Pregnancy With Ulcerative Colitis

Medically Reviewed by Minesh Khatri, MD on March 17, 2024
6 min read

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.

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. If you need to have surgery and want to have children, your doctor may suggest 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.

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. You may need to see an obstetrician who specializes in high-risk pregnancies.

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. A dietitian can help make sure you get a well-balanced diet.

If you're at a healthy weight, when you get pregnant, you should put on 25 to 35 pounds by the end of your pregnancy. If you're underweight to start, you should aim to gain 28 to 40 pounds.

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.

When you're pregnant and have ulcerative colitis (UC), you can take some simple steps to make sure you get the nutrients you and your baby need.

Stick to the basics. Keep your food strategy simple:

  • Fill half your plate with fruits and veggies.
  • Make half the grains you eat whole grains.
  • Trade high-fat dairy, such as whole milk, for fat-free or low-fat options.
  • Eat less salt.
  • Swap sugary sodas for water.
  • Avoid greasy, fried, high-sugar, and spicy foods.
  • Stay away from nuts, popcorn, and corn, because they can make swelling worse.
  • Make sure you drink plenty of water, since diarrhea can cause dehydration.
  • Sometimes, five or six small meals a day are easier to handle than three big ones.

Fruit and veggies. Fruits and vegetables are good for you and your baby. If fiber makes your UC symptoms worse, you may be able to keep them in your diet if you change how you prepare them.

Steam or bake vegetables and fruit instead of eating them raw. Steer clear of high-fiber foods, including broccoli, cauliflower, and apples. Choose items with lots of antioxidants, such as blueberries, cherries, tomatoes, squash, and bell peppers.

Calcium. Your body needs foods high in calcium, especially during pregnancy. Some options include:

  • Yogurt or hard cheeses, which might be easier to digest
  • Juices and other drinks, cereals, and breads with added calcium
  • Tofu, soybeans, black-eyed peas, or canned fish with bones you can eat (such as sardines or salmon)
  • Drinking milk with a meal, or adding it to cereal to make it easier on your system.

If you need to be lactose-free, try:

  • Lactose-free milk or calcium-fortified soy milk
  • Lactase pills or drops, which help you digest lactose

Healthy fats from fish. Fish is a great way to get omega-3 fatty acids, which help build your baby's brain and eyes. They may also cut down on UC symptoms and prevent flares.

Some seafood is high in mercury. But when you're pregnant, you can eat other fish by following these guidelines:

  • Have up to 12 ounces a week of low-mercury fish such as shrimp, canned light tuna, salmon, and catfish.
  • Don't eat shark, swordfish, king mackerel, or tilefish. They tend to be higher in mercury.
  • Limit albacore tuna to 6 ounces a week.

Supplement your diet. Having UC means your body can't absorb some key vitamins and minerals from your food. Talk to your doctor. They might recommend extra supplements with your prenatal vitamins.

For example, if you take the drug sulfasalazine, you may need more folic acid than what's already recommended for pregnant women.

Steroids can lower calcium levels, so you may need a calcium supplement with vitamin D.

You may also need iron to prevent anemia.

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.

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-birthweight 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.

The chance of women passing ulcerative colitis to their 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 their life.