Managing Crohn's Disease During Pregnancy
APRIL 01, 2020
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.
“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 for breastfeeding and most recommend 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, which should never be used in pregnancy).