Controlling Your Disease

Considerations for IBD and pregnancy

We understand a healthy pregnancy, and ultimately a healthy child, is the goal for any expectant mother. That’s why it’s important to control inflammation related to Crohn's disease or ulcerative colitis to keep IBD as inactive as possible during pregnancy.

While we’ve provided some helpful resources below about IBD and pregnancy, it’s best to find a doctor who specializes in IBD. Together you can come up with a management plan for your specific needs.

Importance of disease control

In order to optimize pregnancy outcomes for expectant mothers with IBD and their babies, it's important to control inflammation before pregnancy occurs. Women with active disease at the time of conception have a harder time controlling their IBD and achieving disease remission during pregnancy.

Some studies correlate IBD flares in pregnancy with higher risks for premature deliveries and low birth weights. Active disease, specifically in the perianal region, can also require the need for a C-section instead of a vaginal delivery. Many (if not most) IBD medications can be used safely during pregnancy. Therefore, share your wishes to have children with your IBD doctor early. Have this conversation several weeks to months before you stop your birth control or attempt to conceive – and no time is too early to bring up this topic with your physician.

Talking with your doctor pre-pregnancy will ensure:

• You're on safe IBD medications. Some IBD medications should be avoided during parts (or the entirety) of pregnancy.
• You have all the necessary exams and tests to look for disease activity. Your physician may recommend a colonoscopy, blood work or other tests to look for signs of inflammation. Some of these studies cannot be performed once you become pregnant. You can have active inflammation even when you're feeling well, so it's important to undergo testing to be sure.
• Your medications are optimized. Depending on the results of your testing, your physician may recommend adjusting your dose, timing or type of medication to maximize your chances of a safe pregnancy. You may need to undergo further tests to evaluate disease activity after medication changes are made, so it's best to plan early.

What to know during pregnancy

First, you should notify your IBD doctor if you become pregnant. Women with IBD are at higher risk for spontaneous abortions and other pregnancy complications compared to those without IBD. So it's best to have close follow-up with your IBD provider as well as specialized obstetrics care during this time. Before making any changes to your IBD medications, make sure that you, your obstetrician and your IBD provider are all on the same page about what treatment plan is best for you. IBD patients have the same risk for flares during pregnancy as when they're not pregnant (about 30% per year). As mentioned above, flares during the pregnancy may further heighten the risk for premature deliveries and low birth weights at a time when testing and treatment options may be more limited. Therefore, it's important to remain vigilant about controlling IBD inflammation from conception to birth.

Important takeaways

• Disease activity at time of conception and throughout your pregnancy has health implications for both you and your baby. Work with your doctors to make sure your IBD is properly controlled before conception and during the entirety of your pregnancy. This will help ensure the best possible results for you and your baby during this special time.
• Despite the special considerations that need to be taken, with careful control of IBD inflammation, the majority of women are able to enjoy safe and healthy pregnancies and deliveries.