How to Manage Crohn's Disease During Pregnancy

Statistics

Whiton is one of a million Americans who have contracted a form of inflammatory bowel disease (IBD). People with IBD suffer either from Crohn's disease or ulcerative colitis, which affects the lining of the large intestine. While the cause of IBD is unknown, it tends to run in families, has auto-immune properties, and can be aggravated by environmental factors.

IBD is classified as "familial" rather than "genetic" because inheriting the disease is not definite. Recent studies show that if one parent has the disease, a child has a five to ten percent chance of developing it. If two parents have it, then the rate is as high as 36 percent, according to Dr. Sonia Friedman, MD, a gastroenterologist at Brigham and Women's Hospital in Boston.

Medications and Pregnancy

Women with IBD can conceive and give birth to a healthy babies, although pregnant women with active Crohn's disease have a greater risk of premature delivery, stillbirth, or spontaneous abortion. The Crohn's patient needs to be in remission on stable medications for three to six months before getting pregnant, says Dr. Friedman, adding "The mistake doctors and patients make is going off the medication."

The expectant woman has a two-thirds chance of staying the same or getting better throughout her pregnancy and a one-third possibility of her condition worsening, says Dr. Friedman. Women often experience a flare-up of the disease during the first trimester because they stop taking their medications. If this occurs, Dr. Friedman suggests aggressively treating the patient with medications to induce remission. "You don't want to be treating a sick pregnant person," she says. "It's a disaster."

According to Dr. Friedman and the Crohn's and Colitis Foundation of America (CCFA), most Crohn's medications, including immunomodulators such as 6-MP and Imuran, can be tolerated during pregnancy. Methotrexate or Thalidomide, both linked to birth defects and pregnancy loss, should be avoided. Steroids tend to be safe but may cause premature delivery from the drug's elevation of blood pressure. It is not yet known if the latest drug Remicade is safe for pregnant women and their unborn babies.