Inflammatory Bowel Disease in Pregnancy

Inflammatory bowel disease (IBD) is an umbrella term for a group of medical conditions that cause your digestive system to become inflamed.  The most common types are Crohn’s disease and ulcerative colitis (UC).  Symptoms can include severe diarrhoea, abdominal pain, bleeding from the bowel, fatigue, weight loss and fevers.  Some patients also have symptoms outside their digestive system, such as joint pain, inflamed eyes and skin problems.

 

Inflammatory Bowel Discease - Dr Colin Walsh

How common is IBD in pregnancy?

IBD commonly affects young women of child-bearing age.  Approximately 1-in-200 pregnant women will also have IBD.

What effect will my IBD have on my pregnancy?

Most pregnancies in women with IBD are straightforward, but there are a few extra things to keep in mind.

Firstly, women with IBD are usually taking medication to keep their bowel disease under control.  Some of these medications can affect an unborn baby and should be stopped or swapped before you fall pregnant.  This is why I recommend pre-pregnancy counselling to all women with IBD, at least 3 months before you stop using contraception.  Ideally, you should see a Maternal-Fetal Medicine specialist, who will work with your bowel specialist to find a “pregnancy friendly” medication regime.

Overall, IBD is associated with a slightly increased risk of fetal growth problems and premature delivery.  It’s important to keep a close eye on the baby’s growth with extra ultrasound scans.

There are also some important conversations to have regarding birth.  For women with a previous fistula repair or severe peri-anal Crohn’s disease, elective caesarean section should be strongly considered.  On the other hand, a caesarean may be more complicated in women with multiple previous bowel operations, so maximising the chance of a vaginal birth may be important for these women.

Have you looked after many women with IBD during pregnancy?

Yes, I’ve looked a large number of women with IBD in pregnancy, including women with multiple previous bowel surgeries.  I also have a lot of experience in managing medications for IBD during pregnancy, including steroids and steroid enemas, immunosuppressants and the newer biologic agents such as Remicade® and Humira®.