Dealing with Crohn’s disease during pregnancy
Most women know it’s best to be in good physical health before getting pregnant. For women with Crohn's disease, that means more than eating right and exercising.
Crohn’s disease , along with ulcerative colitis, are conditions of the digestive tract known as inflammatory bowel disease (IBD). About one million Americans have IBD, which can cause abdominal pain and diarrhea. While both men and women are equally susceptible to IBD, symptoms usually start between the ages of 20 and 40, which can be particularly problematic for women.
“Because it affects them in their childbearing years, women need to know when it is safe to get pregnant,” says Dr. Jacqueline Wolf, a national expert on IBD and pregnancy and a physician in the Division of Gastroenterology, Hepatology and Nutrition at Beth Israel Deaconess Medical Center.
According to Dr. Wolf, women who have their disease under control at the time of conception are less likely to have complications, reducing the chance of more active disease during their pregnancy.
“That was true for me,” says Jenna Adler of Salem, MA, whose Crohn’s disease remained in remission throughout her pregnancy. Adler consulted with her IBD specialist who recommended she meet with maternal fetal medicine experts at BIDMC before conceiving to learn as much as she could about how Crohn’s and her medication might affect her pregnancy. Because she was in good health, her doctors assured her that she would not need to make any major lifestyle changes.
“Twenty years ago, women with this disease would be told that they shouldn’t have children or that this would definitely affect their ability to have children,” says Wolf. “Now most women can have a safe pregnancy and delivery if they go into pregnancy without active disease.”
That means using certain medications to keep IBD in check before and during pregnancy, notes Wolf. Although there are limited data about newer biologics, most drugs for IBD appear to be safe during pregnancy and for breastfeeding.
“It’s critical that the obstetrician is educated in these issues and knows how to advise the patient so she has the safest pregnancy and post-pregnancy possible,” explains Wolf.
Wolf says that while there are unknowns with some of the drug treatments, most of the medications are safe in pregnancy. Often, coming off the medication will result in flare-ups. Wolf says every woman needs to make her own informed decision about what is best for her and her baby. However, she advises most women to remain on IBD treatment during pregnancy (with the exception of methotrexate and tofacitinib, which should not be used in pregnancy).
“My doctors assured me that my medications were safe,” Adler says, despite having initial concerns about one medication—the biologic drug infliximab (Remicade)—affecting her baby’s immune system.
“We do not recommend the live rotavirus vaccine for infants of mothers on biologic therapies,” says Adam Cheifetz, MD, director of the Center for Inflammatory Bowel Disease and BIDMC.
While this medication can be transferred through the placenta during the third trimester, negative effects have not been seen on the fetus. In some women, this medication will be timed so that the last dose is given several weeks before childbirth, but in most women, the medication is safely continued throughout pregnancy.
Adler’s advice to other women with IBD who are planning for pregnancy: talk to your doctor and focus on your health.
“The healthier you are, the healthier your pregnancy and your baby will be,” she says.