Any chronic disease can make pregnancy a more challenging experience, and the inflammatory bowel diseases (IBD) – Crohn disease and ulcerative colitis – are no exception. But current management practices for IBD usually makes pregnancy with IBD a safe experience for both mother and child. With careful supervision from a qualified physician, a healthy pregnancy is certainly possible.
Is Fertility Affected by IBD?
Fertility rates are normal in women with IBD in the absence of an active flare-up of their disease. This makes family planning an important topic to discuss with a physician, so that safer medications may be chosen while trying to conceive.
Extensive abdominal surgery may result in scar tissue that can cause infertility in women and impotence in men. If pregnancy is desired in the future, this should be considered when planning surgical treatment for IBD, remembering that IVF can help a couple achieve a successful pregnancy.
Some men experience decreased fertility while taking sulfasalazine, but this can be reversed after discontinuing use of the drug.
How do IBD and Pregnancy Affect One Another?
The state of IBD at conception has a big impact on the course of illness throughout the pregnancy. For those who are in remission at conception, only one third will experience worsening symptoms during pregnancy. However, most women with an active flare-up at conception will continue to have active disease throughout the pregnancy.
The risks associated with pregnancy, such as stillbirth or congenital abnormalities, are no higher in women with IBD who are not experiencing active flare-ups. However, active Crohn’s disease carries a higher risk of miscarriage, premature labor, and low birth weight.
For all these reasons, most physicians want their patients to be in remission for three months before they try to conceive.
What Does Medical Care for a Pregnancy Affected by IBD Look Like?
Most women with IBD will see both an obstetrician and a gastroenterologist throughout their pregnancy, with at least one visit to a maternal-fetal medicine specialist. These specialists will work together to monitor the health of the mother and baby while managing the IBD. Several medications commonly used to treat IBD are safe during pregnancy and breastfeeding, but the risks and benefits of each should be discussed with a physician.
The type of delivery a woman has will depend in part on how the tissues surrounding the anus and vagina have been affected by IBD. If these tissues are unhealthy because of IBD, cesarean delivery may be chosen to prevent the development of fistulas.
Will My Child Have IBD?
Although the genetic contribution to developing IBD is not completely understood at this time, there is a higher risk to children born to parents with IBD.
Offspring of one parent with IBD have a 4 to 8 percent likelihood of developing the disorder over their lifetime. If both parents are affected, that number rises to about 30 percent. Prior to attempting to conceive, parents may choose to consult with a genetic counselor to gain a fuller understanding of the risk to their offspring.
If you have IBD and hope to conceive, whether soon or some day in the future, start having that conversation with your doctor now. This will allow you to begin making the choices that will give you the best chance at conceiving and enjoying a healthy pregnancy for you and your child.