What is inflammatory bowel disease?
The term “Inflammatory Bowel Disease (IBD)” refers to a group of conditions whose main feature is inflammation of the digestive tract. The main two IBDs are Crohn’s disease and Ulcerative Colitis (UC). UC occurs only in the colon (large intestine) and typically the rectum. In contrast, Crohn’s disease can develop anywhere between the mouth and anus, but the most common sites are the terminal ileum (the part of the small intestine near the colon) and the colon. Both UC and Crohn’s disease affect women and often begin at a young age. Thus, they may occur together with pregnancy and, therefore, complicate it.
How common is IBD during pregnancy?
A recent study conducted in Australia reports that IBD is present in approximately 31 per 10,000 pregnant women. Undoubtedly, the number of IBD cases varies among pregnant women around the world. However, this estimate is a clear indication that IBD during pregnancy is fairly common.
How is IBD diagnosed during pregnancy diagnosed?
Diagnosis begins with a suspicion of IBD based on the patients history. Generally, the disease develops gradually with the following symptoms worsening over time:
- Anorexia (the person is severely underweight)
- Diarrhea, which may be bloody and may happen at night
- Melena (dark stools due to the presence of blood). With UC, there also can be overt bleeding from the rectum
- Abdominal pain, typically in the central or right part of the lower abdomen. In Crohn’s disease, the pain can be dull or crampy and its severity varies. In UC, the pain happens typically at the time of defecation
- With UC, there also are often many symptoms outside the digestive tract. This can include joint pain due to arthritis, and also back pain, and problems in the eyes.
If you have IBD, you may also have a history of bone fracture, which would give your doctor another clue. You may also experience modest fevers and, on physical examination, the doctor may find that your liver and spleen are enlarged. Having family members with IBD can raise the level of suspicion. If you are of Ashkenazi Jewish origin, IBD (both UC and Crohn’s disease) is more likely.
Once IBD is suspected, various tests will be conducted on blood samples for signs of anemia, vitamin deficiencies, parasitic infections, iron deficiency, and evidence that the immune system is attacking the body. Doctors will also order what is called a “complete metabolic panel”. This test reveals various aspects of your blood chemistry and your kidney function. Samples of stool will be taken to look for bacterial and parasitic infections, blood, and signs of inflammation. Various genetic tests will be performed to determine whether you carry any genetic sequences associated with UC or Crohn’s disease. Finally, imaging studies will be conducted. These will include either computed tomography (CT) enterography or magnetic resonance (MR) enterography. You may also be given either an MRI of your abdomen or a CT scan of your abdomen. If you are already pregnant, the MRI will almost always be chosen over an abdominal CT. Most importantly, the inside of your colon and part of your small intestine will be examined with colonoscopy, in which a tube-like instrument is inserted through the anus. This will provide your doctors with video footage of the inner lining of the parts of the gastrointestinal tract that are scanned, plus they will be able to take biopsies of selected areas. If you are suspected of having Crohn’s disease that involves higher parts of the gastrointestinal tract, such as the stomach and esophagus or the part of the small intestine thats near the stomach, you also will be tested with an instrument that enters through the mouth in order to view areas that colonoscopy cannot reach.
Does IBD cause problems during pregnancy?
IBD will put you at risk for nutritional deficiencies and gastrointestinal tract bleeding that can be exacerbated by pregnancy. It will also make it more likely that you will have to give birth by cesarean section. If your disease becomes very severe during pregnancy such that you require surgery on your colon, it is possible that the surgery can trigger premature labor.
Does IBD during pregnancy cause problems for the baby?
Loss of nutrients and blood through the gastrointestinal tract can lead to reduced fetal growth. If folic acid intake is inadequate, this can also put your child at risk for neural tube defects, in which parts of the brain or spinal cord are left without a bony covering. IBD puts your embryo/fetus at risk for various poor outcomes, such as low birth weight, congenital abnormalities, and even stillbirth.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the IBD. These can be significant
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
It is important to understand that every woman starts out with a 2 3 percent chance of having a baby with a birth defect regardless of any medications she is taking or any medical conditions she may have.
What should I know about using medication to treat IBD during pregnancy?
Numerous drugs are given to control IBD and its effects. Some of the drugs are thought to be safe during pregnancy, while others have raised concerns. The drug sulfasalazine, a common, effective medication in IBD, is thought to be safe so long as you also take folic acid. Various antibiotics can be given to control gastrointestinal infections without harm to the fetus. Metronidazole and amoxicillin-clavulanic acid both are considered to be low risk. Another drug category used in IBD is called 5-ASA and it appears to be fairly safe, both in pregnancy and breastfeeding, with the exception of one brand, called Asacol HD, although the preparation is being adjusted to make it safe. Steroids have a controversial safety profile in pregnancy. However, because they are highly efficacious, they are frequently on the list of medications to be used during pregnancy, if needed. If given for long periods of time, however, steroids may provoke gestational diabetes and also raise your blood pressure. Therefore, close monitoring by your doctor is necessary.
There is very limited information on the use of biologics (most of which are antibodies that end with the suffix mab) in pregnancy. Two other commonly used drugs are called azathioprine and 6-mercaptopurine. Both are considered acceptable in pregnancy, if other treatments prove ineffective or for some other reason cannot be used.
uld NOT stop taking medication for IBD during pregnancy?
If your IBD is active (not in remission) at the onset of pregnancy, you need to continue your treatment. However, it is possible to switch from one drug treatment to another. Ask your doctors to select the optimal treatment strategy that keeps the disease in check while minimizing risk.
What should I know about choosing a medication for my IBD during pregnancy?
You may find Pregistrys expert reports about the individual medications to treat IBD here. Additional information can also be found in the sources listed at the end of the report.
What should I know about taking a medication for my IBD when I am breastfeeding?
5-AGA drugs, steroids such as prednisone, azathioprine, and 6-mercaptopurine all are considered safe in those who breastfeed.
What alternative therapies besides medications can I use to treat my IBD during pregnancy?
There is really no effective alternative to medications for people with active IBD.
What can I do for myself and my baby when I have IBD during pregnancy?
Work with your doctors to select the optimal treatment strategy that keeps the disease in check while minimizing risk.
Resources for IBD in pregnancy:
For more information about IBD during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following article:
- March of Dimes: Inflammatory Bowel Disease and Pregnancy.