What to know about ulcerative colitis and pregnancy

Pregnancy
Women with ulcerative colitis may have concerns about the course of this disease during pregnancy. However, the condition does not necessarily affect the chances of becoming pregnant, and women with ulcerative colitis can have a healthy pregnancy and a safe delivery.

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that occurs when the lining of the large intestine or rectum becomes inflamed. As the disease progresses, there are periods of flare-ups during which the symptoms become worse.

In this article, we discuss some of the important things to consider to keep both the woman and baby healthy throughout the pregnancy.

Pregnancy and ulcerative colitis links

Pregnant woman with ulcerative colitis speaking to doctor, obstetrician, or gynecologist in office.
Women with UC can speak to their doctor about pregnancy.

The Crohn’s & Colitis Foundation note that the best time for a woman to become pregnant is when her IBD has been in remission for at least 3–6 months and she is not taking steroids or starting a new medication.

A study in Gastroenterology & Hepatology found that about 80% of women who conceive while their IBD is in remission will stay in remission for their entire pregnancy. Most doctors will, therefore, recommend that women aim to get the disease under control before trying to get pregnant. However, this is not always possible.

The study also showed that in up to 45% of women with UC who conceive while the disease is active, symptoms get worse during pregnancy. An additional 24% of women see their disease remain active but stable. Together, these findings mean that about two out of three women who get pregnant while their disease is active will continue to experience symptoms throughout pregnancy.

How ulcerative colitis affects pregnancy

UC may also make complications from pregnancy more likely. A woman with UC has a higher risk of the following than a woman of a similar age without this condition:

  • pregnancy loss
  • premature birth
  • complications with delivery and labor

Women who have undergone certain operations for UC also appear to have slightly decreased fertility rates.

However, a report in the journal Gastroenterology notes that women who have the disease under control and who have never had surgery have the same chance as other women of getting pregnant.

How pregnancy affects ulcerative colitis

Experiencing a flare-up during pregnancy can be concerning. Flare-ups are more likely to occur early on in the first trimester of pregnancy or immediately after delivery.

Stopping a medication during pregnancy increases the risk of a flare-up and worsening disease activity, which is the most significant known risk to the pregnancy.

There is also a minimal chance of a woman passing UC to the baby. The risk is about 1.6% if the mother alone has UC, but it rises to over 30% if both parents have a form of IBD.

What to do if you are pregnant with ulcerative colitis

Any woman with UC who wants to become pregnant or discovers that she is pregnant should work closely with her doctor every step of the way to minimize the risks.

Doctors will treat a pregnant woman with UC as high-risk, meaning that they will want to check in regularly and take extra steps to avoid or manage complications that may arise from the condition.

Diagnosis

A doctor may recommend an ultrasound to diagnose ulcerative colitis.
A doctor may recommend an ultrasound to monitor UC during pregnancy.

Some standard medical procedures are effectively off-limits during pregnancy, as they may put either the woman or the fetus at risk. However, many diagnostic tools that doctors use to monitor and diagnose UC are safe to perform during pregnancy.

These procedures include:

Doctors will not usually order other imaging tests, such as CT scans or X-rays, unless it is an emergency. They might also request a pregnancy-safe MRI without the use of gadolinium, which is a substance that may increase the risk of complications.

Treatment

Although doctors will want to avoid some UC treatment options during pregnancy, several treatments present only a low risk.

Medical treatments

Women who become pregnant may still be able to continue taking some medical treatments for UC. The Crohn’s & Colitis Foundation note that many of the medications that doctors recommend to treat UC should be safe for a pregnant woman and the unborn child.

Additionally, many of these same medications are safe to use while breastfeeding.

Pregnant women and those who are breastfeeding should always check in with a doctor as soon as possible to discuss their treatments before moving forward. In some cases, stopping a medication may make symptoms or the overall condition worse.

Medications for UC that appear to be low-risk during pregnancy include:

  • aminosalicylates, such as sulfasalazine (Azulfidine) and mesalamine (Asacol, Pentasa)
  • immunomodulators, including azathioprine (Imuran), cyclosporine A (Neoral, Sandimmune), and 6-mercaptopurine (Purinethol)
  • biologics, such as infliximab (Remicade) and adalimumab (Humira)

In other situations, doctors will want to adjust the dosage. For instance, if the woman is using corticosteroids when she becomes pregnant, doctors will want to lower the dosage as much as possible. Most doctors will not recommend steroids for UC maintenance therapy during pregnancy.

Other higher risk drugs that doctors may recommend avoiding during pregnancy include:

  • antibiotics
  • thalidomide
  • some biologics late in pregnancy

Surgery

Previous operations for UC do not appear to have negative effects on pregnancy, although certain procedures may affect fertility.

Women who require surgery but then get pregnant should wait until after the pregnancy to have the operation unless the condition is severe and does not respond to medication.

Diet

Taking pre-natal supplements can help prevent folic acid deficiency.
Taking prenatal supplements can help prevent folic acid deficiency.

In people with UC, the large intestine has difficulty absorbing vital nutrients. Therefore, it is crucial to focus on proper nutrition while pregnant.

Anyone with UC who becomes pregnant should ask their doctor about seeing a dietitian. A dietitian can help a pregnant woman create a diet plan that is effective for her condition, and this may make a significant difference both to how she feels and to the health of the baby. The dietitian will recommend foods that the woman should eat or avoid to provide her and the fetus with proper nutrition.

Most women will take prenatal vitamins as part of their pregnancy care. These supplements should provide essential compounds, such as folic acid. These nutrients are especially important for UC treatments that lower folic acid levels in the body, such as aminosalicylates.

Doctors are also likely to recommend that all pregnant women minimize their caffeine and alcohol intake and quit any potentially dangerous habits, such as smoking cigarettes or marijuana.


Outlook

Complications from pregnancy may be slightly more likely for a woman with UC, but many women with the disease have few or no complications during pregnancy.

Most doctors will advise a woman to try to get pregnant when she has been symptom-free for a few months and is not on steroids or starting other medications.

The course of ulcerative colitis varies among individuals. As such, there are no guarantees of a pregnancy that is free from complications. However, this is the case for all pregnancies. Working closely with a doctor throughout the entire pregnancy will give a woman the best chance of avoiding or managing any complications.

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