Pregnancy With Ulcerative Colitis

Your ulcerative colitis (UC) shouldn't prevent you from starting a family. There may be some challenges, but you can still have a healthy pregnancy. Get your questions answered before you start trying to get pregnant.

Will Ulcerative Colitis Make It Harder for Me to Get Pregnant?

Your chances of becoming pregnant are no different than other women your age, but it may be harder if you've had some types of surgery.

For example, in an operation called a full colectomy, a surgeon removes the entire large intestine and creates an internal pouch to hold waste. This can leave scar tissue in your pelvic area. A better choice, if you need to have surgery and want to have children, is a partial colectomy, with a pouch on the outside. It won't affect your chances of getting pregnant. After you've had children, a surgeon can remove the rest of your large intestine and make a pouch on the inside.

How Can I Raise My Chances of a Healthy Pregnancy?

The most important thing you can do is get your UC under control and into remission before you try to get pregnant. If you get pregnant while the disease is still active, there's a good chance your symptoms will continue or get worse during pregnancy.

Active UC flare-ups can leave you underweight and without nutrients that are important for pregnancy. If you don't weigh as much as you should, you're much more likely to have a miscarriage in the first trimester. When you're underweight, you might have a premature and underweight baby.

As soon as you start thinking about getting pregnant, make an appointment to see your doctor as well as your OB-GYN. Talk with them about how to make sure you get the care you need for a healthy pregnancy. A dietitian can help make sure you get a well-balanced diet.

Like women without UC, you should take a prenatal vitamin every day while you're trying to get pregnant and during pregnancy. Sometimes the iron in prenatal vitamins can be rough on your system, so you may need to try different formulations.

Be sure to get your iron levels checked, because women with UC are more likely to get anemia.

You may also need to take extra folic acid, which helps prevent birth defects. Your ulcerative colitis, as well as sulfasalazine that's used to treat it, can make it hard for the body to absorb folic acid.

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How Will UC Medication Affect My Pregnancy?

Two drugs for ulcerative colitis are known to cause birth defects: methotrexate and thalidomide. Ask your doctor to switch you to other drugs at least 3 months before you plan to start trying to get pregnant.

Your doctor may recommend that you stop taking steroids or take a very low dose. They can be risky during pregnancy, including a slightly higher chance that a baby will be born with a cleft palate.

Other medications for ulcerative colitis may be OK to take. Talk to your doctor about keeping your UC under control and how you'll handle a flare during pregnancy.

Can I Deliver a Healthy Baby?

Your chances of having a healthy baby are very good when you get the right care. You'll want to work closely with your doctors to keep your UC well-controlled throughout your pregnancy, because women with inflammatory bowel disease are more likely to have complications such as miscarriage, preterm delivery, and a low-birth-weight baby.

The risk of birth defects may also be slightly higher, but that's more likely due to the medications for ulcerative colitis, not the disease itself.

Your OB-GYN will treat your pregnancy as high-risk and refer you to a perinatologist, an OB specializing in high-risk, complicated pregnancies. That means you'll get regular checkups from your OB-GYN, gastroenterologist, and the specialist.

How Will My Ulcerative Colitis Affect My Baby?

The chance of a woman passing ulcerative colitis to her baby is very small -- about 2% to 5%. The risk goes up to about 30% if both parents have inflammatory bowel disease.

After you deliver, let your pediatrician know about any ulcerative colitis drugs you were taking while you were pregnant.

If you took a biologic drug during the last two trimesters, your baby's developing immune system -- the body's defense against germs -- could have been affected. Your baby can't get any shots with live viruses, such as the rotavirus vaccine, in the first 6 months of his life.

WebMD Medical Reference Reviewed by Traci C. Johnson, MD on November 14, 2017

Sources

SOURCES: 

Dubinsky, M. Inflammatory Bowel Diseases, December 2008.

Maconochie, N. BJOG, February 2007.

Fukushima, T. Toxicological Sciences, 2005.

Cornish, J. Gut, June 2007.

Crohn's & Colitis Foundation of America: "IBD and Pregnancy: What You Need to Know," "Crohn's & Colitis Foundation of America's Clinical Alliance Presents Findings Related to Pregnancy Outcomes in Patients Being Treated for Inflammatory Bowel Disease."

Alan C. Moss, MD, assistant professor of medicine, Harvard Medical School; director of translational research, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston.

American Pregnancy Association: "Eating for Two When Over/ or Under Weight."

Uma Mahadevan, MD, associate professor of medicine and director of clinical research, Center for Colitis and Crohn's Disease, University of California, San Francisco.

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