on to you, you can ask for them to be emailed to you.  If these blood tests haven't been carried out it would be very helpful if you can organise getting that done - make sure you follow the feeding instructions below prior to any blood draw.  It sounds as if your vet suspects some form of laminitis, but if your mare's insulin levels are the trigger for this it's unlikely that NSAID painkillers, like bute, will help as metabolic laminitis isn't an inflammatory event.  You can have a look through the ECIR Files section for more information on pain medication, and I hope other members who have particular experience of looking after pregnant mares will chip in with their ideas.  Getting her diet as tight as possible and her trim as good as it can be should help a lot with her pain levels.

Speaking of diet, getting your mare on the Emergency Diet (details are in the Welcome Letter below) is an important next step.  Although alfalfa tends to be lower in sugar than some grass hays, it contains starch and more glucose than the equivalent amount of grass hay.  On top of this, some metabolic horses just don't tolerate alfalfa very well, and it could be something that isn't helping her at the moment.  It's difficult to know without seeing any blood test results, but as a guide alfalfa probably isn't something to continue.  If you can source some low sugar/low starch grass hay and soak it before feeding it until you can get it tested, that sounds like a good way forward.  Once you've had the hay tested via a wet chemistry test (for example, the EquineAnalytical Trainer 603 test) and got the results back, you can ask one of the ECIR volunteers trained in mineral balancing to balance specific minerals to your hay.   

It's great to hear that you're getting more X-rays done (they can be posted in your Photo album, and there's information in the Wiki about how to do this).  You could also take a look at the Wiki section on Getting Good X-rays.  Fitting soft boots sounds like a good plan, and you might want to think about removing all of her shoes and replacing them with boots.  Getting her trim sorted out (see the section in the Welcome Letter below) can help enormously, and having the farrier/trimmer visit every 2 weeks to begin with might be very useful. 

There's a lot of information to take in, but we're all here to answer any questions you might have.  Don't hesitate to ask if you're not sure about anything, and I hope other members, and Dr Kellon, will contribute regarding looking after pregnant mares. 

Here's the Welcome Letter I mentioned back at the beginning.


Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.


DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.


There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you.

Lesley and over the bridge Omar,
ECIR Group Primary Response,
Highland, UK

Omar - Case History

Kirsten Rasmussen

Hi Shannon, 

Please read the Diagnosis section of Lesley's email and arrange to have blood pulled for ACTH, insulin and glucose when your vet is out this week.  Even if you've had this bloodwork done previously, I would still do it now because you need to rule out PPID/IR as a factor in the hoof pain.  Make sure you pull blood first, before any sedatives or other work is done.  Also make sure it is not fasting (ie, she hasn't been without hay for more than 6 hrs) and that she started her first meal of the day at least 4 hrs prior to the blood draw.

I also want to add that soft boots should go directly on the hoof, not over a shoe, as it's not clear what is being planned.  After the trim, take a full round of hoof photos (all 4 hooves) to accompany the xrays, and post them here.  You can ask for trim markups to guide your farrier, the first set are free.

Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Snickers' Case History
Snickers' Photo Album

Eleanor Kellon, VMD

Hold off on the ACTH until after she foals.
Eleanor in PA  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."