IBD and Pregnancy

What do I need to know about getting pregnant with Crohn’s disease or ulcerative colitis? Let’s talk about the effects of IBD on fertility and pregnancy.

Many patients with inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis are women of reproductive age. One major concern for these women is how IBD can affect fertility and pregnancy outcomes, and how being pregnant might affect the activity of the disease. Patients also express concern about the heritability of IBD to their potential offspring. As a woman with IBD, you might be asking yourself questions like:

  • What is it like being pregnant with Crohn’s disease or colitis?
  • What are the IBD pregnancy risks?
  • Will it be harder for me to get pregnant? What does the research say about colitis or Crohn’s disease and fertility?
  • Which IBD medications are safe during pregnancy? For answers to this common question, we’ve written a separate article on pregnancy and IBD medications.

If you’re asking these questions about colitis or Crohn’s and pregnancy, keep reading. Because IBD can have a major impact on your health and lifestyle, it’s important for women to understand the risks and the advantages (yes, the advantages!) that IBD can impose on the decision to raise a family.

Fertility and IBD

Fertility is a topic of concern among female patients with IBD who worry that there may be a link between UC or Crohn’s and infertility. Fortunately, female patients whose IBD is under control and who have not had pelvic surgery have comparable fertility rates to their peers without IBD.

Crohn’s disease and fertility

Having Crohn’s disease does not necessarily affect one’s fertility, and research has shown that women in remission have similar fertility rates to women without IBD. Although some studies on Crohn’s and fertility have reported lower fertility rates in Crohn’s patients, it’s important to keep in mind that these women were not necessarily less fertile—many women with IBD voluntarily remain childless due to fear of negative outcomes.

Ulcerative colitis and fertility

As with Crohn’s, simply having ulcerative colitis does not have a negative impact on fertility. However, women who have undergone a total abdominal colectomy, a common surgery for UC, may experience lower fecundity rates as a result of the surgery, not as a result of the disease itself (see next section).

Colectomy: fertility and fecundity

Women who’ve undergone a total abdominal colectomy and the subsequent creation of an ileal J-pouch anal anastomosis are known to experienced decreased fecundity rates. Fecundity is slightly different from fertility, as fecundity refers to the ability to conceive naturally, not the likelihood of conception in general. This is due to the pelvic adhesions that may form as a result of the surgery, causing obstruction in the fallopian tubes.

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Crohn's Disease Ulcerative Colitis

Studies have also reported that the open ileal J-pouch anal anastomosis procedure results in lower fertility rates than the laparoscopic version of the surgery. Depending on the patient, women who require this procedure might opt for the laparoscopic ileal J-pouch in order to have better chances for higher fertility rates.

Often, young women who are considering this procedure are advised to put off the surgery until later in life. Another option is the creation of an ileorectal anastomosis. These alternatives aren’t always feasible; women who need to undergo the J-pouch anal anastomosis procedure who wish to conceive might consider in vitro fertilization.

IBD and Pregnancy Outcomes

It’s important for prospective mothers to understand that patients with IBD do generally tend to have worse pregnancy outcomes when compared with women without IBD (negative outcomes may include preterm births, newborns who were small for gestational age, and cesarean section deliveries). Additional studies have found that the rate of negative outcomes is higher in Crohn’s disease than ulcerative colitis.

Many women are concerned that IBD may have negative effects on the newborn child. While some research shows that IBD does lead to negative newborn outcomes (such as decreased birth weight), other studies have found that, while IBD is associated with increased pregnancy complications (spontaneous abortion, eclampsia, preeclampsia, placenta previa, abruptio placentae, or prolonged premature rupture of membranes), it does not lead to worse newborn outcomes.

Still, additional studies comparing IBD and non-IBD pregnancies have reported no negative effect on birth weight nor on rates of abortions, preterm deliveries, cesarean section births, and congenital abnormalities.

Having a Baby and IBD: Advantages

It’s not all bad news. In a qualitative study published in Qualitative Health Research in 2018, a group of 22 mothers with IBD were interviewed and asked questions about pregnancy, motherhood and IBD. The aim of the study was to increase awareness of the realities involved in the transition to motherhood in patients with IBD, a group that tends to restrict their reproductive choices due to the disease.

Interestingly, women in this study reported that, in some ways, living with IBD had given them special skill sets that became advantageous in pregnancy and child-rearing. For example, patients who had been monitoring their diet for years due to the disease found it this practice prepared them well for making the necessary adjustments to their diet during pregnancy. Similarly, interviewees spoke about how the unpredictable nature of living with IBD had given them valuable practice in dealing with the surprises and stressors of child-rearing. While the complications of IBD can affect pregnancy and child-rearing, it’s clear that, in some ways, dealing with the symptoms of IBD gives future mothers an advantageous edge.

Key Topic in IBD and Pregnancy: Maintaining Remission

Researchers and physicians agree: maintaining disease remission at the time of conception and throughout pregnancy is key—for both the mother and the fetus. Active IBD results in decreased fertility rates, and it’s speculated that active IBD at conception can have a negative impact on pregnancy outcomes.

Achieving a healthy pregnancy, mother, and child is more than possible with IBD. Many women with IBD have had successful, healthy pregnancies and are raising healthy families. This success is made possible by a multidisciplinary approach in which women are educated about their choices and confident that their IBD treatment is undertaking measures to improve their maternal health as well.

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References

Hashash, J. G., & Kane, S. (2015). Pregnancy and Inflammatory Bowel Disease. Gastroenterology & Hepatology, 11(2), 96–102. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836574/
University of Leeds. (2018 April 4) Motherhood and inflammatory bowel disease. Medical Press. Retrieved from https://medicalxpress.com/news/2018-04-motherhood-inflammatory-bowel-disease.html
Jihane Ghorayeb et al. (2018) When Your Pregnancy Echoes Your Illness: Transition to Motherhood With Inflammatory Bowel Disease, Qualitative Health Research. DOI: 10.1177/1049732318763114