Family planning and IBD: Expert answers to common questions
Published: May 10, 2019
Having a baby is a wonderful experience, but for many women, health issues can cause them to second-guess their ability to become a mom. Women with inflammatory bowel disease (IBD) may feel as though pregnancy is out of the question. This isn't necessarily true. In the U.S., 1.6 million people have IBD — a group of disorders that include Crohn's disease and ulcerative colitis. Of those, roughly half are women who will consider getting pregnant one day. When it comes to IBD and planning for a family, it's natural to have questions and concerns.
"The IBD Parenthood Project provides guidance to women with IBD on the continuum of care and best practices for managing their IBD throughout all phases of family planning: trying to conceive, pregnancy and postpartum," says Rajeev Jain, MD, AGAF, FACP, IBD Parenthood Project Co-Chair and Gastroenterologist at Texas Digestive Disease Consultants. Led by the American Gastroenterological Association (AGA) with support from the Society for Maternal-Fetal Medicine, the Crohn's & Colitis Foundation and the patient support network Girls With Guts, this program aims to empower women with IBD, their loved ones and health care providers to have open conversations about preconception, pregnancy and post-delivery care.
Dr. Jain offers answers to the most common questions he receives from women about IBD and family planning:
In your experience, what are the top concerns women with IBD have when planning for a family? What are the key steps you would urge her to take before she gets pregnant?
Answer: Many women with IBD are concerned that they won't be able to achieve a healthy pregnancy and worry about factors such as IBD medication being harmful to their baby. Studies show that women who have their Crohn's disease and ulcerative colitis under control, and who have never had surgery, can get pregnant at the same rate as other women in the general public. For women to have a successful pregnancy, their IBD should be under control; avoiding a flare is the most critical aspect to achieving a healthy pregnancy.
What types of health care providers should a woman see to ensure she has a healthy pregnancy?
Answer: Pregnant women with IBD should work with a maternal-fetal medicine (MFM) subspecialist who will coordinate care with her delivery provider and gastroenterologist (GI). A pregnant patient with IBD should be monitored by both a GI, who has a clear expertise in IBD, and an obstetric provider, ideally an MFM subspecialist, with further assistance from other care providers. An obstetrician (OB) or MFM subspecialist should lead pregnancy-related care, and the GI should lead IBD care, with excellent communication among all providers consulted during pregnancy.
What is an MFM subspecialist?
Answer: An MFM subspecialist is an OB with an additional three years of formal education who is board-certified in maternal-fetal medicine, making them highly qualified experts and leaders in the care of complicated pregnancies. An MFM subspecialist is distinct and different from a "high-risk OB."
Are IBD drugs harmful to take while trying to get pregnant or during pregnancy?
Answer: Most women who are in remission when they get pregnant stay in remission throughout pregnancy. Stopping medication can cause a flare, which is a risk to a healthy pregnancy. Treating IBD with the appropriate medication may help reduce a woman's risk of a flare and can help lead to a healthier pregnancy.
Will my children have IBD?
Answer: Up to 3 percent of children with one parent who has IBD will develop the disease (this means about 97 percent will not get IBD).
Are women able to breastfeed while on IBD medication?
Answer: Yes, in many cases, mothers with IBD who breastfeed can simply follow standard nutritional recommendations, which may include increasing the amount of food in her diet or adding omega-3 fatty acids.
To download the patient toolkit and learn more about pregnancy and IBD, visit www.IBDParenthoodProject.org.
AGA's IBD Parenthood Project is funded through support from UCB, a global biopharmaceutical company.