You can have a healthy pregnancy and delivery even if you have Crohn’s disease. The key is to work closely with your doctor and follow your treatment plan so you and your baby can both stay healthy.
Planning Your Pregnancy
If you're thinking about becoming pregnant, it's a good idea to make sure your Crohn's is in remission first. You have a better chance of a smooth pregnancy when your disease isn't flaring or when you haven't started a new treatment. Talk to both your OB-GYN and your gastroenterologist.
Here are some things you may discuss before becoming pregnant:
- Medications for Crohn's don’t usually affect a woman's chance of becoming pregnant. But some treatments -- such as sulfasalazine (Azulfidine) -- can affect a man's fertility. So men with Crohn’s who hope to become fathers should talk to their doctors about changing medication.
- If you take methotrexate, your doctor will suggest you stop before your pregnancy. The drug can harm the baby. Men, too, should stop taking the drug several months before conception.
- If you are taking steroids, your doctor may suggest you wait to become pregnant.
- If you've had surgery for Crohn's you can still have a healthy pregnancy, but it may be harder to get pregnant.
If you are thinking about having surgery, talk to your doctor. You may want to put off surgery until after your pregnancy.
When you're pregnant, have regular visits with both your OB-GYN and your gastroenterologist to monitor your baby's health and your Crohn's. You should see a specialist in maternal-fetal medicine, because pregnancy with Crohn's is considered high risk. Some women say their Crohn's symptoms actually improve when they're pregnant and they have fewer flares.
Make sure your doctors are aware of all the medications you are taking. If you're on a drug treatment plan that works for you, they may suggest you stay on it, but they may also suggest some changes to keep you and your baby safe.
- Tell your doctor if you take steroids, immunosuppressives, biologics, or even antibiotics, or anti-diarrhea drugs. You’ll need to stop certain types of these drugs.
- Some medications, like sulfasalazine and other drugs in the aminosalicylate class, are considered safe while you're pregnant or breastfeeding.
- If you are thinking of becoming pregnant, you should consider adding folic acid supplements to your diet even before conception. These supplements will be needed throughout your pregnancy.
Tests and Procedures
You may need tests to monitor your Crohn's while you're pregnant. Some are OK, but there are other tests you may want to put off until after your baby is born. Your doctor can guide you on this decision.
- Ultrasounds, MRIs, and fetal monitoring devices are considered safe. If you are on steroids or have moderate to severe flares while pregnant, you may have frequent ultrasounds to check on your baby’s growth.
- X-rays and CT scans may be necessary during pregnancy. To limit radiation exposure, abdominal shielding can be used.
- It’s considered safe to have a flexible sigmoidoscopy, where a tube with a camera is placed in your colon to look for any problems. It is probably not a good idea to have a colonoscopy. The tests take a long time and patients usually get drugs to put them to sleep.
You should also avoid X-rays and CT scans if possible. The radiation isn’t good for a developing baby.
Delivery and Breastfeeding
- If you have fistulas, abnormal passageways between organs, or other areas around your vagina or rectum that have been affected by Crohn's, your doctor may recommend you have a C-section.
If you plan to breastfeed, talk to your doctor about your medications and if they're safe for your new baby. Breastfeeding shouldn't make your Crohn's worse, and it offers many health benefits to you and your baby.