Concerns around conception and pregnancy are common when managing an inflammatory bowel disease. And while many with IBD conceive, carry and deliver without complications, it’s worth approaching pregnancy with care and an understanding of what to expect when you’re expecting with UC.
How Does Ulcerative Colitis Affect Pregnancy?
Ulcerative colitis and pregnancy do affect one another, although this largely depends on the state of your condition during conception.
Studies show that if you conceive while in clinical remission, you’re statistically more likely to remain in remission during pregnancy. But if you conceive while your disease is in an active state, your symptoms are more likely to worsen during pregnancy, and there may be worse outcomes for both mother and child.
Some studies show higher rates of fetal loss and preterm birth in patients who conceived during an active flare. This is why experts advise planning your pregnancy when your condition is quiescent.
The Crohn’s & Colitis Foundation recommends planning conception only once your IBD has been in remission for at least 3-6 months when you are not taking steroids or starting a new medication.
Is pregnancy with UC considered high-risk?
A high-risk pregnancy involves increased health risks for the person carrying that pregnancy, the fetus, or both.
Even if you do conceive during remission, there are still risks to be aware of. These include premature delivery, premature labor, delivery complications, miscarriage, and stillbirth. Pregnant patients with UC also have an increased risk of eclampsia, preeclampsia, placenta previa, abruptio placentae, or prolonged premature rupture of membranes. 1
Babies are at risk of low birth weight and can be small for gestational age. Some studies show that mothers with UC are also at risk of delivering children with congenital abnormalities. 2,3 The evidence is somewhat contradictory though, as one study found no connection between IBD and congenital abnormalities. It did however report that children of UC patients with an active disease during pregnancy have a higher risk of developing childhood illnesses.
Can a UC flare cause a miscarriage?
There is unfortunately an increased risk of miscarriage with UC. This is more likely if you experience active UC flare-ups during pregnancy that may leave you underweight or lacking important nutrients.
Whether you’re in remission or not, you should work closely with your doctor, dietitian, and/or nutritionist to ensure you’re getting enough nutrients and nourishment for your health and the health of your baby.
Is a colonoscopy safe during pregnancy?
If you’re pregnant and require a colonoscopy, it’s best to discuss the safety of the procedure with your gastroenterologist. Although a 2010 study did conclude that colonoscopies are safe during the second trimester, some advise pregnant women to hold off until after delivery.
There’s also the matter of the anesthetic protocol to consider. Anesthetics during pregnancy can increase the risk of miscarriage or harm to the child. Some women have undergone colonoscopies without anesthesia but find them more uncomfortable (and experienced increased pain) due to differences in anatomy. If you’re unsure, speak to your doctor about this decision.
Can you have a natural birth with ulcerative colitis?
Women with IBD often have natural, vaginal deliveries without complications, but there are certain cases in which a C-section is the safest option. If you have active perianal disease or active involvement of the disease, a C-section will likely be recommended.
Likewise for those with an ileoanal pouch or a J-pouch. This doesn’t mean you absolutely can’t have a vaginal delivery, but it’s best to discuss this in detail with your doctor.
Are UC medications safe during pregnancy?
Many UC medications are safe during pregnancy. Both Aminosalicylates and 5-ASA appear to be safe for the mother and child.
If you’re on steroids, ask your doctor for a change in medication at least 3 months before trying to conceive, or at least lower the dose as steroids can increase certain health risks.
Medications to avoid when pregnant:
- Methotrexate can cause birth defects and miscarriage
- Thalidomide can cause birth defects and fetal deaths
How does Pregnancy Affect Ulcerative Colitis?
Pregnancy can affect your UC, although this is generally dependent on whether your condition is active or quiescent during conception.
Roughly 66% of patients who conceive during clinical remission remain in remission during pregnancy and the postpartum period. Out of the patients who conceive when their disease is active, 60% continue to have active disease or worsening symptoms.
Can pregnancy cause an ulcerative colitis flare-up?
While it’s unclear whether pregnancy actively causes flare-ups in all cases, UC flares are more likely during the first trimester or straight after delivery. Work closely with your healthcare team to manage any symptoms or exacerbations during these periods.
Nutrition for Pregnancy & Ulcerative Colitis
Meeting your nutritional needs is vital during any pregnancy, especially with ulcerative colitis. Many with UC have deficiencies in iron, vitamin D, vitamin B12, and zinc, but you may need extra nutritional support for a safe and healthy pregnancy.
Women with UC are more likely to develop anemia, so make sure to monitor your iron levels during pregnancy. UC can also make it harder to absorb folic acid, which helps prevent birth defects.
Experts suggest taking prenatal vitamins every day while trying to conceive, or during pregnancy. These can be rough on your system, so ask your dietician or nutritionist for guidance on different formulations.
Support is Key
Safe pregnancy and delivery are absolutely possible for UC patients, but the chances of complications and flare-ups are reduced if you conceive during remission. Try to plan your pregnancy for when you’ve already been in remission for a few months, and work closely with your healthcare team to ensure your medical and nutritional needs are being met.
References
1 https://pubmed.ncbi.nlm.nih.gov/17764676
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1954859/
3 https://pubmed.ncbi.nlm.nih.gov/11926208/
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