Inflammatory bowel disease (IBD) during pregnancy can lead to complications for individuals who are pregnant and the fetus. Timing conception during remission and preventing or managing flare-ups can help improve pregnancy outcomes.

IBD is a classification of bowel diseases that include ulcerative colitis (UC) and Crohn’s disease (CD). Doctors most often diagnose IBD in people under 35 years old. As a result, symptoms and flares may crop up during the reproductive years and potentially affect pregnancy.

Here’s what you need to know about IBD during pregnancy, including treatment options and the risks that active IBD may pose while a person is pregnant.

This feature mentions pregnancy loss, stillbirth, or both. Please read at your own discretion.

People with IBD who have not had prior abdominal surgery and who are not currently experiencing a flare in symptoms may expect pregnancy outcomes similar to those of people who do not have IBD.

If IBD is active at conception, there’s a greater chance that symptoms may worsen during pregnancy or in the postpartum period. Around 65% of people who are in active IBD at the time of conception will experience symptoms while pregnant, and these symptoms may potentially worsen throughout pregnancy. UC has a higher risk of flare-ups when compared with CD.

If IBD is flaring during pregnancy, especially if the condition is severe or unmanaged, it may lead to complications like preterm delivery, developmental issues for the fetus, and intrauterine growth restriction. In severe cases, it can even lead to stillbirth.

With an effective treatment plan in place, most people with IBD can have complication-free pregnancies and deliveries.

Symptoms of IBD during pregnancy are similar to those you might experience with a flare outside of pregnancy.

They include:

Pregnancy doesn’t cause IBD, but it can make the condition flare. If you are in remission at the time of conception, there is a high chance you won’t have IBD issues in pregnancy.

The hormonal changes and immune system shifts of pregnancy may cause a flare in symptoms that were previously in remission. More specifically, researchers suggest that IBD may be triggered or worsened due to an increase in pro-inflammatory cytokines (proteins) in the body, leading to increased inflammation.

The risk of pregnancy complications varies depending on whether you have UC or CD. Complications are less likely if IBD is in remission at the time of conception.

More specifically:

  • people with UC that is in remission do not have an increased risk of flare-ups during pregnancy compared with the general population
  • people with active UC at the time of conception may have an increased risk of flare-ups during pregnancy
  • people with CD generally have a lower risk of flare-ups during pregnancy than those with UC

IBD that is active in pregnancy may increase the risk of certain complications for the fetus, including the risk of:

In severe cases, the condition can even lead to pregnancy loss or stillbirth.

There are also potential risks for the individuals who are pregnant, including:

If doctors need to perform further investigation and monitoring of your symptoms during pregnancy, they typically use the following methods:

Experts explain that routine endoscopy and imaging are not necessary for IBD during pregnancy. Tests such as CT and enhanced MRI may not be safe for a developing fetus.

You may continue taking most of your IBD medications during pregnancy. That said, there are some medications that can cause developmental issues for a fetus and other health issues. It’s important to discuss all medications with your doctor, especially if you’re planning to conceive.

Potentially safe medications to take during pregnancy include:

  • 5-ASA therapies: Doctors consider 5-ASA therapies low risk during pregnancy, with the exception of Asacol and sulfasalazine.
  • Thiopurines: People who take these may require monitoring of their liver enzymes and metabolite levels. This kind of medication is also safe for people who are breastfeeding.
  • TNF inhibitors: These do not pose significant risks to the fetus and are safe to take while breastfeeding. Examples include infliximab, adalimumab, golimumab.
  • IL-12/23 inhibitors: People who take medications such as vedolizumab and ustekinumab show similar pregnancy outcomes to the general population, which suggests these drugs are low risk for use during pregnancy and breastfeeding.
  • Combination therapy: A doctor may suggest you continue on this kind of therapy — for example, TNF inhibitors and thiopurines — but recommend careful monitoring for an increased risk of infection during the infant’s first year of life.

Potentially unsafe medications include:

  • Asacol may carry a risk of developmental issues for a fetus from its coating
  • sulfasalazine may affect folic acid absorption
  • tofacitinib, upadacitinib, and ozanimod may carry a risk of developmental issues for a fetus (people should discontinue use 3 months before pregnancy)
  • corticosteroids may carry a risk of:
    • gestational diabetes
    • preterm birth
    • low birth weight
    • gestational hypertension
  • a doctor may use cyclosporine in rare, life threatening situations, but it may carry a risk of the following:
    • gestational diabetes
    • hypertension
    • preterm birth
  • methotrexate may carry a risk of fetal developmental issues (people should discontinue use 3 months before conception)
  • new biologics, which include IL-23 inhibitors like risankizumab, do not have enough information to indicate safety during pregnancy

Timing matters when it comes to pregnancy with IBD. Researchers explain that up to 80% of individuals whose IBD in remission at the time of pregnancy experience no serious complications.

Experiencing IBD flare-ups during pregnancy may lead to complications, like preterm delivery.

Attending prenatal appointments and receiving effective treatment for IBD during pregnancy can help minimize these risks.

While there’s currently no cure for IBD, a review of existing research suggests pregnancy may reduce flares of IBD for up to 10 years postpartum.

Studies have not shown that pregnancy causes IBD. Instead, pregnancy may trigger symptoms in people who already have IBD, even if the condition wasn’t active before.

Most women with IBD can deliver their babies vaginally. Doctors may recommend cesarean delivery for people with active perianal CD or prior rectovaginal fistula or those who have had ileal pouch-anal anastomosis (IPAA) surgery.

Yes. Babies can have IBD at birth, but it is rare.

With effective treatment and careful monitoring, most individuals with IBD can have healthy pregnancies and deliveries. It helps to be proactive as early as possible when you are trying to conceive.

Working with your doctor to manage your IBD activity and symptoms can increase the likelihood of having a healthy pregnancy and help prevent complications.