Crohn's Disease and Pregnancy
How Does Crohn's Disease Affect Pregnancy? continued...
Being pregnant may protect you against future flare-ups of Crohn's disease. It's also possible it may reduce the need for surgery in the future. This is because pregnant women produce the hormone relaxin. Relaxin stops premature contractions of the uterus. It is thought that relaxin might inhibit the formation of scar tissue.
Women who have IBD have normal pregnancies and deliveries at the same rate as women without IBD. It is mainly when you have active Crohn's disease that problems can occur. Active Crohn's disease raises the risk of miscarriage. It also creates a higher risk of premature delivery and stillbirth. Women with inactive Crohn's disease, though, also have a slightly higher risk of miscarriage as compared with pregnant women.
Can Pregnant Women Take Medication for Crohn's Disease?
With or without Crohn's disease, you need to discuss all your medications with your doctor when you are pregnant. In general, medication for Crohn's disease does not change during pregnancy. It might, though, if you have a change in your condition. As for specific types of drugs to treat Crohn's disease, only antibiotics and methotrexate must be avoided. That's because of the harm they can do to the fetus.
Drugs in the aminosalicylate class (5-ASA drugs) do not damage the fetus or increase the risk of complications. These drugs include:
In addition, if you are taking a 5-ASA drug, you will be able to breastfeed safely.
If you are on steroids, you should not get pregnant. If you are taking a corticosteroid such as prednisone or another steroid and do get pregnant, your doctor will prescribe the smallest possible dose. If you are breastfeeding while taking steroids in moderate to high doses, your baby should be monitored by a pediatrician.
Drugs that affect the immune system are called immunomodulators and immunosuppressives. These drugs do not seem to cause problems during pregnancy when they are used in standard dosages. The exception is methotrexate. Methotrexate should not be taken if you are pregnant. Nor should it be taken by either a man or a woman who is trying to conceive. Methotrexate can cause the death of the fetus. It can also cause congenital abnormalities. If you are taking methotrexate, you also should not breastfeed.
Biologic drugs such as infliximab (Remicade) and adalimumab (Humira) seem to be safe for use during pregnancy. They also do not appear to be secreted in breast milk.
If you are taking vitamins before becoming pregnant, you can continue taking them. If you are taking sulfasalazine, you need to be particularly sure you get enough folic acid. Folic acid prevents neural tube birth defects such as spina bifida. Sulfasalazine blocks the absorption of folic acid.