Crohn’s Disease and Pregnancy
What is pregnancy like in Crohn’s Disease?
Some women with Crohn’s disease may worry about whether being pregnant will affect their condition, while others may fear that the disease or the medications they are taking will harm the fetus.
Crohn’s disease is a long-term condition that causes inflammation in the digestive tract. Along with ulcerative colitis, Crohn’s is a type of inflammatory bowel disease.
Common symptoms of Crohn’s disease include diarrhea, abdominal cramps, fatigue, and unwanted weight loss. These symptoms can vary in severity and often come and go in cycles.
Doctors refer to long periods with few or no symptoms as being in remission. There is no cure for Crohn’s disease, so treatment aims to keep a person in remission.
How do Crohn’s Disease and pregnancy affect each other?
How Crohn’s disease and pregnancy affect each other depends on whether the woman’s symptoms are in remission.
Most women who conceive while Crohn’s disease is in remission can have a healthy pregnancy. According to the Crohn’s & Colitis Foundation, the best time for a woman to become pregnant is when her Crohn’s disease has been in remission for at least 3 to 6 months.
Research reveals that many women who become pregnant while Crohn’s disease is active will have their symptoms active throughout pregnancy. Active Crohn’s disease can affect the health of both the woman and the fetus, increasing the risks of:
- early birth
- low birth weight
- other complications related to childbirth
Being pregnant during remission does not change the risk of symptoms returning, according to a 2017 study.
Is it safe for women with Crohn’s to get pregnant?
A 2016 study found that women with inflammatory bowel disease were more likely to be unable to conceive than women without the disease. Researchers think that some women choose not to have children because of concerns about their safety and that of their babies.
However, most women who become pregnant while Crohn’s disease is in remission can have a normal pregnancy and have a healthy baby.
Some research suggests that pregnancy may have long-term health benefits for women with Crohn’s. These benefits include a lower recurrence rate and less need for surgical intervention.
However, it is extremely important for a person with Crohn’s to talk to their doctor before becoming pregnant. The doctor can recommend the best time to get pregnant and adjust treatment plans if necessary.
Does Crohn’s disease affect fertility?
Studies show that Crohn’s disease does not reduce fertility while in remission. However, it may be more difficult for a woman to conceive when her symptoms are active.
Women who have had surgery for Crohn’s disease may find it difficult to get pregnant.
Most medications that doctors prescribe to treat Crohn’s disease do not affect fertility. Consult a doctor for more advice on this.
Before getting pregnant, there are a few things a person with Crohn’s may need to think about. These:
timing of conception
Experts generally recommend that a woman with Crohn’s disease wait until their disease is in remission for at least 3 to 6 months before conceiving.
It’s also important to talk to a doctor before trying to get pregnant. Doctors can advise on treatment changes that may be necessary during pregnancy.
Surgery is often a treatment option for people with Crohn’s disease. According to the Crohn’s & Colitis Foundation, previous bowel resections (surgery that involves removing part of the bowel) do not appear to affect pregnancy in women with Crohn’s.
However, some types of surgery for Crohn’s disease can lower fertility rates, so a woman may want to delay surgery until she can have children. The doctor can recommend the best timing for different surgical options.
Although these procedures are typically safe, any abdominal surgery a woman has while pregnant can pose a risk to the fetus. Doctors only recommend surgery during pregnancy when the woman’s health deteriorates.
During her pregnancy, a woman with Crohn’s disease should follow the same general dietary recommendations for all pregnant women. Ask your doctor about the Crohn’s disease diet.
Some women take a medicine called sulfasalazine to reduce inflammation associated with Crohn’s. However, this drug reduces their ability to absorb folic acid, an essential vitamin for the developing fetus. In these cases, doctors may recommend that the woman take extra folic acid.
Most diagnostic procedures for Crohn’s disease are safe during pregnancy, but doctors only use them if necessary. Safe procedures include:
- rectal biopsy
- abdominal ultrasound
- upper endoscopy
- MRI – although doctors avoid using gadolinium (contrast dye) in the first trimester
However, doctors will usually only use CT scans and standard X-rays for pregnant women in emergencies.
Women with Crohn’s disease can have a vaginal delivery even if they have had a previous colostomy or ileostomy. However, these women are slightly more likely to need a cesarean delivery.
A 2016 study found that 20.9 percent of pregnant women with Crohn’s disease and 15 percent of women without the disease had a cesarean section.
Doctors may also recommend a cesarean delivery for pregnant women who have:
- who had previous j-pouch surgery
- with active Crohn’s disease
- with scarring in the perineal area
According to a study published in the Journal of Crohn’s and Colitis, women with inflammatory bowel disease are as likely to breastfeed their babies as anyone else. The study also shows that breastfeeding does not cause flare-ups and may even reduce the risk of flare-ups within the first year after giving birth.
Doctors can advise on which medications are safe while breastfeeding.
How does pregnancy affect treatment?
Doctors generally recommend that women with Crohn’s disease continue to take their medication as usual during pregnancy.
Experts consider most medications for Crohn’s disease to be low-risk during pregnancy, including steroid medications. However, her doctor may lower her steroid dose while a woman is pregnant.
Some people take methotrexate and thalidomide to treat Crohn’s disease. These drugs can cause congenital disabilities or other complications. A woman should never take these drugs while trying to conceive, while pregnant or breastfeeding.
Before women try to conceive, they should talk to a doctor about the effects of medications they are taking on fertility or pregnancy.
Can a baby inherit Crohn’s disease?
The risk of inheritance of Crohn’s disease is usually quite low.
According to the Crohn’s & Colitis Foundation, if a biological parent has inflammatory bowel disease, the baby has an approximately 2 to 9 percent risk of inheriting the disease. However, if both biological parents have inflammatory bowel disease, the probability rises to about 36 percent.
Research shows that some women with Crohn’s disease choose not to have children because of concerns about their safety and that of their babies. However, most women who conceive while Crohn’s disease is in remission can have a normal pregnancy and a healthy baby.
During pregnancy, many medications and diagnostic tests for Crohn’s disease are low-risk, and the woman can usually continue her treatment as usual. The doctor can recommend the best time for a woman with Crohn’s to conceive. He can also make the necessary changes to the medication.