Preparing for Pregnancy with IBD: Before, During, & After
Planning for pregnancy can be an exciting time, but it can bring up a lot of concerns — even more so when you have inflammatory bowel disease (IBD). Having IBD doesn’t limit you from becoming pregnant and, in fact, with preparation and assembling a care team, you can have a healthy pregnancy and baby.
If you are actively planning to become pregnant or simply curious about the future, we cover the basics of pregnancy and IBD in this post.
If IBD is currently in remission and no history of surgery for IBD, pregnancy can happen at the same rate as the general population. If IBD is currently active or you have a history of ileal pouch-anal anastomosis (IPAA) surgery, proctectomy, or a permanent ostomy, you may experience decreased fertility.
If you have been trying unsuccessfully to get pregnant for longer than 6 months, discuss getting a referral for an infertility evaluation, especially if you have had prior abdominal surgery.
When you have a chronic condition and are considering having children, there is always concern over possibly passing that condition onto a child. There are hundreds of genes implicated in developing IBD, so there is not a single known gene that can be passed on and, as of now, it can’t be determined ahead of time through any DNA testing.
Studies have found that there is around a 3% chance that a child will develop IBD if the mother has IBD, and around a 30% chance if both parents have IBD.
There are many types of medications that are used to treat IBD and understandable hesitation to use them during pregnancy. The good news is that there is a long-term and ongoing study that has been looking at the effects of medications such as biologics on pregnant women and their babies.
The results so far conclude that most medications are safe during pregnancy with a couple of exceptions.
- Methotrexate needs to be stopped at least 3 months before becoming pregnant due to the risk of congenital malformations.
- Corticosteroids such as prednisone can increase the risk of gestational diabetes during pregnancy and should not be used unless necessary during this time.
- Tofacitinib has limited human data on safety during pregnancy. It’s recommended to avoid this medication or use it with caution.
Thiopurines (such as azathioprine) and the rest of the biologics used for IBD are safe to use during pregnancy and can be continued as normal. Your doctor may adjust your dosing schedule for biologics in your third trimester depending on which type you are on.
There is potentially a slight increase in infection in infants if thiopurines and biologics are used in combination, so it’s generally discouraged unless the risk of IBD flare in the mother is high.
There has been no evidence that taking IBD medications during pregnancy will lead to developmental delays in babies (in either growth or learning). If you have any concerns or questions about your medications, make sure to discuss these with your doctor or Care Team.
Preparing for Pregnancy
Assemble your team
Part of the preparation process includes assembling your healthcare team, which includes you! Your care team should be in communication before, during, and after pregnancy to best coordinate your care.
This should include your:
- Gastroenterologist (GI) to manage your IBD
- Obstetric provider (OB) or Maternal-Fetal Medicine (MFM) specialist (trained in handling more complicated pregnancies) to lead pregnancy-related care
- Registered Dietitian (RD) or Certified Nutritionist Specialist (CNS) for dietary support
- Psychologist or counselor to support mental and emotional health
One of the greatest risks for healthy pregnancies is the inflammation associated with having an IBD flare. If you are planning for a pregnancy, maintaining remission at least 3–6 months before trying to conceive will increase your chances of becoming pregnant as well as reducing the risk of having a flare while pregnant.
Discuss with your doctor the best plan for achieving remission and preventing possible IBD flares while pregnant.
Meeting with a Registered Dietitian or Certified Nutritionist Specialist before pregnancy can be helpful for both prenatal nutrition and for nutrition that supports IBD remission. In addition to a varied and balanced diet, it’s recommended to anyone trying to get pregnant (with or without IBD) to take 400 mcg of folic acid each day to reduce the risk of birth defects.
Emotional and mental health
Preparing for pregnancy can be an exciting, stressful, and overwhelming time all at once. Be ready and comfortable calling and leaning on your support networks throughout this time including family, friends, and partners.
Using your communities of support can help you feel more emotionally stable yourself. If you are going through pregnancy with a partner, try to practice clear expectation setting and open communication so you can support one another.
In addition, if you are diagnosed with a pre-existing mental health condition, be sure to let your care providers know you are trying to get pregnant so that they can be prepared to help you through this process.
Lastly, try to practice self-care during this time in the way that feels best for you! Some common self-care practices include journaling, walking, and meditation, but you can design your self-care practice around what works for you.
Your Maternal-Fetal Medicine specialist or OB provider will determine the frequency of prenatal visits to monitor your pregnancy. Your GI provider will be monitoring your IBD during this time with lab work each trimester and following up with you as needed.
Managing inflammation during your pregnancy is especially important, so continue to take your medications as scheduled. However, having an IBD flare while pregnant does not necessarily mean you will have an unhealthy or difficult pregnancy! You, your MFM or OB, and your GI doctor can work together to monitor you more closely and determine what the best treatment options are for you and your baby.
You will also want to continue nutrition counseling during pregnancy to make sure getting adequate nutrients that you are more likely to be deficient in such as iron, vitamin D, and vitamin B12. Following up with the dietitian will also be critical if you are diagnosed with gestational diabetes.
Women with IBD are also at higher risk of inadequate weight gain during pregnancy, so nutrition counseling can also help with hitting weight gain targets.
Recommended Weight Gain
|Pre-pregnancy BMI (Body Mass Index)||Weight Gain|
|< 18.5||28–40 lb / 12.7–18.1 kg|
|18.5–24.9||25–35 lb / 11.3–15.9 kg|
|25–29.9||15–25 lb / 6.8–11.3 kg|
|≥ 30||11–20 lb / 5.0–9.1 kg|
During this time, you will also want to consider expanding your care team to include a pediatrician for when your baby is born. They can coordinate care with your MFM/OB and GI doctor regarding medications during breastfeeding and any other concerns you may have.
Your MFM or OB provider will determine the best delivery method for you based on your history and current disease activity. There is a high chance of vaginal delivery, however, a c-section may be needed if you have a history IPAA surgery (aka J-pouch), prior rectovaginal fistulas, or active perineal disease.
Postnatal Care for Mom and Baby
Care for mom
As your GI doctor may have adjusted your medication dosages in the third trimester, you will want to start your medications again as soon as possible. Depending on your delivery method, you should be able to restart biologics 24–48 hours after delivery. Make sure to discuss this with your GI doctor before giving birth.
If you have a permanent ostomy and experienced issues with your stoma during pregnancy, you may want to follow up with a colorectal surgeon or ostomy/wound nurse for ostomy management.
During breastfeeding, you will need to increase your calorie intake for adequate breastmilk production. It’s also recommended to get 200–300 mg of omega-3 fatty acids each day, either through foods or supplements. Food’s rich in omega-3 fatty acids include fatty fish (salmon, tuna, mackerel, sardines), oysters, omega-3 fortified eggs, walnuts, flax, and chia seeds.
If you are struggling to eat enough or staying hydrated, you may want to follow up with the dietitian for lactation nutrition support. Fenugreek is often used in lactation supplements, but it should be avoided in those with IBD as diarrhea is a common side effect.
After giving birth, it’s essential to consider your mental health just as you would your physical health. Postpartum is an extremely emotional time, and most people experience some emotional difficulty. The duration and intensity of these feelings range, and for most people these feelings are short-term; often called the “baby blues,” these feelings typically last for around three weeks.
However, for some these feelings of depression and anxiety remain and require treatment. Please know, these feelings are common and are often treatable.
When to seek mental health help
Some signs to let immediately your care provider know you need assistance are if you have difficulty caring for yourself or your baby, if your feelings of distress are not going away after around two weeks postpartum (and may be getting worse), and if you have thoughts of hurting yourself or your baby. If you are having feelings of suicide, you can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or go to suicidepreventionlifeline.org/chat.
Don’t hesitate to let your care team know if you are feeling symptoms of depression — they will be able to help! If possible, try and talk to the people who will be going through the postpartum period with you in advance (whether that be a partner, friends, or family) to let them know what their signal should be to let your care provider know you need additional support.
Don’t be shy about communicating symptoms to your GI provider, even if they seem small to you! For example, as someone with IBD, fatigue may be a common part of your life. Fatigue is also extremely common in the postpartum period. Be sure to communicate with your care team about this so they can keep an eye on your symptoms.
As always, use your social support networks, and try to carve out pockets of self-care for yourself (as hard as it may seem)! Caring for yourself will make you more able to care for your baby.
Care for Baby
It will be important to discuss with your baby’s pediatrician your diagnosis and the medications that you were taking during your pregnancy. For example, if you were on a biologic medication during your third trimester, your baby should not be receiving any live vaccines during their first 6 months.
Most medications are safe to continue taking while breastfeeding, except for methotrexate and tofacitinib. If possible, sulfasalazine should also be avoided during breastfeeding and replaced with an alternative aminosalicylate (5-ASA) medication.
You will be able to follow the standard breastfeeding recommendations from the American Academy of Pediatrics. They recommend exclusive breastfeeding for 6 months, with continuation of breastfeeding for 1 year or longer as desired.
Key Points & Resources
- You can still have a healthy pregnancy when you have IBD!
- Most IBD medications are safe with pregnancy and breastfeeding.
- Assemble your care team to support you before, during, and after pregnancy.
- Achieving and maintaining IBD remission is important for becoming pregnant and during your pregnancy.
The IBD Parenthood Project is a fabulous resource for prospective parents, with information for finding providers and printable checklists to bring into your doctor’s appointments and get your questions and concerns answered.
Source: Mahadevan U, Robinson C, Bernasko N, et al. Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology. 2019;156(5):1508-1524. doi:10.1053/j.gastro.2018.12.022