INFLAMMATORY BOWEL DISEASE
How does Inflammatory Bowel Disease (IBD) and the medications to treat it affect pregnant women and their developing babies? What should you know as a pregnant women with IBD? Dr. Mahadevan-Velayos, a gastroenterologist with UC San Francisco Medical Center, explains what's known about IBD and pregnancy and what researchers are still trying to figure out.
Dr. Uma Mahadevan-Velayos is an Associate Professor of Clinical Medicine and Director of Clinical Research at the University of California, San Francisco (UCSF) Center for Colitis and Crohn's Disease.
The most common age to be diagnosed with IBD (Crohn’s disease (CD) and ulcerative colitis (UC)) is during the reproductive years making medications and treatment during pregnancy a frequent concern. Women with IBD are as likely to get pregnant as women without IBD in the same age range. However, surgery, particularly in the pelvis such as removal of the colon and rectum (total colectomy with or without a J-pouch) reduces fertility considerably. This may be due to scar tissue in the pelvis.
Once pregnant, women with IBD have higher rates of spontaneous abortion (miscarriage), low birth weight, and preterm birth as well as complications of labor, and thus should be followed as high risk pregnancies. Women with IBD have a one-third risk of flaring during pregnancy, similar to the non-pregnant women with IBD. Simply having IBD significantly increases the risk of a complication of pregnancy even if the patient is in remission. Disease activity may increase this risk further. A cesarean section is recommended for obstetric concerns only or for active perianal CD at the time of delivery. Otherwise, women with IBD can successfully have vaginal delivery. Patients with an ileal pouch anal anastomosis (J pouch) may choose elective cesarean section to preserve anal sphincter function and prevent incontinence in the future.
It is important to keep the IBD as inactive as possible during pregnancy and therefore most medications are continued during pregnancy. Sometimes obstetricians will recommend stopping IBD medications because of their FDA (Food and Drug Administration) category, without considering the consequences on disease activity. It is therefore important that you notify your GI doctor of your pregnancy immediately and let them know if you plan to stop any medications. They will usually recommend continuing most of them. It is even better to discuss how your disease will be managed before you even get pregnant so you have a plan that everyone is comfortable with!
The majority of medications used in IBD are considered low risk and may be continued in pregnancy, however, some medications used to treat IBD are contraindicated and because they are known to cause birth defects. A full discussion of the risks and benefits of medication use in pregnancy should be discussed with your health-care provider.
• Women with IBD have the same chance of getting pregnant as women in the general population, unless they have had surgery in the pelvis.
• Women should attempt conception ideally once their disease is under good control.
• Once pregnant, given the potential increased risk of complications such as preterm delivery, women with IBD should be followed as high risk OB patients with a multidisciplinary team consisting of the gastroenterologist, obstetrician and pediatrician.
• Most medications can be continued during pregnancy and breastfeeding but prior to doing so a complete discussion of risks and benefits should be had with the gastroenterologist and obstetrician.
For information about participating in the OTIS Autoimmune Diseases and Pregnancy Study, please go to the Autoimmune Diseases Study Page. More information
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