Inflammatory bowel disease during pregnancy

Most women who have inflammatory bowel disease (ulcerative colitis or Crohn's disease) during pregnancy have healthy babies. 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 do well. Sometimes the disease becomes more active during the pregnancy. If the disease is active when a woman becomes pregnant, the symptoms may become worse.

Women with IBD (either Crohn's disease or ulcerative colitis) are two times as likely as women without the disease to have a small or premature baby. Women with Crohn's disease are more likely to have a cesarean delivery (C-section).¹ These risks may be higher in women who have active disease when they become pregnant or who have active disease during their pregnancy.

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 breast-feeding. Your doctor will look at your symptoms and your pregnancy and will be able to determine the risks of medicine for you. In general:^{2, 3}

• Aminosalicylates are safe to use during pregnancy and breast-feeding.
• Corticosteroids are usually safe and should be considered for women with moderate to severe Crohn's disease.
• The use of antibiotics such as metronidazole should be decided on a case-by-case basis by your doctor. Ciprofloxacin should not be used.
• Studies show that the immunomodulators azathioprine (AZA) and 6-mercaptopurine (6-MP) have little or no effect on pregnancy, but their safety is not certain. They should not be used by women who breast-feed.
• Cyclosporine may be safe, but it is rarely used. It is only used for severe active disease when other drugs don't work to get rid of symptoms. When remission occurs, the medicine should be changed to another immunomodulator to keep symptoms from coming back.
• The use of TNF antagonists (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 breast-feeding.
• Nutrition given into a vein (total parenteral nutrition, TPN) may be used during pregnancy if needed.

Citations

1. Cornish J, et al. (2007). A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut, 56(6): 830-837.

2. Friedman S, Lichtenstein GR (2006). Crohn's disease. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 785-801. Philadelphia: Saunders Elsevier.

3. Friedman S, Lichtenstein GR (2006). Ulcerative colitis. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 803-817. Philadelphia: Saunders Elsevier.