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If you’ve followed along on our female reproductive health for inflammatory bowel disease (IBD) series, you know that we still have one key topic to cover: pregnancy. If you or someone you know has IBD and wants a short but informative breakdown on how IBD management may change before, during, and after pregnancy, keep reading!
You may be worried about how your genetics can affect that of your potential child. The likelihood that offspring get IBD from one of their parents is 1.6%-5.2% and if both parents have IBD, the risk goes up to 36% . In general, Crohn’s disease is more likely to be inherited than ulcerative colitis . There are many other factors that contribute to development of inflammatory bowel diseases, such as one’s environment, lifestyle, and microbial health, among other factors .
How do you manage IBD before and during pregnancy?
There are two IBD drugs to absolutely avoid if you want to increase your chances of having a healthy baby: methotrexate and thalidomide . It’s encouraged to have an obstetrician trained for high-risk cases and your gastroenterologist to provide a personalized plan for safe conception and pregnancy, especially to reduce the risks of complications or triggering IBD disease activity . Even for those in remission, pregnancy complications or poor outcomes are more likely to occur than in the general population, but there’s lots of ways to get support .
Here’s a comprehensive checklist of things to consider related to pregnancy, retrieved from Pregnancy and the Patient with Inflammatory Bowel Disease: Fertility, Treatment, Delivery, and Complications .
Making sure you continue to take your medication before conception and throughout pregnancy is crucial to keep your IBD under control. Most medications are deemed safe for pregnancy and breastfeeding, but extra attention should be awarded if taking corticosteroids, some antibiotics, methotrexate, or a combination therapy of thiopurine and biologic to prevent harm to the fetus.
Wondering what the evidence for all this is?
Methotrexate lingers in the body long after the last dose and can accumulate in the tissue of the newborn through breastfeeding.
Aminosalicylates and biologic agents are low risk: studies on exposure to infliximab, adalimumab, certolizumab, and anti-TNF drugs found that they don’t increase the risk of negative pregnancy outcomes or birth defects compared to healthy parents.
Corticosteroids have mixed support. While budesonide is considered safe, prednisone intake is riskier, as it increases the likelihood of pregnancy complications. Prednisone has even been linked to orofacial clefts if taken during the first trimester, with one study reporting a 3.4 times higher chance of this occurring due to corticosteroids. That being said, a newer study of nearly 52,000 pregnancies did not find any added risk of orofacial clefts, but did find an association with gestational diabetes, preterm birth, hormonal issues (adrenal insufficiency), and low birth weight. Interestingly, budesonide and prednisone are considered safe to use while breastfeeding. Considering some opposing data when it comes to corticosteroids, scientists recommend that they be taken at the lowest dose required to improve IBD symptoms in the pregnant parent.
Antibiotics such as ciprofloxacin and metronidazole are common IBD treatments and worth taking a look at when it comes to potential impacts on both parents and newborns. If you read our blog post on antibiotics and gut health, you may recall that these treatments can affect your microbiome and potentially that of your baby. Both are considered low risk for pregnancy safety, but metronidazole can lead to orofacial clefts and is not recommended during breastfeeding.
Despite the findings that most IBD drugs are safe for breastfeeding, many new parents tend to avoid breastfeeding because they’re still worried about how it might affect their child. Breastfeeding is a valuable aspect of infant development, from cognitive to microbiome development, so better education is required to encourage parents to make the most informed decisions about feeding their children based on what will be safest, healthiest, and best for the family’s lifestyle.
You might also be curious about what to expect for delivery: Caesarean (C) section or vaginal birth? Studies show that mode of delivery doesn’t contribute significantly to risk of childhood IBD and that depending on your disease activity or surgery history, one mode of delivery might be more favourable. For example, it may be recommended that those who have J-pouch undergo a C section in order to avoid damage to the pouch and anal sphincter . This would be a great question for your obstetrician as each person is different. 
The bottom line on pregnancy is that proper education and encouraging open conversations on these topics will help avoid added challenges and break stigma. The best course of action if you’re worried about your health is to ask questions to your medical team, who should be attentive, open, and prepared to address your concerns. Knowledge is empowering and can make the journey easier.
It’s also empowering to monitor your own health as much as possible. One way to keep track of your medications, symptoms, and supplements in preparation for birth is using the Phyla app.