Introduction

If you’re living with inflammatory bowel disease (IBD) and thinking about starting or expanding your family, you’re likely wondering about the safety of pregnancy with your condition. This question weighs heavily on the minds of many people with Crohn’s disease or ulcerative colitis, and it’s completely understandable why.

The good news is that most people with IBD can have healthy pregnancies and babies. However, planning ahead and working closely with your healthcare team is crucial for the best outcomes. Whether you’re newly diagnosed and years away from pregnancy, or actively trying to conceive, understanding how IBD affects pregnancy—and vice versa—can help you make informed decisions about your reproductive health.

This comprehensive guide will walk you through everything you need to know about pregnancy with IBD, from medication safety to what to expect during each trimester.

The Short Answer

Yes, it is generally safe to get pregnant with IBD. Most people with Crohn’s disease or ulcerative colitis can have successful pregnancies and healthy babies. The key is maintaining disease remission before and during pregnancy, working with a specialized healthcare team, and carefully managing medications. With proper planning and monitoring, your chances of a healthy pregnancy are similar to those without IBD.

The Complete Answer

Understanding IBD and Fertility

First, let’s address a common concern: IBD typically doesn’t affect your ability to get pregnant. Research shows that people with IBD in remission have similar fertility rates to the general population. However, active disease or certain complications can impact fertility, which is why achieving and maintaining remission before conception is so important.

For people with Crohn’s disease, previous surgeries or scarring might affect fertility, but this varies greatly from person to person. If you’ve had multiple surgeries or are concerned about fertility, discussing this with a reproductive specialist alongside your gastroenterologist can provide clarity.

The Importance of Disease Control

The most critical factor for a safe pregnancy with IBD is having your disease well-controlled before you conceive. Active IBD during pregnancy poses more risks than most IBD medications. This might seem counterintuitive, but it’s a crucial point that many people don’t realize.

When IBD is active during pregnancy, it can increase the risk of:

• Preterm birth
• Low birth weight
• Pregnancy complications
• Increased disease flares
• Need for emergency interventions

On the other hand, when IBD is in remission during pregnancy, outcomes are generally excellent. This is why your gastroenterologist will emphasize the importance of stable remission for at least 3-6 months before trying to conceive.

Pregnancy’s Effect on IBD

Many people worry that pregnancy will worsen their IBD, but research suggests a more nuanced picture. If you conceive while in remission, you’re likely to stay in remission throughout pregnancy. In fact, some people experience improved symptoms during pregnancy, possibly due to the immune system changes that occur.

However, if you conceive during an active flare, the disease is more likely to remain active or worsen during pregnancy. This underscores why timing and disease control are so important.

Medication Safety During Pregnancy

One of the biggest concerns people have is about medication safety. The landscape of IBD medication safety during pregnancy has evolved significantly, and many medications previously thought to be risky are now considered safe and necessary.

Many IBD medications are safe during pregnancy and should be continued. These include:

• Most aminosalicylates (like mesalamine)
• Certain immunosuppressants (like azathioprine)
• Many biologic medications (like infliximab, adalimumab)
• Some corticosteroids when needed short-term

However, some medications do need to be avoided or modified. Your healthcare team will review your specific medications and make appropriate adjustments well before you try to conceive.

What Patients Should Know

Planning Ahead is Key

The most important step you can take is to plan your pregnancy in advance. This isn’t always possible, but when it is, it makes a significant difference in outcomes. Start the conversation with your healthcare team at least 3-6 months before you want to try to conceive.

During this planning phase, your team will:

• Assess your current disease activity
• Review and optimize your medications
• Check your nutritional status
• Ensure you’re up to date on vaccinations
• Coordinate care between specialists

Questions to Ask Your Doctor

Come prepared to your appointments with specific questions. Here are some important ones to consider:

• “Is my IBD currently in remission, and if not, what do we need to do to achieve remission?”
• “Which of my current medications are safe during pregnancy?”
• “Do I need any medication changes before trying to conceive?”
• “What monitoring will I need during pregnancy?”
• “Who will be on my care team during pregnancy?”
• “What signs should I watch for that might indicate a flare?”

Red Flags and When to Seek Help

During pregnancy, it’s important to stay vigilant for signs of IBD flares while also being aware of normal pregnancy symptoms. Contact your healthcare team if you experience:

• Persistent abdominal pain (different from normal pregnancy discomfort)
• Blood in stool
• Significant changes in bowel habits
• Unexplained fever
• Severe fatigue beyond normal pregnancy tiredness
• Rapid weight loss

Never stop your IBD medications without consulting your doctor, even if you’re concerned about pregnancy safety. The risks of uncontrolled IBD typically outweigh the risks of most medications.

Related Questions

Do I need to change my medications?

This depends on your current medications. Many IBD drugs are safe during pregnancy, but some may need to be switched. Your doctor will review your regimen and make changes months before you try to conceive, not after you’re already pregnant.

Will pregnancy affect my IBD?

If you conceive in remission, you’ll likely stay in remission. Pregnancy doesn’t typically worsen IBD when the disease is well-controlled beforehand. Some people even experience symptom improvement during pregnancy.

Can I breastfeed on IBD medications?

Most IBD medications that are safe during pregnancy are also safe during breastfeeding. In fact, many biologics have minimal transfer into breast milk. Your healthcare team will provide specific guidance based on your medications.

What about delivery and postpartum?

Most people with IBD can have vaginal deliveries unless there are specific complications like active perianal Crohn’s disease. The postpartum period requires careful monitoring, as some people may experience flares in the months after delivery.

The Bottom Line

Having IBD doesn’t mean you can’t have a healthy pregnancy and baby. The key to success lies in planning, preparation, and maintaining good disease control. Most people with well-controlled IBD have pregnancy outcomes similar to those without the condition.

Start the conversation with your healthcare team early, ideally months before you want to conceive. Work together to optimize your health, review your medications, and create a comprehensive care plan. Remember that active IBD poses more risks to pregnancy than most IBD medications do.

Your journey to parenthood with IBD may require extra planning and monitoring, but it’s absolutely achievable. Trust in your healthcare team, stay informed, and don’t hesitate to ask questions. With the right preparation and support, you can look forward to a healthy pregnancy and the joy of welcoming your baby.

Medical Disclaimer: This article is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider before making any changes to your treatment plan or when planning a pregnancy.