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Pregnancy and IBDIf you have Crohn's disease or ulcerative colitis and want to have children, you may have many questions -- including these: - Will I be able to become pregnant?
- Will pregnancy make my IBD worse?
- Will the disease or the medications I take for it harm my baby?
- Will I be able to breastfeed?
Each person's disease is different. Any choices you make regarding pregnancy should be made in collaboration with your gastroenterologist and obstetrician. But here are some broad answers:
Conception and IBDGenerally speaking, women with ulcerative colitis or with Crohn's disease in remission can become pregnant as easily as other women. Women with active Crohn's disease may have more difficulty becoming pregnant. If it is the man who has IBD, that is another matter. Because the medication sulfasalazine (AzulfidineÒ) decreases sperm count, a man taking this drug should switch to another 5-ASA compound, with his doctor's approval. For three months before conception, men should also avoid taking methotrexate. Smoking, too, should be avoided by hopeful parents-to-be. Women should not take methotrexate before or during pregnancy or while breastfeeding because of its toxic effects on the developing fetus or newborn.
Effect of pregnancy on women with IBDWomen should be well before becoming pregnant. It is not a good idea to begin a pregnancy when the disease is flaring, when the woman has recently begun a new treatment, or when she is on steroid medications. If she is already pregnant, she should continue on the regimen that has kept her well even if it includes steroids (although her doctor will try to minimize the steroid dose). Some women stop their medications when they learn they're pregnant because they worry about harming the baby. If disease then flares, it can be very difficult to get it back under control.
In some cases, IBD actually improves during pregnancy. That's because in all pregnancies, the body suppresses the immune system to prevent it from rejecting the fetus. In women with IBD, this phenomenon often serves to put the disease in remission. One study of women with Crohn's disease suggests that pregnancy also may protect against future flare-ups and may reduce the need for surgery. This has to do with a hormone produced by pregnant women called relaxin that prevents the uterus from contracting prematurely. Relaxin also may prevent the future formation of scar tissue, which frequently causes Crohn's disease patients to require surgery. However, women should not use pregnancy as a means to treat a flare-up, even if previous pregnancies induced a remission.
Effect of IBD on pregnancy, delivery, and the developing fetusWomen with IBD are as likely to have normal pregnancies and deliveries as those without IBD. Most problems occur with women with active Crohn's disease. Inflammation-creating proteins in the disease may pose a greater risk of miscarriage, premature delivery, or stillbirth. While the risk of miscarriage in the general population is one in six pregnancies, it is slightly higher in women with active Crohn's disease.
Medications for IBD during pregnancyIn most cases, medication schedules are maintained during pregnancy. If the woman's condition changes, drugs or dosages may be altered. Here is a rundown on the most commonly used drugs: - Aminosalicylates. Sulfasalazine (Azulfidine®) and other 5-ASA compounds such as mesalamine (Asacol®, Pentasa®, Rowasa®, Canasa®), balsalazide (Colazal®), and olsalazine (Dipentum®) do not increase complications or harm the fetus. Sulfasalazine may cause nausea and heartburn. Women can breastfeed while taking a 5-ASA compound.
- Corticosteroids. Prednisone and other corticosteroids are safe during pregnancy, although it's best if women are not on steroids at the beginning of a pregnancy. If a woman becomes pregnant while on steroids, the doctor usually tries to minimize the dose. Nursing infants of women on moderate-to-high dosages of prednisone should be monitored by a pediatrician.
- Immunomodulators (immunosuppressives). Immunosuppressive drugs such as azathioprine (Imuran®), 6-mercaptopurine (6-MP, Purinethol®), and cyclosporine A (Sandimmune®, Neoral®) appear safe during pregnancy in standard dosages. Men should avoid these drugs for three months before conception, and both men and women should avoid methotrexate [see above].
- Biologics. Infiximab (Remicade®), a biologic compound approved for the treatment of both Crohn's disease and ulcerative colitis, does not seem to be associated with increased risks to the developing fetus or with an increase in pregnancy complications. It also does not appear in breast milk.
- Antibiotics. If possible, these should be avoided during pregnancy.
- Thalidomide. Because this drug can cause birth defects and fetal death, it should always be avoided during pregnancy.
Diagnostic procedures during pregnancyIf necessary, many diagnostic procedures—including colonoscopy, sigmoidoscopy, upper endoscopy, rectal biopsy, and abdominal ultrasound—can be safely performed during pregnancy. CT scans and standard X-rays should not be taken during pregnancy unless a medical emergency requires them. MRIs can be done safely in pregnancy, however. The impact of surgery before and during pregnancyPrevious bowel resections do not appear to have any negative effects on pregnancy in women with Crohn's disease. Women also have had successful pregnancies after ileoanal anastomosis for ulcerative colitis—a procedure in which the colon and rectum are removed and the ileum (the last segment of the small bowel) is connected to the anus.
It appears that women who have undergone ileostomies for ulcerative colitis or Crohn's disease have slightly decreased fertility rates. If this procedure is not urgently needed and you plan to have children, speak with your doctor about the best timing for such surgery. Women who have had an ileostomy also can have a prolapse (drop) or obstruction of the ileostomy during pregnancy. Waiting a year after the surgery before becoming pregnant reduces that likelihood.
Women with Crohn's disease who have developed fistulas (abnormal passages) or abscesses (collections of pus) around the rectum and vagina should probably not have an episiotomy during labor. In these cases, delivery is often performed by Caesarian section.
Unless the patient's condition is serious and unresponsive to drugs, surgery should be postponed until after delivery. Any abdominal surgery poses a risk to the fetus.
Nutritional needs during pregnancyAll pregnant women—including those with IBD—should eat a well-balanced diet and remain on any vitamins they were taking before becoming pregnant. That includes folic acid to prevent spina bifida and other neural tube birth defects. Folic acid is particularly important for women taking sulfasalazine, which inhibits folic acid absorption. Passing on IBDIt is possible but certainly not inevitable that a child of a parent with IBD will have it, too. If one parent has Crohn's disease or ulcerative colitis, the chance of a child developing the condition is approximately 9%. If both parents have IBD, the child's chances may be as high as 36%.
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Date Posted: July 7, 2006 |
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