Inflammatory Bowel Disease During Pregnancy

Topic Overview

Most women who have inflammatory bowel disease (ulcerative colitis or Crohn's disease) can have a normal pregnancy and deliver a healthy baby. IBD does not affect the pregnancy itself. In most cases, if a woman who has inflammatory bowel disease (IBD) is not having symptoms (is in remission) when she becomes pregnant, she will stay in remission during pregnancy. Sometimes the disease becomes more active during the pregnancy. If the disease is active when a woman becomes pregnant, it is likely to stay active during the pregnancy. Doctors recommend that women wait until their disease is in remission before trying to get pregnant.

The type of IBD and how bad it is determines the health of the baby and the risk of premature delivery. The treatments used during pregnancy also play a role. Women with severe disease are more likely to have a premature delivery and a baby with a low birth weight.

X-ray tests, imaging of the lower portion of the large intestine (flexible sigmoidoscopy), 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 breastfeeding. Your doctor will look at your symptoms and your pregnancy and will be able to tell you about the risks of medicine for you. In general:

• Aminosalicylates are usually safe to use during pregnancy and breastfeeding.
• The use of corticosteroids will be decided on a case-by-case basis. They can be considered for women with moderate to severe inflammatory bowel disease when the risk of active disease is more harmful to the baby than the risk of taking the medicine during pregnancy.
• The use of antibiotics such as metronidazole will be decided on a case-by-case basis by your doctor. Ciprofloxacin should not be used.
• The use of immunomodulators azathioprine and mercaptopurine will be decided on a case-by-case basis. They can be considered for women with moderate to severe inflammatory bowel disease when the risk of active disease is more harmful to the baby than the risk of taking the medicine during pregnancy.
• The use of cyclosporine will be decided on a case-by-case basis. It may be considered for women with moderate to severe inflammatory bowel disease when the risk of active disease is more harmful to the baby than the risk of taking the medicine during pregnancy.
• The use of biologics (such as infliximab) during pregnancy is still being studied. They should only be used when other medicines have not worked and when the health of the mother or the fetus (or both) is at risk.
• Methotrexate, thalidomide, and mycophenolate mofetil should not be taken while you are pregnant or breastfeeding.
• Nutrition given into a vein (total parenteral nutrition, TPN) may be used during pregnancy if needed.