“Many female patients tell me that they read something online or were told by their doctors that they couldn’t … start a family,” says Nirupama N. Bonthala, MD, a gastroenterologist who is part of the Integrated IBD Pregnancy and Fertility Program at Cedars-Sinai in Los Angeles. “But most [women with Crohn’s] can have a healthy pregnancy and healthy babies.” It’s true that you may need to take a few extra steps to ensure a healthy outcome for yourself and baby, but you can likely start — or expand — your family when you’re ready. Here, we address common questions about fertility, family planning, pregnancy, and life postpartum.
1. Myth: You won’t be able to get pregnant if you have Crohn’s disease.
If your disease is under control and you haven’t had a major operation — an ileoanal anastomosis, or J-pouch — “your chance of conceiving and having a successful pregnancy is no different than that of the general population,” says Rajeev Jain, MD, cochair of the IBD Parenthood Project and a gastroenterologist at Texas Digestive Disease Consultants in Dallas. Unfortunately, it’s a misconception that women with Crohn’s can’t get pregnant. That myth has major repercussions, as the IBD Parenthood Project Working Group points out. According to a 2016 study in the Journal of Crohn’s and Colitis, 17 percent of women with IBD choose not to have children — about twice the rate of the general population. “Women are concerned about passing down IBD to their children or that pregnancy will make flares worse or difficult to manage,” says Dr. Jain. But “learning that you can get the disease under control and your fertility will be no different is eye opening for patients,” he says.
2. Fact: Flares could get worse during pregnancy.
It’s possible. “This is always a concern, and I tell patients that during this time, there’s a one in three chance you might flare,” says Jain. To minimize the odds of this happening, you should be in remission for three to six months before you conceive, he says. But it’s not all bad news. About one-third of people see their flares quiet down during pregnancy, says Dr. Bonthala. “Some women actually do feel quite good,” she says.
3. Fact: Flares during pregnancy can affect your child’s health.
Being as well controlled as you can be is the best-case scenario, because with active inflammation, your body has to both grow your baby and manage the disease. “Your body is not a good multitasker when pregnant,” says Bonthala. As such, there’s an increased risk of miscarriage, premature delivery, labor and delivery complications, and low–birth weight babies, she says. That said, by working with your doctors and being regularly monitored throughout your pregnancy, you can get things back under control to protect both your health and the baby’s, adds Jain.
4. Fact: Certain surgeries can interfere with my ability to get pregnant.
Certain surgeries — J-pouch, proctectomy, permanent ostomy — can lead to inflammation and scarring of the fallopian tubes, thereby decreasing fertility, according to a paper published in April 2019 in the journal Gastroenterology by the IBD Parenthood Project Working Group. Though these surgeries may decrease the ability to get pregnant, it’s still possible. “The important thing is that we want to make sure the patient is closely being seen by a GI doctor who has expertise in IBD and a maternal-fetal medicine specialist [high-risk pregnancy experts],” says Jain. “I also have the colorectal surgeon looped into care so that we’re all working together.” If you’re not getting pregnant after three to six months of trying, you may be referred to a fertility specialist to consider assisted reproductive technology, such as IVF.
5. Myth: You can’t take IBD medication during pregnancy.
It’s a common belief that all IBD meds cause harm, says Christopher Robinson, MD, a working group member of the IBD Parenthood Project and maternal and fetal medicine physician at Roper St. Francis Healthcare and Summerville Medical Center in Summerville, South Carolina. But most medications used to treat Crohn’s can still be taken when you’re pregnant, meaning you don’t have to unnecessarily risk flares. After speaking with your doctor, there is no reason to skip your prescriptions. “Patients may forget that a healthy mother is what gives us the opportunity for a healthy baby,” he says. Of course, your medications need to be evaluated to understand what’s keeping flares under control. Don’t assume that all of your doctors are in contact with each other; review a list of your medications with your ob-gyn, gastroenterologist, and other members of your healthcare team. Aminosalicylates, biologics, and immunomodulator therapies can be taken during pregnancy, according to the April 2019 paper. One IBD medication that’s not safe for pregnancy, says Bonthala, is methotrexate. Many doctors actively avoid prescribing this medication for women of childbearing age, she says. It’s recommended to stop methotrexate at least three months before conception.
6. Fact: Having Crohn’s disease could interfere with your postpartum health.
For any woman, having a baby brings about drastic physical and mental shifts, and some of them are especially challenging — even for women who don’t have a chronic illness. “It’s very joyful to have a newborn, but it can be incredibly stressful,” says Bonthala. “Though data doesn’t show [that] stress can cause flares, it makes intuitive sense that the more stress you have means the more symptoms you’ll have.” For some women, the huge hormonal shifts after delivery can also trigger a flare. And the rigors of managing the disease and caring for a newborn can weigh on your emotional health. A study published in January 2019 in the journal Gut found that there was a slight increase in the risk for mental illness postpartum among women with Crohn’s. (There was one new case for every 43 pregnant women with IBD.) Setting up a support structure — help around the house, a few good friends who can set up a “meal train” — can go a long way. To reduce the chance of flares after delivery, your doctor should time things carefully so you don’t miss any doses of medication postpartum, and the ob-gyn team should also be looped in. That means prescriptions should be ready and filled, or you should be scheduled for infusions. Ask your GI doctor if you can use telemedicine for appointments or at-home infusions, so you don’t have to leave the house with a new baby in tow, suggests Bonthala.
7. Myth: You’ll definitely pass Crohn’s disease to your baby.
This can be a common worry for any hopeful or soon-to-be mom who has Crohn’s disease. But the risks may be smaller than you think. According to the National Human Genome Research Institute, children who have one parent with Crohn’s have a 7 to 9 percent risk of developing the disease. If both parents have IBD, that risk goes up to 35 percent. Bottom line: If you want to start a family, you don’t have to deny yourself that dream just because of your IBD. Start the conversation with your doctor so you and your baby can be as healthy as possible during your pregnancy and beyond.
