Pregnancy and Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) does not affect the outcome of pregnancy and more than 80% of women with IBD are able to have full-term healthy babies. The incidence of congenital abnormalities, low birth weight and spontaneous miscarriage is no greater than would occur in the general population. Patients with severe disease requiring surgery have an increased risk of complications but with the use of intravenous feeding (TPN), the outcome has been much more successful.

The effects of pregnancy on IBD

Most patients find that they feel very well during pregnancy and that their disease goes into remission. The risk of the disease relapsing during pregnancy is around 33%, which is no higher than the rate of relapse in patients who are not pregnant. Relapses tend to be more common in the first trimester (3 months) and can be more severe following delivery - possibly due to the sudden fall in the hormone levels which occurs when labour begins.

The course of the disease during pregnancy usually relates to disease activity at the time of conception. Therefore, it is recommended that you do not try to become pregnant when the disease is active as it may worsen. Ileostomy patients may have trouble with the function of the stoma in the second trimester (6 months+) due to displacement by the growing foetus (reported incidence of obstruction is 10% but therefore 90% of patients do not have problems). If this complication occurs, the patient develops abdominal pain and the stoma ceases to function. Patients with ileo-anal anastamoses are usually advised that the delivery be by Caesarean section.

The effect of drugs on pregnancy and the foetus

Most drugs used in the treatment of IBD are relatively safe for use during pregnancy and the reported incidence of abnormalities to the foetus are no higher than would be expected in the general population. However, the treatment needs to be carefully balanced so that remission is achieved whilst causing the least possible harmful effects to the developing foetus. Active disease itself can be detrimental to foetal development so treatment should continue as prescribed to reduce the risk of relapse. Supplements of folic acid are recommended during pregnancy especially when patients are given Salazopyrin which causes levels to fall in the body. Methotrexate must never be used during pregnancy.

Certain antibiotics, such as metronidazole, should not be used in the first trimester of pregnancy and only thereafter for severe perianal disease. Most antibiotics also tend to pass into breast milk. However, if the doctor believes that these medicines are essential to control the IBD, it is not necessary to stop breast feeding as the levels in breast milk are less than the usual doses given to babies.

Dietary treatment

Most patients with CD previously on a restricted diet find that they are able to widen their food intake when pregnant without relapsing. It is also quite safe to supplement with an elemental diet if you feel your nutritional intake is not sufficient. A dietitian will be able to advise you on this. After delivery most women have to go back to their original diet if they wish to avoid a relapse.

Investigations during pregnancy

As mentioned previously, the majority of patients will experience a remission of their disease during pregnancy and require no more intervention than the normal ultrasound scans. However, if investigations do need to be performed, white cell scans, cause much less exposure to radiation and are very useful in monitoring the disease progress. MRI scans do not cause any exposure to radiation but are not recommended during pregnancy.

Many patients are concerned about passing their disease on to their children. There is a small chance of this happening - around 8-9% of children of parents with CD may develop the disease at some point in their lives, therefore 92% of children will not, so this should not deter you from having children.

General care during pregnancy

This is very much the same advice as given to pregnant women who do not have IBD, only it is more important that you should follow the advice below:

1. Rest during every opportunity you have and practice relaxation exercises as instructed by the midwife.
2. Eat a healthy, well-balanced diet. As mentioned previously, you may be able to widen a restricted diet. If this is not the case you should supplement your diet with an elemental liquid under the dietitian's instructions. Take supplements of folic acid and iron tablets. Ask your doctor for dosage advice on these and other vitamin and mineral supplements.
3. Ensure you do not become constipated. Many patients find their bowels work better than previously as the constipation often associated with pregnancy ensures that diarrhoea becomes a 'normal' motion.