What are the implications for fertility and pregnancy?
Women with ulcerative colitis who are planning pregnancy should discuss this with their physician. In general, women with ulcerative colitis that is under control have similar fertility rates and birth outcomes to women without this condition. Women experiencing fertility issues who have a male partner taking sulfasalazine should consider tests of sperm count, as this drug can reversibly lower sperm counts. There have been some studies that suggest men taking azathioprine or 6-MP have a higher rate of birth defects in their offspring, but this has not been convincingly confirmed.
In general, women with well-controlled ulcerative colitis appear to have similar birth outcomes to women without the disease. Some studies have shown an increased risk of premature birth (before 37 weeks) and low-birth weight infants. It is felt that those women with active disease are at greatest risk for these negative outcomes. For women with ulcerative colitis, we recommend that the disease be in remission and that patients discuss their plans for pregnancy with their physician before attempting to conceive. We also recommend consultation with a high-risk obstetrician in a number of cases.
The risk of a disease flare during pregnancy is similar to the non-pregnant population. As mentioned, it is important to maintain the disease in remission prior to attempting pregnancy, as there may be a higher risk of low birth weights infants in women with active disease due to pre-term labor. It is important that patients are not undertreated simply because she is pregnant. In fact, the same treatment principles apply to pregnant and nonpregnant patients alike. Most studies of women who were pregnant while taking either 5-ASA, azathioprine/6MP, steroids, cyclosporin, or anti-TNF therapy have not shown an increase risk of birth defects or detrimental birth outcomes. Thus, continuing those medications that keep the disease quiet is important in women prior to and throughout the pregnancy.