It can be hard to focus on our future goals and what our life will look like after we get a diagnosis. The amazing thing is, even with being chronically ill, we can have fulfilling and successful lives. One topic that is oftentimes a worry for IBD patients is pregnancy and what that will look like for us once we get a diagnosis. Dr. Uma Mahadevan M.D. at UCSD Colitis and Crohn’s Center presented on the Management of IBD in Pregnancy and this session brought concrete important knowledge on what is currently known for dealing with IBD and pregnancy. She focused on the impact of IBD on pregnancy outcomes, the management of patient medications, and IBD care during both delivery and postpartum. I have broken down the session for patients to digest it easier and read the facts about dealing with pregnancy and IBD, from contraceptives to the delivery process.
Preconception:
- Preconception planning and education are vital for a health pregnancy! If you are considering starting a family, it is important to first talk with your GI provider and remember that this should be an interdisciplinary process and may include OB’s, Maternal-Fetal Medicine Specialists, Nutritionists and Pediatricians.
- With regards to disease management; GI’s will suggest a 3-month steroid-free remission prior to conception and will most likely confirm this through an endoscopy. Methotrexate should be stopped three months prior to conception.
- OB provider might ask for low-dose aspirin, which may reduce risks of preeclampsia.
- Cannabis is not recommended in regards to pregnancy as it can be passed through breast milk.
- With regards to contraceptives, what Dr. Mahadevan recommended is long-acting reversible contraceptives as opposed to pill contraceptives and estrogen.
9-month Pregnancy Plan:
- If your IBD is in remission, you can expect a GI and lab work visit every trimester and as needed. There will be counseling on mode of delivery.
- If your IBD is in a flare during pregnancy, you should be doing a GI follow-up every two weeks and possible adjustment of medication. Other methods of managing flares can include lab work, endoscopy, radiologic imaging, and surgery. Again, you will consult your doctor about the delivery method.
- In regards to medication, if you are on biologics, expect to continue throughout your pregnancy without stopping. Aminosalicylates and thiopurines can continue throughout as monotherapy.
- UC patients are more likely to experience flares during pregnancy, this may be because less UC patients are on biologic therapy.
- PIANO, which is a 1700 patient prospective registry of pregnancy outcomes in women with IBD, showed that fetal exposure to both biologics and thiopurines had no increase in congenital malformations, preterm births, infections in first year, or low birth weights. This is such an amazing study and brings many of us patients at ease.
- Stopping an anti-TNF can actually increase relapses in disease but no impact on an infant’s infection. Dr. Mahadevan said that she did not increase the dosage of an anti-TNF no matter the weight gain during pregnancy.
Delivery:
- Most women with IBD can have a successful vaginal delivery! However, often times planned cesarean sections are done and those with an active perianal disease and rectovaginal fistulas should get a cesarean section.
- With a vaginal delivery, biologics can be resumed 24 hours after the delivery if there is no infection found and 48 hours after a cesarean if no infections are found.
- Methotrexate and tofacitinib should not be used when breastfeeding. Thiopurines and biologics can be continued.
- All vaccines should be given on schedule to the newborn except you should avoid live vaccines for the first 6 months if there is in-utero biologic exposure.
While it can be daunting to start the process of building a family while you have IBD, it is doable. The research shows that there are excellent developmental milestones for children and the research only continues to get stronger. If you are interested in learning more about managing pregnancy and IBD check out IBDparenthoodproject.org as well as the PIANO research initiative!