Pregnancy and IBD
Planning before pregnancy is very important especially when you have IBD. If your disease is
under control and in complete remission, you will be able to conceive more easily, have a
healthier pregnancy, give birth to a healthier baby, and have a better postpartum experience.
This can also help minimize your child’s risk for future health problems as an adult.
IBD Affecting Pregnancy
Having active disease during pregnancy can be very stressful on your body. Frequent trips to
the bathroom, abdominal pain, or nausea and vomiting can cause a lot of discomfort. And, if
you add this on top of the pregnancy related nausea, vomiting, and fatigue, it becomes even
more difficult.
Active disease during pregnancy can cause problems for the baby. Research has shown that
patients with active disease have a 35% higher chance of miscarriage when compared to those
who are in remission. Active disease during pregnancy can lead to: low birth weight, pre-term
birth, and sometimes the loss of baby, although it’s rare.
Pregnancy Affecting IBD
Pregnancy itself usually doesn’t cause a flare of IBD. Some older research showed an increase
in disease activity in the first trimester; however this was more likely because of the
discontinuation of IBD medications, which used to be a common practice.
Disease activity during pregnancy is usually dictated on whether or not you had active or
inactive disease at the time of conception. Studies have shown that 70-80% of patients who
were in remission when they conceived will remain in remission throughout the pregnancy.
Patients with ulcerative colitis may have issues with their J-pouch during pregnancy. Because
your uterus is expanding with the baby, it can put pressure on the pouch and may cause it to
have difficulties holding the waste matter properly. This can cause more frequent bowel
movements.
There is usually a “rule of thirds” for Crohn’s patients who become pregnant. One-third of
patients will see an improvement in their disease, one-third of patients will see no change in
their disease activity, and one-third of patients can get worse.
The information provided in these forms is not meant to replace your physician’s advice. Please discuss with your physician or
health care provider for the up to date information and to check if information provided in these forms is right for you.
Passing IBD to Kids?
There are many different theories as to what causes IBD. Genetic mutations have clearly been
proved to be involved with the development of Crohn’s and colitis. It is not uncommon to see
more than one family member affected by IBD, especially first degree relatives. If one parent
has the disease, the chance of your child developing IBD is approximately 5-7%. If both parents
have the disease, the chances increase to 35%. Unlike other genetic diseases, IBD doesn’t get
transmitted to babies at a higher rate. Just having a gene mutation doesn’t cause you to have
IBD; it is usually a combination of different factors such as immune problems and
environmental factors that, along with genetic mutations lead to the development of IBD.
Nutrition and Pregnancy
A well-balanced diet with an adequate number of calories, vitamins and minerals is important
for your baby’s growth and development. IBD increases your nutritional demands, particularly
if your disease is active or if you are underweight. A dietician may be needed to develop a diet
to best suit your needs. Because some of the best foods for you during pregnancy can trigger
symptoms, it is important to adjust your diet according to how you feel and get creative to get
your nutrients. If the fiber in fruit and vegetables bother you, try juice. Make sure it is 100%
juice and no sugar is added. Fish, which contains omega-3 fatty acids, is good for healing
inflammation. Make sure to eat fish with low levels of mercury such as salmon, catfish, tilapia
and shrimp. A daily prenatal vitamin will help replenish any vitamins and minerals you may be
losing because of diarrhea. Calcium and Vitamin D are important for both you and baby. Not
only are they necessary for building the baby’s bones and teeth, if you are deficient in vitamin D
you are at risk for developing pre-eclampsia and diabetes. Taking steroids will put you at a
higher risk for developing calcium and vitamin D deficiency. In this instance, a supplement may
be needed. The latest research shows that a higher dose of vitamin D (4000 IU/day) can be
very helpful in preventing complications during pregnancy. If you have Crohn’s disease and you
have had part of your small intestine removed, particularly the terminal ileum, you are at risk
for having low vitamin B12 levels. You may need regular Injections of vitamin B12 to prevent
anemia. Taking Folic acid before conception and during the first 12 weeks of pregnancy can
dramatically reduce the chances of your baby having a neural tube defect. Most women are
told to take 400 micrograms per day. Patients with Crohn’s disease of the small intestine have
a difficult time absorbing folic acid. Also, if you are on sulfasalazine or have had a portion of
your small intestine removed, you may also have a hard time absorbing folic acid. For these
individuals, the recommended daily amount of folic acid is 2000 micrograms (2 milligrams).
The information provided in these forms is not meant to replace your physician’s advice. Please discuss with your physician or
health care provider for the up to date information and to check if information provided in these forms is right for you.
Medications and Pregnancy
Most of the medications given to patients with IBD are safe to take during the pregnancy.
Some individuals are concerned with immunosuppressive medications such as azathioprine or
6-MP during pregnancy. Studies have not found any risks with these medications. Experts
usually recommend continuing these medications during pregnancy.
Aminosalicylates: These medications are generally considered safe during pregnancy. If you
are taking sulfasalazine, you should also be taking a high dose of folic acid. It is recommended
at least 2 mg per day. Sulfasalazine will block the absorption of folic acid which is very
important for the baby’s brain and spinal cord.
Antibiotics: Ciprofloxacin (Cipro) and metroniadazole (Flagyl) are commonly used antibiotics in
IBD. Ciprofloxacin is usually avoided during pregnancy. Metronidazole appears to be low risk
and can be used for a longer period of time.
Steroids: Steroids are considered low risk during pregnancy if they are needed to control active
disease. There is an increased risk of diabetes in pregnancy (gestational diabetes) and largebirth-weight babies with steroid use. Cleft palate has also been associated with steroid use
during pregnancy, but this is more typical in mothers who are asthmatics, not those with
Crohn’s or colitis.
Azathioprine/6-MP: The use of these medications has been controversial. The most recent
data shows that these medications are safe. The majority of physicians recommend continuing
these drugs throughout pregnancy, because the risk of stopping the medication and having a
flare is greater that the risk of the drug. However, if you still want to stop this medication for
fear of fetal harm, it takes several weeks for the medication to leave the body. This should be
therefore discussed with your doctor before trying to conceive.
Biologics: All three biologics [Infliximab (Remicade®), Adalimumab (Humira®) and Certolizumab
(Cimzia®)] appear to be safe during pregnancy. Recent studies have not shown any increased
risk for birth defects. During the third trimester, some doctors may want to hold these
medications because they can transfer through the placenta and enter the baby’s blood.
Though, even this has not been found to be dangerous in recent studies.
***If you have been on biologics during pregnancy, your baby should not receive any LIVE
vaccines during the first 6 months***
High Risk Medications
The information provided in these forms is not meant to replace your physician’s advice. Please discuss with your physician or
health care provider for the up to date information and to check if information provided in these forms is right for you.
Medications like methotrexate and thalidomide can cause serious birth defects. Besides
causing a miscarriage, methotrexate can cause bone defects in the baby. You should stop this
medication for at least 3 to 6 months before getting pregnant. Thalidomide is known for
causing limb defects, as well as other major organ complications in the baby. If you are on
either one of these medications, you should be using at least two different methods of
contraception and taking frequent pregnancy tests
Antidiarrheal medications such as Lomotil® (diphenoxylate) and ciprofloxacin (antibiotic) are
also avoided during pregnancy.
Herbal supplements to avoid during pregnancy: black cohosh, ginseng, cascara, juniper,
kavakava, senna and high doses of vitamin A.
Breastfeeding and IBD
Breastfeeding has many benefits for your baby. Some research shows breastfed babies have
less of a chance of developing IBD. Many of the medications given for IBD can be secreted in
the breast milk. These drugs may not be safe for the baby. Discuss with your doctor about the
safety of medications during lactation. Some lactation experts recommend Fenugreek to
enhance milk production. This herbal supplement can cause rectal bleeding and worsen colitis.
Surgery and Pregnancy
The indications for surgery in a pregnant and non-pregnant patient are the same. If you are
experiencing obstruction, perforation, abscess, and bleeding surgery may be necessary.
Although the indications for caesarean section do not differ in women with IBD, they do
undergo elective caesarean sections more frequently than the normal population. In Crohn’s
disease, a vaginal delivery may trigger or worsen existing perineal disease. In this situation, a
caesarean section may prevent aggravation or perineal disease and/or anal incontinence. For
the most part, you will be able to have a normal vaginal delivery without any problems unless
there other obstetric or personal reasons. A C-section may be suggested if you have perianal
disease at the time of delivery or a J-pouch.
Endoscopy: Endoscopy procedures are typically avoided during pregnancy. If absolutely
necessary, a flexible sigmoidoscopy can be done with minimal sedation. Research also shows
that if needed, a colonoscopy can be safely performed. Risks and benefits should be discussed
with your doctor.
The information provided in these forms is not meant to replace your physician’s advice. Please discuss with your physician or
health care provider for the up to date information and to check if information provided in these forms is right for you.