IBD and Pregnancy: What You Need to Know

Bringing a new life into the world is a thrilling journey, but when you have IBD, concerns about how it might affect your pregnancy can be overwhelming. Women with IBD can have healthy pregnancies and infants. However, they are more likely to have complications of pregnancy, such as miscarriage, premature delivery, or difficulties during labor and delivery, than women without IBD, even if their disease is in remission.

Fortunately, with proper care and guidance from both a gastroenterologist and obstetrician, most women with IBD can experience a healthy pregnancy and welcome a healthy baby into their lives. Here’s what you need to know about IBD and pregnancy.

1. IBD May Impact Your Ability to Get Pregnant

Conception can be influenced by the activity of your IBD. Most women with ulcerative colitis or Crohn’s disease in remission have the same chances of getting pregnant as other women their age. However, those with active IBD may encounter difficulties. Conceiving during a disease flare is discouraged, as it is associated with a higher risk of complications like miscarriage, premature birth, or low birth weight. Surgical procedures in the pelvis, particularly colectomy with J-pouch, may also decrease fertility rates. It’s crucial to halt the use of methotrexate, a medication linked to birth defects, three to six months before attempting conception for both men and women.

2. Continue Taking Your Prescribed IBD Medications During Pregnancy

The ideal time to plan pregnancy when you have IBD is during a remission phase of at least 3–6 months without the use of steroids. Active disease during pregnancy increases the risk of preterm birth and low birth weight. Most IBD medications pose minimal risk to pregnancy. Therefore, it is essential to continue taking your prescribed medications until you have discussed the possibility of stopping them with your healthcare provider. Consult the Foundation’s IBD Medication Guide to understand the potential impact of the medication you are taking while pregnant. Talk to your doctor if you have additional questions on IBD medications and your pregnancy.

3. Diagnostic Procedures and Pregnancy

If necessary, many diagnostic procedures like colonoscopy, sigmoidoscopy, and abdominal ultrasound can be safely performed during pregnancy. Since colonoscopy is typically performed under anesthesia, most doctors recommend waiting to undergo these procedures until the second trimester, and CT scans and standard X-rays should be avoided unless medically urgent. MRIs can be done safely in pregnancy; however, the use of gadolinium should be avoided in the first trimester.

4. IBD Surgery and Pregnancy

Some bowel surgeries, including ileoanal anastomosis and colectomies, do not typically have negative effects on fertility in women with IBD. However, other surgeries including colectomies with J-pouches may reduce fertility rates. It’s essential to discuss the type and timing of surgery with your doctor. Women with Crohn’s disease who have fistulas or abscesses around the rectum and vagina at the time of delivery should discuss delivery options with their doctor, as they may want to consider a Caesarean section. Abdominal surgery during pregnancy is generally reserved for severe and unresponsive cases.

5. What Can I Eat While Pregnant?

Nutrition is crucial for all pregnant women, including those with IBD. A well-balanced diet and continued vitamin intake are essential. Folic acid is vital for preventing neural tube birth defects and is especially important for those taking sulfasalazine, which can inhibit folic acid absorption. If you have concerns about your diet during your pregnancy, consider making an appointment for a consultation with a dietitian. 

With thoughtful planning, monitoring, and medical guidance, women with IBD can embark on the journey of motherhood with confidence. Your healthcare team can help ensure a healthy pregnancy.

For more information about pregnancy and IBD, please click here.

You can make an impact on IBD cures! Please consider making a donation to the Crohn’s & Colitis Foundation.