Pregnancy and IBD

A safe pregnancy starts with planning and getting the disease under control

• Planning
• Calm disease
• A healthy baby

Pregnancy is possible and goes well for most patients

A reassuring message

Most patients have healthy babies. The best time to become pregnant is when the disease has been calm, without steroids, for three to six months, confirmed by tests.

Active disease during pregnancy is more dangerous for the mother and baby than most of the medicines used to treat it.

Plan with your doctor

Before pregnancy

• A pre-pregnancy consultation — to assess disease activity and review your medicines
• Folic acid every day — starting three months before pregnancy if possible, and at a higher dose if you take sulfasalazine
• Reviewing medicines — some must be stopped a while before pregnancy, such as methotrexate and some modern tablets
• Vaccinations and tests — such as immunity to rubella (German measles) and hepatitis B, and iron and vitamin D levels

What about my medicines?

Medicines

• Most can be continued — such as mesalazine, azathioprine and most biologic treatments; they are usually continued throughout pregnancy
• Medicines not used during pregnancy — methotrexate, and modern tablets such as JAK inhibitors and S1P (sphingosine-1-phosphate) receptor modulators; if you become pregnant while taking them, contact the clinic straight away
• Steroids — can be used to treat flares when needed, for the shortest time possible
• Do not stop any medicine on your own — stopping treatment may cause a flare during pregnancy

Each patient's plan is reviewed individually with her doctor.

Safe monitoring during pregnancy

During pregnancy

• Shared care — between the IBD clinic and the obstetrics and gynaecology clinic
• Calprotectin — safe for monitoring disease activity
• Bowel ultrasound — safe and radiation-free
• Endoscopy when needed — a limited endoscopy can be done if necessary, and is usually safe

CT scans are not used during pregnancy unless absolutely necessary.

Birth, breastfeeding and your baby's vaccines

After pregnancy

• Type of delivery — a vaginal birth is possible for most patients; a caesarean section may be preferred with active disease around the back passage (anus) or after some operations
• Breastfeeding — recommended, and possible with most IBD medicines, except methotrexate and the modern tablets
• Your baby's TB vaccine — if you received a biologic treatment during pregnancy, tell the maternity team before the birth, because the TB vaccine (BCG) is usually delayed until 6 months of age; non-live vaccines are given on schedule
• After the birth — continue your treatment and follow-up, as the disease may flare after delivery

Fertility in men and women

Fertility

Fertility is usually normal in patients, but it may be lower when the disease is active or after some operations. Most treatments do not affect men's fertility.

Sulfasalazine may temporarily lower the sperm count; it returns to normal after switching medicine.

Pregnancy and the disease: the summary

Key messages

• Plan pregnancy for when the disease is calm
• Start folic acid before pregnancy
• Most medicines can be continued; do not stop them without advice
• Active disease is more dangerous than most medicines
• Tell the maternity team and the paediatrician about your treatment before the birth

Contact the clinic if you are:

• Planning a pregnancy
• Having symptoms come back during pregnancy
• Having questions about breastfeeding
• Unexpectedly pregnant
• Wanting to stop any medicine
• Asking about your baby's vaccines

If you have heavy bleeding or severe pain during pregnancy, go straight to the nearest emergency department.