Crohn’s disease is an illness that affects the bowel, intestine and other parts of digestive tract, causing them to be chronically ulcerated and inflamed. People who suffer this disease may have severe attacks followed by remission which can even last months or years. They don’t have any way of knowing when they will have attacks or remission. Crohn's disease is also seen in some pregnant women. What happens with Crohn’s disease and pregnancy, then? Will it affect the baby?
How Does Crohn’s Disease Affect Pregnancy?
The Mother
Luckily, there are women who see their Crohn’s disease affected positively while pregnant. Pregnancy seems to reduce the symptoms. This may be because pregnancy suppresses the immune system to help the body not reject the baby.
Pregnancy may also help protect you from future flare-ups, even reducing the chance of surgery in the future. When women are pregnant, they produce relaxin which is a hormone that protects the uterus from contracting. It is believed this hormone helps inhibit scar tissue from forming in Crohn's disease.
The Baby
- Those who have inactive Crohn’s disease will have a small increase in miscarriage compared to pregnancies for women without Crohn’s.
- If Crohn’s disease is active in pregnancy, there is an increased risk of miscarriage, as well as a higher rate of premature delivery or even stillbirth.
How Can You Manage Crohn’s Disease While Pregnant?
Before Pregnancy
If possible, speak with your OB or doctor about concerns before conceiving. The mother’s state of health at conception can be a powerful determinant of how the pregnancy will go. If the mother is in remission when she conceives, she is at no greater risk for a flare up than a woman who isn’t pregnant. If a woman gets pregnant while her disease is active, it has a one-third chance of getting worse while pregnant, one third of staying the same and one third of going into remission.
When you are trying to conceive, speak with your OB, your general doctor and your gastroenterologist. This team will help track your Crohn’s disease and pregnancy.
During Pregnancy
It’s important to keep your disease well managed while you are pregnant. If you experience a flare up while pregnant, it can be difficult to get it under control.
Can You Take Medication for Crohn’s Disease?
Whether you have Crohn’s or not, you should discuss any medications with your doctor to be safe. Generally, Crohn’s medications don’t change while you are pregnant. However, you will want to avoid methotrexate and antibiotics as these can harm the baby.
Some drugs are safe while you’re pregnant and generally belong to the 5-ASA drugs or aminosalicylate class. They are also known to be safe while breastfeeding. These include:
- Sulfasalazine
- Olsalazine
- Mesalamine
- Balsalazide
Take these medications for treatment of Crohn's disease and pregnancy safety. If you are taking steroids, you should avoid getting pregnant until you are off. If you are on prednisone or another steroid and do conceive, your doctor will prescribe the smallest dose.
Do You Need Surgery for Crohn’s Disease?
Those women who have an active Crohn’s at the start of pregnancy might need surgery during pregnancy. Some reasons you may need surgery are perforation or abscesses in the intestine, refractory colitis, or obstructions.
If it looks like surgery is a possibility, it’s best to have it performed before the 24th week. In most cases, surgery for Crohn’s disease while pregnant is safe and the decision is best coordinated with your OB and your GI doctor to keep risks low. The OB and colorectal surgeon will usually work together to help keep the baby safe.
There are some non-surgical procedures such as sigmoidoscopy, colonoscopy and perianal/anal exams that may be needed to aid in evaluating symptoms such as bleeding, pain and diarrhea. Risks versus benefits on these procedures vary and should be discussed with your doctors to best assess your individual situation.
Do You Need a Cesarean Delivery?
Most women who have Crohn’s disease and pregnancy won’t need to have a cesarean delivery. But those who have rectal or perianal involvement with their disease may be advised to have a cesarean. In the absence of this consideration, the necessity of cesarean delivery will be assessed on the standard obstetric indications.
For those planning a vaginal delivery, it shouldn’t require extra interventions. As with other mothers, those with Crohn’s are encouraged to birth in positions comfortable for them, stay mobile and have a calm setting. If an episiotomy is used, it’s advised to go laterally as opposed to vertically.