Pregnancy and Crohn's Disease
Pregnancy and Crohn's Disease
A part of the group of diseases known as Inflammatory Bowel Disease (IBD), Crohn's disease is a chronic condition wherein the bowel, intestine, or any other part of the digestive tract can become inflamed and ulcerated, or marked with sores. This condition commonly affects the lower part of the small intestine, known as the ileum. Crohn's disease can, however, also affect any part of the stomach, large or small intestine, mouth, or even the esophagus. It generally affects people between the ages of 15 and 30. The disease can also go into a phase of remission (a period marked by no symptoms that can last for weeks or months or even years) or undergo a phase marked by severe symptoms. Women having Crohn's disease and wanting to conceive often wonder if they can plan a safe pregnancy. Having Crohn's disease does not mean that you have to avoid pregnancy. The only precaution that has to be taken is to find ways to remain free from a flare-up of Crohn's during your pregnancy.
Is It Difficult To Get Pregnant With Crohn's Disease?
If you are in a remission phase of Crohn's disease, then becoming pregnant works in the same manner as it is with people who do not have Crohn's. However, if you are in the active phase of Crohn's disease, then you are likely to have a difficult time becoming pregnant. Even in the remission phase, you need to be in good overall health in order to conceive. This does not mean that women having Crohn's disease are unlikely to become pregnant. They also have just an equal chance as those without Crohn's to conceive. However, fertility issues often arise in Crohn's patients from abdominal and pelvic surgery. The scarring from such types of surgery often inhibits fertility. In women who have undergone surgical procedures such as total or partial colectomy, involving the removal of a part or the entire large intestine due to Crohn's disease, fertility issues are particularly severe.
Conceiving with Crohn's Disease
It is generally advised that you try to conceive during a remission period of Crohn's disease. Women whose Crohn's disease is in the remission phase can become pregnant easily. However, conceiving during the active phase of Crohn's disease is generally not advised by doctors. This is so because if conception takes place during a flare-up of the disease, it is likely that the Crohn's disease will continue to remain active throughout the pregnancy, and thus, puts you at a much higher risk of problems, such as premature delivery, miscarriage or even having a baby with a low birth weight.
If you have had surgery in the pelvic region, in particular, if you have undergone a colectomy with J-pouch to treat Crohn's disease, then you are likely to have significantly lower fertility rates. One of the medications for Crohn's disease is methotrexate, which is known to cause abortions and congenital malformations in the fetus. Therefore, if you are planning to conceive, then this medication needs to be stopped at least six months prior to conception in both men and women. You should not resume methotrexate while you are pregnant or while breastfeeding.
Planning a Pregnancy with Crohn's Disease
Doctors recommend that the best time to become pregnant for women suffering from Crohn's disease is when the disease is in remission for at least three to six months, and you are off steroids. It is not recommended that you become pregnant when you have just started a new medication for Crohn's disease. You will increase your risk of a premature delivery or have a baby with low birth weight if you have a flare-up of Crohn's disease during your pregnancy. Doctors, therefore, prescribe medications to maintain a state of remission and prevent flare-ups so that you can safely carry your pregnancy to term. There are now many new Crohn’s medications that have been proven to have minimal risk for pregnant women.
Women suffering from Crohn's disease have successful pregnancies and children. However, as they are always at risk of a flare-up, which can cause further complications with the pregnancy, labor and delivery process, women suffering from Crohn's disease are considered to be high-risk obstetrics patients.
Important Considerations to be Undertaken during Pregnancy with Crohn's Disease
Diet in Pregnancy and Crohn's Disease: In order to have a safe pregnancy with Crohn's disease, women are advised to consume a nutritious and vitamin-rich diet. Folic acid or folate, which is an important part of any pregnancy, is highly recommended for women having Crohn's disease. Folate is a B-vitamin that is found naturally in many vegetables and fruits. Having foods containing folate will help to build DNA and RNA in the child. It will also protect the child's DNA from potential mutations. Some foods that you can consume to increase your intake of folate include: broccoli, brussels sprouts, beans, citrus fruits, spinach and peanuts.
However, do consult your doctor about which foods you can have because certain food sources of folate are known to be tough on the digestive tract if you suffer from Crohn's disease. You can also get folic acid supplements prescribed by your doctor. You should ideally begin these folic acid supplements before you conceive and continue taking them throughout your pregnancy.
Care in High-Risk Pregnancy with Crohn's Disease
Being a high-risk obstetrics patient and high-risk pregnancy due to Crohn's disease, your pregnancy medical team will include an obstetrician, a gastroenterologist, a general practitioner and a nutritionist as well, who will track your progress and keep changing your drug regimen as and when they see fit during your pregnancy. It is necessary that you begin to work with your obstetrician and your gastroenterologist from before you become pregnant so that together they can help you come up with a pregnancy plan to manage Crohn's and have a safe delivery.
Medications in Pregnancy and Crohn's Disease
Your medical team will probably choose to prescribe aminosalicylates as your first-line of medication for Crohn’s in pregnancy, as these are considered to be relatively safe for the fetus and have minimal side effects for the mother as well. However, folate consumption needs to be increased, as these aminosalicylates interfere with the process of folic acid absorption in the body. Immunosuppressive drugs such as Restasis (cyclosporine) and Imuran (azathioprine) may also be prescribed in standard doses as these also have a low risk during pregnancy. These immunosuppressive drugs do tend to have an effect on the baby's immune system, though the effects are not long lasting and will disappear within a month of birth.
Can Women Suffering from Crohn's Disease have a Normal Delivery?
It is possible for women having Crohn's disease to have vaginal delivery, but if they are in the active phase of the Crohn’s disease, then a cesarean delivery is recommended.
What are the Chances of a Crohn's Flare-up during Pregnancy?
The likelihood of having a flare-up of Crohn's disease reduces drastically once you become pregnant. This is because your pregnant body will suppress the immune system and stop it from rejecting the fetus. This phenomenon helps to keep Crohn's disease in remission during pregnancy. Many women having Crohn's are successfully able to lower their Crohn's medication dose during pregnancy. However, this is completely up to the doctor and you should not stop or reduce your medication without the recommendation of your doctor. Stopping the Crohn's medication could very well lead to a Crohn's flare-up, putting severe stress on the fetus and pregnancy.
You can have a successful pregnancy and a healthy baby even if you suffer from Crohn's disease. You just need to keep following your doctor's advice and follow certain basic health tips to keep your condition under control. Keep eating healthy and avoid foods that are likely triggers of Crohn's. Also consume plenty of fluids and get proper rest. Always inform your medical team immediately if you notice any change in your Crohn's symptoms.
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