IBD & Pregnancy
What you should know about inflammatory bowel disease (IBD) and pregnancy.
Inflammatory bowel disease (IBD) refers to a condition where there is chronic inflammation of part or all of the digestive tract. The two major types of IBD are ulcerative colitis and Crohn’s disease. Both can create similar symptoms that include severe diarrhea, pain, fatigue and weight loss but affect different parts of the digestive tract. When inflammation is severe, IBD is considered to be in an active stage. When inflammation is less or without symptoms, IBD is considered to be in remission.
Becoming pregnant with IBD
If your IBD is in remission, you should be able to conceive as easily as other women your age. About two-thirds of women who become pregnant while in remission will stay in remission for the duration of their pregnancy. Most physicians recommend that women try to conceive while their IBD is in remission.
If you have active IBD, you may experience greater difficulty getting pregnant, having a preterm birth or having a baby with low birth weight. Women with active IBD at the onset of pregnancy are likely to experience ongoing active symptoms during pregnancy.
Effects of IBD on pregnancy
In some cases, IBD symptoms actually improve during pregnancy. The reason: when you are pregnant, your body naturally suppresses your immune system to prevent your body from rejecting the fetus. So, this suppression of the immune system may actually enhance movement toward remission during your pregnancy.
But, it is also possible that changes in the immune system may worsen IBD symptoms during pregnancy and also in the post-partum stage. Having active disease during pregnancy can increase your risk of going into premature labor. It can be very difficult to regain control over your IBD symptoms if a flare-up occurs while you are pregnant. This may then lead to poor health for you and may put the baby at higher risk for possible complications. Therefore, it is optimal that your symptoms are in remission before getting pregnant.
Labor, delivery and postpartum with IBD
The level of active disease symptoms can affect a doctor’s choice of medications and treatment during labor, delivery and the postpartum period. See more about medications for IBD during pregnancy (link)
Most women can have a vaginal birth with the exception of those with Crohn’s disease who have developed fistulas (abnormal passages) or abscesses (pockets of pus) around the rectum and vagina. It these are active at the time of delivery, a Caesarean section will be ordered. In patients with a J pouch, the general recommendation is a Caesarean section but women should discuss this with their obstetrician and gastroenterologist because there may be situations where a vaginal delivery may be appropriate.
Nutritional needs during pregnancy
All pregnant women, especially those with IBD, should eat a balanced diet to get all the nutrients you need to stay healthy and to nourish your growing child. If you were taking vitamins before getting pregnant, you should continue those vitamins during pregnancy and ensure that this regimen includes at least 2 mg of folic acid a day, especially if you are taking sulfasalazine, which tends to inhibit folic acid absorption. Folic acid deficiencies are associated with spina bifida and other neural tube birth defects. Also, some vitamins may not be appropriate for pregnancy, so it’s always best to check with your doctor regarding your dietary supplements.
It does not appear that breastfeeding worsens IBD symptoms. However, concerns about the possible transfer of medications used to control IBD to the child cause some women to avoid breastfeeding or stop IBD medication while breastfeeding. In most cases, breastfeeding is encouraged. The nutritional benefit for the child and the bonding that it creates between mother and child tend to outweigh the potential risks to the child. But, you are always encouraged to discuss this with your healthcare provider prior to breastfeeding in light of the specific medications you are taking.