Women with Inflammatory Bowel Disease (IBD), including Crohn’s Disease and Ulcerative Colitis, are often childbearing age, as 50% of patients are diagnosed before the age of 35. Many people with IBD worry about the chances of having a baby, how pregnancy changes will affect their disease, and whether treatments will harm the child.
Fertility and IBD
Understanding how inflammatory bowel disease affects fertility can be reassuring. It is possible to manage some aspects of IBD that have been shown to decrease fertility.
Many women think they need to stop their IBD medication to become pregnant, but it’s not always the case. Having an active disease may reduce fertility.
The overall fertility rate for women with Crohn’s disease and ulcerative colitis has been reported to be similar to women without IBD.
IBD can affect the fertility of men, too. Limited attention has been paid to reproductive issues faced by men with IBD. Factors such as surgery, medications may contribute to infertility in men. Most drugs recommended for IBD patients don’t cause infertility, however, drugs such as Sulfasalazine or Methotrexate can lower the man’s sperm count. The effects are reversible, and abnormalities can resolve when the drug is discontinued. Medications should be discussed with healthcare providers before taking.
Methotrexate, an immunosuppressant, should not be taken by either partner when trying to conceive, or by women while pregnant. These drugs can cause congenital deformities or miscarriages and may affect sperm formation. When planning a pregnancy, it is advised to discontinue methotrexate, and use contraception for 6 months or more prior to conception.
Tofacitinib may cause fertility problems, which may affect the ability to have children
For women with IBD, extensive abdominal or pelvic surgery can increase the risk of infertility. One example is ileal pouch-anal anastomosis surgery (IPAA), the removal of the colon and rectum, but not anal sphincters. If you are planning to conceive, you may wish to discuss this with your provider. In vitro fertilization (IVF) can also help in becoming pregnant.
Pregnancy and IBD
A woman’s disease condition during pregnancy depends on the severity and extent of the disease when she becomes pregnant. Women with active IBD are likely to have disease activity during pregnancy. Severity of IBD and flare-ups are directly associated with adverse outcomes during the pregnancy progression. Disease activity at the time of conception and during pregnancy is associated with a higher rate of spontaneous abortion, preterm delivery, and low birth weight.
The key to a healthy baby is a healthy mom. It is usually recommended that women try to conceive when they are in remission, or the disease has been inactive on a stable dose of medications for 3 months or more. It is important to maintain remission by continuing your medication to have a normal pregnancy and healthy baby.
A woman considering pregnancy should try to eat as healthy as possible and consider taking a supplement containing 400 mcg or more of folic acid (the amount in a prenatal vitamin). A higher dose may be recommended if you are also taking Sulfasalazine, as it affects the absorption of folic acid. Folic acid reduces the risk of birth defects, called neural tube defects, in the unborn baby. Doctor may do blood tests in women to check that vitamin B12, vitamin D and iron levels are normal.
Other precautionary measures to take during pregnancy:
- Stop smoking
- Avoid consuming alcohol and taking recreational drugs
- Visit the doctor frequently and monitor all medications
- Limit caffeine intake to less than 250 mg per day
- Consider testing for rubella (German measles), varicella (chickenpox), HIV, hepatitis B, and inherited genes (e.g., cystic fibrosis) before pregnancy
The recommended pregnancy care team consists of an Obstetrician and Gastroenterologist. Visits with the Gastroenterologist will be based upon the severity of the disease during pregnancy. Obstetrician appointments generally occur:
- Every 2 to 4 weeks until 28 weeks of pregnancy
- Generally, every 2 weeks between 28 and 36 weeks
- Once per week between 36 weeks and delivery
For women taking steroids, ultrasound monitoring of the baby’s growth may take place every 4 weeks after 18-20 weeks of pregnancy
IBD medications and pregnancy
All medications will be reviewed with the healthcare provider prior to and during pregnancy. Some medications are safe during pregnancy and breastfeeding. Methotrexate should be stopped approximately 6 months before trying to conceive and during pregnancy, as it can cause birth defects.
AZA and 6-MP are not given to people who are pregnant or likely to become pregnant in the near future. These drugs may cause harm to an unborn baby.
Labor and delivery
The method of delivery, vaginal or caesarean, is dependent on the health of tissue around the vagina and anus, the choice of delivery and the baby’s progress during labor. Underlying conditions will affect medication and treatment recommendations during labor and after delivery
Breastfeeding is strongly encouraged, as it is beneficial for both the mother and the baby. Breastfeeding will not cause flare-ups. However, it is important to consult the healthcare providers to check the safety of medications while breastfeeding.
Inflammatory bowel disease (IBD) often arises in young women and men during their fertile reproductive lifespan. It is natural to worry how Inflammatory bowel disease or any chronic condition will affect pregnancy and the baby. With appropriate therapy, most women can have a normal pregnancy and deliver a healthy baby. Keeping the disease under control prior to conception and throughout the pregnancy will help ensure the best outcome for the mother and baby.