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 complications of labor and delivery, than women without IBD, even if their disease is in remission. Although pregnancy cannot always be planned, the best time for a woman with IBD to become pregnant is when her IBD is in remission.
According to recent studies, women with IBD do well during pregnancy if their disease was inactive at the time of conception. If a pregnancy occurs during a period of active disease, however, the disease is more likely to remain active or to worsen during pregnancy. It is recommended for a woman to be in remission for at least 3–6 months and off steroids and on a stable treatment course before getting pregnant, if possible.
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Medication
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To maintain a state of remission and prevent IBD flares during pregnancy, it is important to continue taking prescribed medications if advised by your healthcare provider. Many IBD medications have been shown to cause minimal risk to the pregnancy. To learn more about a particular medication, you can use the IBD Medication Guide, which includes recommendations for pregnancy.
If you are planning a pregnancy, talk to your gastroenterologist and discuss which medications are safe and appropriate so that you can keep your disease under control and optimize your chances of having a healthy pregnancy. Your doctor may recommend that you also see a high-risk OB specialist.
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Disease Monitoring
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If necessary, many diagnostic procedures, including colonoscopy, sigmoidoscopy, upper endoscopy, rectal biopsy, and abdominal ultrasound, can be safely performed during pregnancy. CT scans and standard X-rays should be avoided during pregnancy unless a medical emergency requires them. MRIs can be done safely in pregnancy, however, the use of gadolinium should be avoided in the first trimester.
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Surgery
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For some people, IBD has caused complications that were previously treated with surgery. Some procedures, such as a bowel resection or ileoanal anastomosis, do not appear to have any negative effects on pregnancy. Other surgeries, such as colectomies with ileostomies or J-pouches, may cause a slight decline in fertility rates.
It is important to discuss family planning with your healthcare team to consider the best timing for surgeries and the potential effects a particular surgery may have. A Caesarean section may be recommended for women with active abscesses or fistulas around the rectum and vagina at the time of delivery or if they’ve had a history of certain surgeries. During pregnancy, all elective abdominal surgery should be postponed until after delivery to reduce risk to the fetus.
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Heredity
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It is possible, but certainly not inevitable, that a child of a parent with IBD will have it too. If one parent has Crohn’s disease or ulcerative colitis, the chance of a child developing the condition is approximately 2–9%. If both parents have IBD, the child’s chances may be up to 36%.
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Nutritional Needs
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All pregnant women, including those with IBD, should eat a well-balanced diet and remain on any vitamins they were taking before becoming pregnant. Prenatal vitamins and vitamin B12/folic acid are encouraged.
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Breastfeeding
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Breastfeeding is encouraged and may be protective in the development of IBD for the infant. Most IBD medications are safe to continue during breastfeeding. Methotrexate should not be taken while pregnant or breastfeeding. Be sure to consult with your doctor or lactation specialist if you have questions regarding a particular medication.