IBD During Pregnancy: What to Know When Planning for a Family
Pregnancy can sound scary when you have a chronic health condition like Inflammatory Bowel Disease. Here's what to know to ease your mind.
Jessica Caron was 21 when she was diagnosed with Inflammatory Bowel Disease (IBD), a term describing conditions that cause chronic inflammation of the gastrointestinal tract. Her symptoms were brutal: abdominal pain, bloating, and an urgent need to run to the bathroom. But even after she found the right treatment, Caron, a Goshen, New Hampshire native, still worried–especially about her future. How would her IBD affect her chances of one day getting pregnant, not to mention giving birth to a healthy baby?
Women make up about half the 1.6 million people in the United States living with IBD. And since medication is required to keep the condition under control, pregnancy can seem daunting.
"Many women with IBD opt for voluntary childlessness because they fear a negative outcome," says Christopher Robinson, M.D., MSCR, a working group member of the IBD Parenthood Project and maternal-fetal medicine physician at Roper St. Francis Healthcare and Summerville Medical Center in Summerville, South Carolina.
Caron isn't one of them. She saw four doctors before finding one who listened to her concerns and was eager to help her start a family. "He really took my life goals as our treatment goals," she says. Today, she has two boys, ages 3 and 6. Happily, she's also been in remission since 2015. "Now," says Caron, "I can focus on being a parent."
So you can rest assured that even if you have IBD, getting pregnant is possible, and so is having a normal pregnancy. Here are a few things to keep in mind in order to bring your bundle of joy into the world when living with IBD.
Find a gastroenterologist you can talk to
Although gastroenterologists (GI) specialize in gut health, they should take your feelings into account, too. "I tell my IBD patients: we're working collaboratively. We need to trust each other," says Rajeev Jain, M.D., AGAF, FACP, IBD Parenthood Project co-chair and a gastroenterologist with Texas Digestive Disease Consultants in Dallas. "If they don't trust me, they may not follow the recommendations I make." And patients who learn "more about their illness will get better care," adds Dr. Jain.
Once you've found the right doctor? Know it's never too early to start the conversation about wanting to have a baby one day!
Expand your team of doctors
Besides your GI, you need some other medical experts to chime in about your family planning. The first step is getting an ObGyn, and then look for a maternal-fetal medicine specialist, (an ObGyn specialized in treating pregnant women with chronic health problems).
Depending on the extent of your IBD, you may also need to consult a colorectal surgeon. It also could be helpful to get a nutritionist, lactation consultant, or a psychiatrist if some extra emotional support is needed.
Get things under control before you conceive
Once you mentally decide you're ready to be a mom, you'll wish you were pregnant ASAP. Be patient! "For women with IBD, the most important factor of a successful pregnancy is having their condition under control," says Dr. Jain.
The right medication will help. So may managing stress since evidence shows it can lead to IBD relapse. It's also important to treat any other conditions that may arise, such as Small Intestine Bacterial Overgrowth (SIBO), in which too much gut bacteria grows in your small intestine. "SIBO can occur in patients with IBD if they've had previous bowel surgery," explains Dr. Jain.
It's critical that you're in remission 3 to 6 months before you begin trying to conceive. That may seem like an eternity, but if you're able to manage your IBD and have never needed surgery because of it, your chances of getting pregnant will be about the same as the average woman. Plus, studies show that women who are in remission that long are less likely to have an IBD flare up during and after pregnancy. That bodes better for your health and the health of your baby.
Evaluate your medications
It's legit to worry about what the drugs you're taking will do to your fertility—and the baby growing inside you. But that doesn't mean you have to go off of your IBD medication! "A lot of physicians see someone with IBD who's pregnant and doing great and tell her to get off the medication that's controlling her bowel disease," Dr. Jain says. "It's a huge misconception."
While not as extensively studied as other meds, most IBD drugs are nearly always appropriate to take during pregnancy. And while they may have some side effects, "the benefits of taking these medications and staying in remission during pregnancy far outweighs any risks," says Dr. Jain.
Bottom line: Never stop your IBD treatment without first talking to your doctor. You could bring on a flare that potentially risks your pregnancy.
- RELATED: Taking Medication During Pregnancy
Discuss your delivery
Many women with IBD are concerned they'll have to give birth via C-section. If you have perianal disease—that is, complications around your rectum or anus—or have had a special surgery related to your IBD, that may be the case. If not, and if you've been monitored throughout your pregnancy, "you can probably anticipate a normal delivery," Dr. Robinson says.
Your doctor will likely talk about this with you around 35 weeks when you get your B strep test.
Try not to worry
In many cases, you'll be able to safely breastfeed while still taking your meds. And just because you have IBD doesn't mean your new baby automatically will, too. There's only a 3 percent chance you'll pass on the disease, according to the IBD Parenthood Project. (Keep in mind, that number rises to 30 percent if both you and your partner have IBD.)