Having IBD and/or an ostomy does not prevent women from getting pregnant and having healthy babies. With the careful supervision of specialists within the fields of gastroenterology, maternal fetal medicine (MFM) and colorectal surgery (CRS), most women with IBD and/or ostomies can have both a healthy pregnancy and a healthy baby.1
With regard to conception, fertility and pregnancy, there are some important considerations to keep in mind:
Conceiving during an IBD flare is generally not advised. If conception occurs during an IBD flare, disease is likely to remain active throughout the pregnancy. Doing so risks poor birth outcomes, including miscarriage, premature delivery, or having a baby with a low birth weight.
It is generally recommended that a woman with IBD consider pregnancy when IBD is in remission for at least 3-6 months and she is not taking steroids. It is not advised that a woman become pregnant when starting a new IBD-related medication as it may take time for her body to adjust to the medications.
Coordination of Care
The IBD Parenthood Project, an initiative led by the American Gastroenterological Association (AGA), the Crohn’s & Colitis Foundation, the Society for Maternal-Fetal Medicine (SMFM) and Girls With Guts (GWG), lays out in detail how women with IBD should conduct preconception planning leading all the way to labor and delivery. The IBD Parenthood Project outlines how care needs to be well-coordinated amongst healthcare providers and how IBD medications and surgeries affect fertility and pregnancy.
The bottom line is that in order for there to be a healthy newborn baby, the mother should be healthy and in remission. In order to prevent IBD flares during pregnancy, it is important to continue taking prescribed medications as supervised by the mother’s gastroenterologist.2
Pregnant women with IBD should work with a maternal-fetal medicine (MFM) specialist who will coordinate care with her delivery provider, gastroenterologist and colorectal surgeon. An MFM subspecialist should lead pregnancy-related care, and the GI should lead IBD care, with coordinated communication amongst all the providers consulted during pregnancy.
Medications in Pregnancy
In most cases, medication schedules are maintained during pregnancy. However, there are some considerations and exceptions. It is also important to note that if a woman’s IBD status changes, medications or dosages may be altered prior to or during pregnancy.
It is recommended to avoid methotrexate, which can cause a spontaneous abortion and/or congenital birth defects. Methotrexate should be stopped 3-6 months before conception in both men and women, and should not be taken while pregnant or breastfeeding. Another concern is infertility in men on sulfasalazine, which can be reversed by stopping the medication well before conception. Many other medications, including biologics and small molecules, should be discussed with your gastroenterologist to ensure how they should be taken, if/when they should be stopped prior to delivery and when they can be resumed again after delivery.
While bowel resections do not appear to affect pregnancy in women with Crohn’s disease, women who have had abdominal and pelvic surgery, particularly a total proctocolectomy with an ileostomy or IPAA/J-Pouch, may have lower rates of fertility.3 Men who have had such surgeries may experience retrograde ejaculation and erectile dysfunction, which may affect fertility as well.
Nonetheless, many women with permanent ileostomies or an IPAA/J-Pouch due to IBD have had successful pregnancies by coordinating their care and keeping in close contact with their physicians regarding medication compliance and pregnancy milestones. The same goes for women with Crohn’s disease who have developed fistulae or abscesses around the rectum and vagina.
- Mahadevan, Uma, et al. (2019). Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology, 156:1508–1524. https://doi.org/10.1053/j.gastro.2018.12.022
- IBD Parenthood Project. (2019). American Gastroenterological Association. https://ibdparenthoodproject.gastro.org/
- Isaacs, K.L. (2014) Pregnancy Concerns in Patients with Ileal Pouch Anal Anastomosis for Ulcerative Colitis: Time for Increased Education Across Specialties. Digestive Diseases & Sciences, 59, 1075–1077. https://doi.org/10.1007/s10620-014-3120-8