What is inflammatory bowel disease (IBD)?
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.
Will I be able to become 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.
Will pregnancy make my IBD worse?
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.
Will the disease or the medications I take for IBD harm my baby?
Some women stop their IBD medication when they learn they are pregnant for fear that it might harm the baby. But, the majority of medications used to treat IBD are safe for pregnancy. Research has shown that most IBD-related medications that are taken before and during pregnancy have no negative effect on the mother, fetus or newborn child.
What medications are safe to treat my IBD during pregnancy?
Here are some of the most common medications used to treat IBD and how each affects the mother and baby.
Aminosalicylates are anti-inflammatory drugs that have a long history of being used to treat patients with IBD. These include mesalamine (Asacol, Rowasa, Pentasa, Salofalk) and sulfasalazine (Azulfidine, Salazopyrin). Neither mesalamine nor sulfasalazine has been found to increase the risk of adverse effects during pregnancy. Women taking sulfasalazine should also be taking a folate supplement because sulfasalazine decreases folate stores in the body.
Corticosteroids are frequently used to control inflammation in patients with IBD, especially during flares. Though corticosteroids are usually effective for symptoms control, long-term use increases the risk of numerous side effects. When the potential benefit of putting your disease in remission outweighs the risks of the medication, your doctor may prescribe short-term use of corticosteroids. Prednisone, prednisolone and methylprednisolone are the corticosteroids of choice since they metabolize better for the developing fetus. Breastfeeding while taking corticosteroids is considered safe.
Immunomodulators reduce inflammation by making the immune system less active. It is the inflammation that is responsible for causing the damage associated with IBD. Azathioprine (AZA) and 6-mercaptopurine (6-MP) are two immunomodulaters that are frequently used in combination to treat IBD. The current recommendation is to continue using AZ and 6-MP during pregnancy.
Biologics are designed to block or protect the body from tumor necrosis factor (TNF), which is the inflammatory response that occurs in IBD. Infliximab (Remicade), adalimumab (Humira) and certolizumab (Cimzia) are three of the most commonly used biologics to treat IBD. There is no data to suggest that these medications could alter the development of the fetal immune system. But, some experts recommended stopping these drugs around 22 weeks into the pregnancy because the drug can cross the placenta after this time period. Passing these medications on to the infant through breastfeeding carries a very low risk.
You should avoid the following medications because of possible serious side effects on the developing child:
Methotrexate is an immune suppressant has been shown to cause severe birth defects or possible death to the fetus. Methotrexate should be stopped at least three months prior to getting pregnant and cannot be used during pregnancy or while breastfeeding.
Thalidomide is an immunomodulator that is sometimes used to treat Crohn’s disease but should be avoided during pregnancy. This drug has been shown to cause severe birth defects and possible death in the fetus and newborn. Thalidomide must be stopped at least one month prior to getting pregnant and cannot be used while breastfeeding.
Antibiotics are frequently used in the management of IBD but should be avoided during pregnancy, if possible.
Will I be able to have a vaginal birth with IBD?
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.
Will I be able to breastfeed?
It does not appear that breastfeeding worsens IBD symptoms. However, concerns about the possible transfer to the child of medications used to control IBD 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.
Will I pass IBD to my child?
Though it is possible to pass ulcerative colitis or Crohn’s disease on to your child, the risk is relatively low. If one parent has IBD, the chance of your child developing the condition is approximately 2-9%. If both parents have IBD, that risk jumps to as much as 36%. Even so, the odds are still in favor of your child not getting IBD.