Dealing with Crohn's Disease During Pregnancy
APRIL 01, 2016
Most women know it’s best to be in good physical health before getting pregnant. For Elizabeth Kelly, that meant more than eating right and exercising — it meant bringing her Crohn’s disease under control.
“I have always had the attitude that we’re going to figure this out,” says Kelly. “The disease is not going to own me. Instead, I own the disease, and it won’t stop me from doing what I want to do.”
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 Digestive Disease Center 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.
“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. “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. But it’s tricky, she admits, as some of the medications frequently used to treat IBD are not approved for use during pregnancy and some might lead to birth defects. Little is also known about the safety of the drugs during 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 women who are on treatment to remain on treatment (with the exception of methotrexate, which should never be used in pregnancy).
“The most fear I had throughout the process was taking the medication and what it would mean for my baby,” recalls Kelly, when faced with the decision about continuing her treatment during pregnancy. “How I would live with it if something happened?”
Kelly decided, on her doctor’s advice, to continue her treatment during at least the first trimester. She suffered bouts of nausea during those months and in the end, felt it would be best to stay on the medicine to keep her disease under control.
Kelly had a brief recurrence after delivering her baby girl, Emeline, but now both mom and daughter are doing well.
“Being a mother is the most wonderful gift in the world,” says Kelly. “I’m looking forward to being a healthy mom who takes care of her child. The only way I can be here to take care of her is if I take care of myself."