IBD and Pregnancy

IBD can affect many people, including young women that wish to have children. Unsurprisingly, the potential impact of IBD can become a significant concern for future parents. Concerns include

• How IBD affects fertility
• Medications that can/cannot be taken during pregnancy/breastfeeding
• Effects of IBD on the pregnancy
• How the pregnancy can affect IBD
• Passing on IBD to one’s child

Although there are some issues to consider when considering having children, IBD does not usually present a significant problem. See below for a summary of common issues and concerns around pregnancy and IBD.

Fertility

IBD can affect fertility for both males and females, however, this depends on a number of factors. For males, some medications can affect the quality of sperm and sperm count. This includes sulfasalazine, which can reduce sperm count and cause poor sperm motility (i.e., reduced ability to move through the female reproductive tract). Similarly, methotrexate can reduce the quality of the sperm. Although these changes can reduce fertility, they are temporary and reversible when the drug is stopped. Crohn’s disease, when severe, can cause nutrient deficiencies, which can also affect sperm quality.

For females, IBD does not generally affect fertility in women with that have inactive IBD and no prior pelvic surgery – these women have fertility rates similar to that of women without IBD. Disease activity, and associated symptoms such as inadequate nutrition or weight loss, can impact sex hormones and affect the menstrual cycle, reducing fertility. Corticosteroids used to treat IBD may also affect the menstrual cycle and reduce fertility. Fortunately, when IBD is adequately controlled, fertility issues caused by medications or active disease are no longer an issue. Methotrexate is a medication that should not be taken if females are trying to become pregnant, as it can cause spontaneous abortions and birth defects.

Heritability of IBD – Can I pass my IBD on to my child?

We do not know exactly what causes IBD, however it appears that IBD emerges as a result of both genes and environmental factors that are yet to be properly understood. Due to the genetic component, there is an increased probability of a child developing IBD if a parent has IBD, however, this risk is relatively small. Research shows an estimated 9% chance of a child developing IBD if one parent has IBD, and a 36% in situations where both parents have IBD.

Drugs – How can my medication affect my pregnancy?

With a few exceptions, drugs used to treat IBD are generally safe to continue while pregnant or breastfeeding. Research has shown that, although some drugs carry a small risk for pregnant women, these risks are significantly outweighed by their benefits for your health and wellbeing.

The following drugs are considered safe for pregnancy and compatible with breastfeeding, although some conditions apply and this must be discussed with your doctor.

• Aminosalicylates
  • Balsaalazide
  • Mesalamine
  • Olsalazine
  • Sulfasalazine
• Immunomodulators
  • Thiopurines (azathioprine, 6-mercaptopurine) are considered safe
• Biologics
  • Infliximab
  • Adalimumab
  • Certolizumab pegol
  • Golimumab
• Corticosteroids
  • Budesonide

Prednisolone is a considered safe, with only animal studies showing an increased risk of cleft palate, which has not been shown to be of increased risk in humans. There may be an increased risk of gestational diabetes, high blood pressure and pre-eclampsia in pregnant women.

The following biologics have an limited data in pregnancy, and should be discussed with your gastroenterologist:

• Ustekinumab
• Vedolizumab
• Cyclosporine

The immunomodulator drugs cyclosporine and methotrexate are not compatible with breastfeeding. Methotrexate is also not suitable to take during pregnancy.

Advice

Pregnancy can be an exciting and challenging life event. While women with IBD may need to take extra steps to ensure the health and wellbeing of them and their child, the condition should not stop you from having children. The characteristics of your IBD diagnosis and the treatment that you are receiving are unique to you. As such, you should discuss your intention to have children with your doctor prior to pregnancy so that they may guide you through any potential issues associated with IBD. Active disease presents the biggestchallenge for fertility and pregnancy. As such, the most important steps you can take are to consult with your doctor as required and to follow your treatment plan carefully (i.e., taking the correct dosage of medications, at the correct times). Good doctor consultation and medication adherence will ensure you have the greatest possible chance of remission, and a problem-free pregnancy.