What to Know About Crohn’s Disease and Pregnancy

Crohn’s disease typically affects people of reproductive age. If you live with Crohn’s, you may be wondering if your disease will have an impact on fertility and pregnancy.

Crohn’s is an inflammatory bowel disease (IBD) that can affect all parts of the digestive system. Most often, Crohn’s affects the intestinal walls, particularly the small intestine and parts of the large intestine or colon. Symptoms include diarrhea, rectal bleeding, weight loss, and fatigue.

If you have Crohn's and plan to become pregnant, you may have understandable fears. You may be worried about your fertility, your disease during pregnancy, whether your baby will inherit the disease, the effect of IBD on the pregnancy itself, and what medications are safe to take during pregnancy.

Pregnant person and doctor

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Most people with well-controlled Crohn’s can have a healthy pregnancy with minimal complications. The most significant risk factor for adverse pregnancy outcomes is disease activity at conception or during pregnancy.

If you are pregnant and have Crohn’s, your doctor should closely monitor your disease and help keep it in a quiet state. If your Crohn’s is in an active state, or you have had prior surgery to treat blockages or other complications from Crohn’s, there is a possibility that your fertility/pregnancy will be affected.

This article will discuss how Crohn’s can affect fertility, pregnancy, and the postpartum period. Understanding this can help you achieve the best possible outcome for your and your baby’s health.

Crohn’s and Fertility

While the overall fertility rate for people with Crohn’s is lower than the fertility rate of the general population, it does not mean that you will necessarily be affected or that there is nothing you can do about it.

Several factors, such as active or inactive IBD and previous pelvic surgeries, can impact fertility when living with Crohn’s.

Inactive IBD

Well-controlled Crohn’s is associated with better pregnancy outcomes. The infertility rate in people with inactive Crohn’s who do not have a history of pelvic surgery is similar to that of the general population, which is 5% to 14%.

Active IBD

If your Crohn’s is active, you may have more difficulty getting pregnant. Working with your doctor and maintaining a treatment plan can help increase your chances of conception.

Pelvic Surgery

Having proctocolectomy (PCL) and ileal-pouch anal anastomosis (IPAA) surgeries can reduce fertility due to the chance of the surgery resulting in fallopian tube obstruction. However, having these surgeries done laparoscopically can lower the chances of obstruction and thus infertility.

If you have had previous pelvic surgeries and desire to become pregnant, talk to your doctor about your options.

 

Is Crohn’s Hereditary?

When choosing whether or not to become pregnant you may wonder, will my baby inherit the disease? If one parent has a form of IBD, your baby’s chances of having a form of IBD is about 5%. If both parents have IBD, the chances of your baby having a form of IBD increase to 33% to 36%.

Before Conception

Since managing Crohn’s can be challenging, booking an appointment with your doctor before becoming pregnant can give you guidance on how to have the healthiest pregnancy possible.

Having a thoughtful conversation to discuss risks to you and your baby can help you minimize these risks through counseling, monitoring, and medication adherence.

During Pregnancy

Most people with Crohn’s can have a healthy pregnancy and a healthy baby, however, there are some things to consider during pregnancy.

Active Disease

Having active Crohn’s while pregnant can increase your risk of miscarriage, premature birth, or having a baby with low birth weight. If conception occurs during a flare-up, your Crohn’s is more likely to remain active throughout pregnancy. If possible, timing your pregnancy to when you are in remission is advised.

Medication

Since having your Crohn’s in remission is most important for a healthy pregnancy, adhering to the treatment plan prescribed by your doctor is imperative. Most medications for Crohn’s can be taken throughout pregnancy. However, there are some considerations and exceptions.

The following medications are the most commonly used in Crohn’s:

  • Aminosalicylates do not appear to cause complications or harm the fetus. However, sulfasalazine does lower folic acid, which is important to a developing fetus. If you are on this drug, be sure to supplement with folic acid.
  • Corticosteroids are low risk during pregnancy, but they are best avoided at the beginning of a pregnancy. If you become pregnant while on steroids, talk to your doctor, as they will likely want to reduce your dosage.
  • Immunomodulators like Imuran (azathioprine) or Sandimmune or Neoral (cyclosporine A) are low-risk. But methotrexate should be avoided by both males and females.
  • Biologics like adalimumab (Humira) are considered low risk. However, adalimumab does cross the placenta in high levels late in pregnancy, so your doctor may give you a final dose in the middle of your pregnancy and then wait until you’ve delivered to administer more.

Medications To Avoid When Pregnant

Avoid these medications that are sometimes taken by people with Crohn's disease:

  • Methotrexate can cause miscarriage and congenital malformations. It is recommended to stop using this medication three to six months before conception in both males and females.
  • Thalidomide can cause birth defects and fetal death.
  • Antibiotics should be avoided if possible during pregnancy.

Complications

While having inactive disease at the time of conception and during pregnancy can help minimize the risk of complications, all patients with IBD are at a greater risk for malnutrition, venous thromboembolism (a clot in a vein), hemorrhage after birth, and cesarean delivery.

Active IBD can cause loss of appetite, or diarrhea which can lead to malnutrition. Blood clots are more common with pregnant IBD patients, and your doctor may put you on a blood thinner to prevent these from occurring. If you have an anal fistula, your doctor may recommend a cesarean delivery.

 

Crohn’s Diagnosis and Monitoring During Pregnancy

Having imaging studies done to monitor active Crohn’s or diagnose Crohn’s may be necessary during pregnancy. In these cases, the preferred method is ultrasound. If more detailed images are needed, MRI can be used without contrast.

Flexible sigmoidoscopy is considered safe during pregnancy and is the procedure of choice. Colonoscopy should only be considered when a life-threatening lower gastrointestinal (GI) bleed has been observed.

After Birth

Though most people who have low or inactive disease while pregnant have fewer complications, the risk of relapse after birth is increased for all who live with Crohn's. In one study, 31% of people experienced a flare after giving birth. The risk of a flare increased due to several factors.

Having an increase in disease activity during your third trimester increases your risk of a flare after birth. Reducing your medications during or after pregnancy can impact the likelihood of experiencing a flare.

After a C-section, you can be at a higher risk for developing an ileus (slowing or stopping of intestinal muscle contractions), especially if you had an IPAA surgery where the pouch was manipulated during delivery.

If you have an ostomy you are at a higher risk of stoma complications after delivery. To reduce the risk of these postpartum complications, try to avoid excessive weight gain.

Breastfeeding

The recommended duration for breastfeeding for those with Crohn’s is the same for those without IBD. The American Academy of Pediatrics recommends exclusive breastfeeding for six months with a continuation of breastfeeding for one year or longer as mutually desired by the breastfeeding parent and child.

While breastfeeding is recommended, it is important to talk to your doctor about the medications you are on and whether or not you can breastfeed while taking them.

Most drugs for Crohn’s are safe for use while breastfeeding and will not harm your baby. However, you should check with your doctor to be certain.

Do Not Take While Breastfeeding

It is not recommended to take tofacitinib as there is a lack of data on its effects on the baby.

Frequently Asked Questions

What medicines for Crohn’s disease can be taken while pregnant?

Most drug treatments for Crohn’s are safe during pregnancy, but you should talk to your doctor to confirm that all medications you take are safe. Methotrexate should be avoided during pregnancy.

How do you treat Crohn’s disease while pregnant?

The goal of treating Crohn’s during pregnancy is to keep it in a state of remission. If your Crohn’s is in an active state when you become pregnant the goal is to lower the activity of the disease. This is often done through prescription medications.

How do you get Crohn’s disease?

The causes of Crohn’s are unknown, but are thought to involve a combination of genetic, environmental, and lifestyle factors. The genes related to Crohn’s are involved in immune system function.

Studies have found that those living in urbanized societies are at higher risk, suggesting that industrialization and sanitation may play a role. Smoking and certain eating habits may also increase your risk.

How do you test for Crohn’s disease?

A variety of tests can be used in the process of diagnosing Crohn’s including blood tests, tissue tests, ultrasound, X-ray, computed tomography (CT) scan, or endoscopy. A full medical history along with symptoms will also be taken into consideration.

What should you not eat with Crohn’s disease?

Certain foods may trigger Crohn’s symptoms. These include but are not limited to:

  • Insoluble fiber foods such as seeds, broccoli, whole nuts, and whole grains
  • Lactose (a sugar found in dairy)
  • Sugary foods like pastries
  • High fat foods like butter and cream
  • Alcohol and caffeinated beverages
  • Spicy foods

A Word From Verywell

Embarking on the journey of pregnancy can be an exciting yet scary time, especially when living with a chronic illness like Crohn’s. Managing your disease can put you in the best possible place for conception, pregnancy, and postpartum.

Putting your health first can make sure that your baby stays healthy. Taking care of your health and communicating regularly with your doctor can help you have a safe and healthy pregnancy with good outcomes.

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