Crohn's Disease and Pregnancy

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 stay healthy.

If you're thinking about becoming pregnant, talk to both your OB-GYN and your gastroenterologist.

Does Crohn's Disease Affect Conception?

If you have active Crohn's disease, you may have a harder time getting pregnant than you would when it's in remission. Ideally, you should be in good health and in remission when you get pregnant.

If a man who wants to become a father is taking sulfasalazine (Azulfidine) for Crohn's disease, they should ask their doctor to change their medication. Sulfasalazine can cause a lower sperm count.

The drug methotrexate is deadly to unborn babies and newborns. If a man is taking methotrexate for Crohn's disease, they should stop taking it for 3 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 1 in 3 chance of having IBD. If only one parent has Crohn's disease, the chance of the baby getting the condition is about 9%.

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 baby.

Being pregnant may protect you against future flare-ups of Crohn's disease. It may also lower the need for surgery in the future. This is because pregnant people make 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 happen. 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.

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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 baby.

Drugs that affect the immune system are called immunomodulators and immunosuppressants. 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 baby. It can also cause birth defects. If you are taking methotrexate, you also should not breastfeed.

Drugs in the aminosalicylate class (5-ASA drugs) do not damage the unborn baby 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 taking 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.

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.

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Should Pregnant Women Be Tested 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 people 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.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on September 17, 2019

Sources

SOURCES:

Crohn's and Colitis Foundation of America: "IBD and Pregnancy: What You Need to Know."

FDA: “FDA approves Amjevita, a biosimilar to Humira.”

National Digestive Disease Information Clearinghouse: "Crohn's Disease."

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