IBD During Pregnancy
The majority of women who develop the disease are usually in their reproductive years.
Most women who have inflammatory bowel disease (ulcerative colitis or Crohn's disease) during pregnancy have healthy babies. However, it is important to the health of mothers and their babies to have close management of the disease before considering becoming pregnant. If a woman who has inflammatory bowel disease is not having symptoms (is in remission) when she becomes pregnant, she will do well in most cases. Sometimes the disease becomes more active during the pregnancy, and therapy is usually recommended.
Women with IBD may have slightly higher rates of pregnancy complications such as miscarriage, preterm delivery, low birth weight, and small for gestational age babies. In addition, surgery for IBD usually has implications on one’s ability to conceive a baby.
X-ray tests and imaging of the entire large intestine (colonoscopy) are usually avoided during pregnancy to prevent harming the fetus.
In some cases, active inflammatory bowel disease can be worse for the fetus than the medicines used to control symptoms. Ask your doctor which medicines are safe for you to take during pregnancy and breast-feeding. Your doctor will look at your symptoms and your pregnancy and will be able to determine the risks of medicine for you. In general:
- Aminosalicylates are low risk to use during pregnancy and breast-feeding.
- Corticosteroids are usually low risk and should be considered for women with moderate to severe Crohn's disease.
- The use of antibiotics such as metronidazole should be decided on a case-by-case basis by your doctor. Ciprofloxacin should not be used.
- Studies show that the immunomodulators, azathioprine (AZA) and 6-mercaptopurine (6-MP) are low risk for use in pregnancy. They should not be used by women who breast-feed.
- The use of infliximab during pregnancy is considered low risk, but its effects on a developing fetus are still being studied. It should only be used with close monitoring and counseling with your IBD physician.
- Methotrexate, thalidomide, and mycophenolate mofetil should not be taken while you are pregnant or breast-feeding.
Any patient with IBD should consult with an IBD specialist as well as their obstetrician to determine the safest and most effective form of treatment.