If you have inflammatory bowel disease (IBD), including Crohn's disease, you may be wondering how your condition will affect your pregnancy (and vice versa), and how to manage your symptoms if you have them while you're expecting. Here's a guide to dealing with Crohn's disease during pregnancy.
What is Crohn's disease?
Inflammatory bowel disease is a group of conditions that includes Crohn’s disease and ulcerative colitis, which cause chronic intestinal inflammation. (Despite its similar name, irritable bowel syndrome (IBS) is a separate, non-inflammatory condition.)
IBD symptoms can range from mild to severe and may vary depending on where the inflammation is happening in your gastrointestinal (GI) tract. Common symptoms may include frequent diarrhea, rectal bleeding, abdominal pain, cramping and unexplained weight loss.
While it's important to know what to expect if you have the condition and get pregnant, the good news is that with expert medical care, most women with IBD can have healthy pregnancies.
When is the best time to get pregnant if you have Crohn's disease?
Doctors recommend that women with IBD receive preconception counselling. Ideally, you’ll try to conceive while the disease is in remission (after you've been symptom-free for three to six months).
You may have a harder time conceiving when your disease is active. If you do get pregnant during a flare-up, you may be more likely to experience active disease symptoms during pregnancy, which can increase the risk of complications.
In general, most women with Crohn's disease can get pregnant just as easily as women without it.[1] But women who have had pelvic surgery for Crohn's, especially those who have had a colectomy with a J-pouch, may find it more difficult to conceive.
Other kinds of procedures may not affect conception or pregnancy. For instance, if you've had a bowel resection or an ileoanal anastomosis, your chances of becoming pregnant, having a healthy pregnancy and welcoming a healthy baby are about the same as for women without Crohn’s disease.
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What pregnancy complications are more common with Crohn’s disease?
Most women with Crohn's have healthy pregnancies and babies. That said, an IBD pregnancy is still considered high-risk, because you’re more likely than women without IBD to have certain complications (including premature delivery, labor and delivery complications, a low birth weight baby or miscarriage).[2] That holds true even if you conceive while your condition is in remission.
Having the active disease further increases these risks, so it’s important that you and your medical team work to maintain a state of remission throughout pregnancy.
There are certain steps you can take to minimize your chances of a flare-up during pregnancy. Continue taking any medications prescribed by your physician, eat a healthy, well-balanced diet, and take any vitamin supplements recommended by your doctors. Getting enough folic acid is especially important since some of the medications for IBD (such as sulfasalazine) make it harder to absorb folic acid.
If you have active perianal Crohn's disease (PCD), talk to your practitioner about your labor and delivery options. Because PCD may increase your risk of perineum tearing during a vaginal birth, your practitioner may recommend a C-section for moms with this type of Crohn's.
How will pregnancy affect Crohn's disease symptoms?
It’s hard to know, since pregnancy affects each woman differently. If you conceived during a period of remission, the chances are good that you will stay in remission throughout your pregnancy.
Even so, about a third of women who are symptom-free when they get pregnant experience a flare-up during the course of pregnancy. Relapses are most common during the first trimester.
Women who conceive when their Crohn’s disease is active are more likely to experience symptoms during pregnancy.
Can you continue to take Crohn’s disease medications during pregnancy?
It depends. Some of the medications you normally take to keep your condition under control are considered low-risk (and therefore safe to take) during pregnancy. Others are not.
It’s important to review all medications you're taking with your health care provider. Your doctor may be able to substitute an alternate medication for one that isn't recommended during pregnancy.
You and your doctor will weigh the risks and benefits of continuing with your medications. A significant flare-up during pregnancy can be more risky than some of the drugs used to treat Crohn's.
Your doctor may lower the dose you take of a certain drug, suggest you taper off one of your medications during pregnancy to minimize any potential risk (as may be recommended for infliximab, especially by the third trimester), or advise you not to take a medication during the first trimester (as might be the case with prednisone).
Medications that are typically considered low-risk (and therefore probably safe to use with your doctor's approval) during pregnancy include the following:
- Sulfasalazine
- 5-aminosalicylate (5-ASA) drugs
- Steroids such as prednisone (typically considered safe, though may slightly increase your risk of pregnancy complications including gestational diabetes and high blood pressure)
- Azathioprine and 6-mercaptopurine
- Infliximab, adalimumab, and certolizumab pegol (generally considered safe, but there is some concern with these medications crossing the placenta, so your doctor may take you off them during third trimester if your disease is in remission)[3]
With close, expert medical supervision, the chances are good that you'll have a healthy pregnancy and baby if you have Crohn's disease. So try to enjoy the journey as much as you can! And as always, talk to your doctor frequently with any questions and concerns you have all along the way.
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