What Is Crohn's Disease?
Crohn's disease is a chronic illness in which the intestine, bowel, or another part of the digestive tract become inflamed and ulcerated. Ulcerated means it is marked with sores. Along with ulcerative colitis, Crohn's disease is part of a group of diseases known as inflammatory bowel disease, or IBD.
Crohn's disease most commonly affects the lower part of the small intestine. That part is called the ileum. The disease can, though, occur in any part of the large or small intestine, stomach, esophagus, or even the mouth. It can occur at any age, but it is most common between ages 15 and 30.
What Are the Symptoms of Crohn's Disease?
People with Crohn's disease experience periods of severe symptoms. These are followed by periods with no symptoms that can last for weeks or years. The period with no symptoms is called remission. Unfortunately, there is no way to know when a remission will occur or when symptoms will return.
The symptoms of Crohn's disease depend on where the disease is in the bowel. They also depend on its severity. In general, symptoms can include:
Does Crohn's Disease Affect Conception?
If you have active Crohn's disease you may have a more difficult time getting pregnant than you would when it's in remission. Ideally, you should be in good health and in remission when you conceive.
The drug methotrexate is deadly to fetuses and newborn babies. If a man is taking methotrexate for Crohn's disease, he should stop taking it for three months before attempting conception. Women with Crohn's disease should avoid methotrexate before getting pregnant and while pregnant. If you are taking methotrexate after giving birth, you should not breastfeed.
If both parents have IBD, the child has about a one in three chance of having IBD. If only one parent has Crohn's disease, the chance of the baby getting the condition is about 9%.
Crohn's disease seems to affect children more severely than adults. A child with Crohn's disease may have slower growth and delayed sexual development.
How Does Crohn's Disease Affect Pregnancy?
For some people, pregnancy has a positive effect on Crohn's disease. Pregnancy can lessen the symptoms. This is probably because pregnancy itself causes a suppression of the immune system. That happens so the body won't reject the fetus.
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:
- balsalazide (Colazal)
- mesalamine (Apriso, Asacol, Delzicol, Lialda, Pentasa)
- olsalazine (Dipentum)
- sulfasalazine (Azulfidine)
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 adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, infliximab (Remicade), and infliximab-abda (Renflexis) and infliximab-dyyb (Inflectra), biosimilars to Remicade, 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.
Should Pregnant Women Undergo Testing for Crohn's Disease?
When you are pregnant and have Crohn's disease, you may safely undergo any of the following if they're needed:
X-rays and CT (computed tomography) scans, though, should be avoided unless absolutely necessary. MRI (magnetic resonance imaging) scans appear to be safe during pregnancy.
What Is the Effect of Surgery for Crohn's Disease on Pregnancy?
Women who have had bowel resections (surgeries to remove part of the bowel) do not appear to have any problems during pregnancy. Women who have had ileostomies may have lower fertility rates. An ileostomy is a procedure in which the end of the small intestine is brought through a hole in the abdomen called a stoma. It's done so that waste may be emptied into a bag attached to the stoma. It may be best to wait for a year after this surgery to become pregnant in order to reduce the risk of the ileostomy dropping or becoming blocked during pregnancy.
Some women with Crohn's disease develop fistulas -- abnormal passageways between organs. If you have a fistula or an abscess -- a cavity filled with pus -- that's near the rectum and vaginal area you will likely be advised to deliver your baby by cesarean section, or C-section.