IBD and Pregnancy -- What You Should Know

Growing up, Jaclyn Gear always lived a healthy life as an active teenager participating in athletics all the way through her college years.  By 2009, Gear was married and pregnant with her first son, Liam. “I had a great pregnancy,” said Gear. “I gained weight, the baby was growing perfectly and I was never once sick.” 

Six months later, after a healthy post-delivery, Gear began what she thought were symptoms of the stomach flu.  She attempted to ease her symptoms with over-the-counter medications and consulted her primary doctor to no avail.  About two months after initially getting sick, she ended up in the ER with a 102-degree fever that would not break and weighing a very frail 98 lbs. After a series of tests, all signs were leading to Crohn’s.  “I went for a second opinion and before we could get serious testing completed, I was pregnant yet again,” said Gear. This time, pregnancy was much more challenging. “It was hard to gain weight, and my iron levels were extremely low. It was just pain and sickness all the time.”  

Without a definite Crohn’s diagnosis, doctors were unable to give her medication. Although her symptoms persisted, Gear would go on to successfully deliver a healthy baby boy, Connor (pictured).

Two months after her second delivery, in March 2012, multiple tests confirmed-Jaclyn had Crohn’s.  “I was sad, disappointed, angry, and nervous about my children having it as well,” she said. Instead of becoming more discouraged, Jaclyn decided she would fight back. After a few months of doing research and talking to other mothers who have Crohn’s, Jaclyn decided she would share her story in the hopes of helping others. Currently, she is taking basic medications, gaining weight, avoiding certain foods, and feeling better than ever.  “I have a chance to make a difference. What saved me was talking about it,” she said. "It is important for other young mothers to know you can have a successful pregnancy and healthy baby with Crohn's."

Are you a Crohn's or colitis patient trying to get pregnant, or have you already conceived? Here are a few things you should know:

-There is no increased risk of birth defects among newborns from women who take certain biologic medications (infliximab, adalimumab and certolizumab) or immunomodulators (azathioprine and 6-mercaptopurine) to control their IBD. Women should not take methotrexate within 3-6 months before or during pregnancy or while breastfeeding because of its toxic effects on the developing fetus or newborn.

-According to a recent study, the risk of flaring during pregnancy is the same as in the non-pregnant IBD patient: approximately 33 percent per year. Ideally, women should be in remission and on stable maintenance medication prior to attempting conception.

-Women with IBD have higher rates of complications during pregnancy and should be treated as high-risk obstetric patients. Even women with inactive IBD can have an increased risk of miscarriage, preterm birth, small-for-gestational-age infants, and complications of labor and delivery, although most women with IBD go on to have successful deliveries.

-Women should be well before becoming pregnant. It is not a good idea to begin a pregnancy when Crohn's or colitis is flaring, when the woman has recently begun a new treatment, or when she is on steroid medications. If she is already pregnant, she should continue on the regimen that has kept her well even if it includes steroids (although her doctor will try to minimize the steroid dose) except for methotrexate, which should be stopped.

-Folic acid (2 mg daily) is particularly important for women taking sulfasalazine, which inhibits folic acid absorption (folic acid helps prevent spina bifida and other neural tube birth defects). All pregnant women -- including those with IBD -- should eat a well-balanced diet and remain on any vitamins they were taking before becoming pregnant.

Learn more about IBD and pregnancy at: http://www.crohnscolitisfoundation.org/resources/pregnancy-and-ibd.html