Pregnancy and Crohn's Disease or Ulcerative Colitis

By Dr. Yvette Leung

Most women who have ulcerative colitis or Crohn’s disease, both of which are inflammatory bowel diseases (IBD), are usually able to have a normal pregnancy and a healthy baby. But there are some important considerations to be mindful of before and during your pregnancy.

Becoming Pregnant with Crohn's Disease or Ulcerative Colitis

If you are a woman and your ulcerative colitis or Crohn’s disease is in remission, you should be able to conceive as easily as others your age. If your Crohn's or colitis is active, you may experience more difficulty becoming pregnant because of poor nutrition and irregular menstrual periods. It is usually not a good idea to try and get pregnant when you are experiencing a flare-up, starting a new treatment regimen or when taking steroids. Getting pregnant may also be difficult if you have had surgery in the pelvic region, especially if you’ve had a colectomy (the surgical removal of all or part of your colon) with a J pouch. This procedure is associated with lower fertility rates.

If you are a male with Crohn's disease or ulcerative colitis, your fertility should be similar to other men your age. But, certain medications you may be taking for your disease may be problematic. Medications like sulfasalazine (Azulifidine®) affect sperm count and the quality of the sperm. With your doctor’s approval you should consider switching to another 5-ASA compound, such as mesalamine. Men with Crohn's or colitis should also stop taking methotrexate at least three months before attempting to conceive. Methotrexate has been shown to affect sperm production in animal studies. Smoking should also be avoided by both the mother and father prior to becoming pregnant to reduce the associated complications and health risks to the developing fetus.

Crohn's or Colitis Symptoms during Pregnancy

In some cases, Crohn's disease or ulcerative colitis 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 disease 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 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 disease is in remission before getting pregnant. This means that it is important to make sure there is no evidence of inflammation related to Crohn's or colitis present in your bowels before getting pregnant. This is why your doctor may order tests such as a colonoscopy before you start to try to get pregnant.

Medications before and during Pregnancy

Some women stop their Crohn's or colitis medication when they learn they are pregnant for fear that it might harm the baby. But, the majority of medications used to treat Crohn's disease or ulcerative colitis are safe for pregnancy. Research has shown that most Crohn's or colitis related medications that are taken before and during pregnancy have no negative effect on the mother, fetus or newborn child. Because having a flare is associated with potentially serious problems for both the mother and fetus, most doctors feel this it the worst time to ‘take a chance’ by stopping Crohn's or colitis medications.
The exception is methotrexate, which has been shown to cause severe birth defects or possible death to the fetus. Methotrexate is typically used apart from Crohn's or colitis, to treat several types of cancer, rheumatoid arthritis and psoriasis. Methotrexate should be stopped at least three months prior to getting pregnant and cannot be used during pregnancy or while breastfeeding.

Diagnostic and Surgical Procedures during Pregnancy

In certain situations there may be a need for diagnostic procedures, such as a colonoscopy or sigmoidoscopy during pregnancy. These can usually be performed safely during pregnancy. However, computerized tomography (CT) scans and standard X-rays should not be taken during pregnancy due to the radiation that is emitted during the procedure unless the potential benefits outweigh the associated risks of radiation. Magnetic resonance imaging (MRI) is considered safe for both mother and baby.
Surgery should be postponed until after delivery, unless your condition is serious and unresponsive to the medications you are taking. Any type of abdominal surgery during pregnancy can pose a risk to the fetus.

Nutritional Needs during Pregnancy

All pregnant women, especially those with Crohn's disease or ulcerative colitis, should eat a balanced diet to get all the nutrients you need to stay healthy and to nourish your growing child. If you were taking vitamins before getting pregnant, you should continue those vitamins during pregnancy and ensure that this regimen includes at least 2 mg of Folic Acid a day, especially if you are taking sulfasalazine, which tends to inhibit folic acid absorption. Folic acid deficiencies are associated with spina bifida and other neural tube birth defects. Also, some vitamins may not be appropriate for pregnancy, so it’s always best to check with your doctor regarding your dietary supplements.

Delivery

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. If 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.

Learn About Medications Used to Treat Crohn's Disease and Ulcerative Colitis During Pregnancy and Breastfeeding

Passing Crohn's or Colitis to Your 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 the disease, the chance of your child developing the condition is approximately 2-9%. If both parents have Crohn's or colitis, that risk jumps to as much as 36%. Even so, the odds are still in favor of your child not getting the disease.

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