IBD & Pregnancy

Inflammatory bowel disease and pregnancy can go well with planning and steady disease control. Most people with Crohn’s disease or ulcerative colitis can conceive and have healthy pregnancies. The strongest predictor of good outcomes is being in remission at conception and staying there. Many IBD medicines, including most biologics, are safe to continue. Some drugs must be stopped before trying to conceive. Breastfeeding is encouraged for most. (gastro.org)

Key takeaways

• Aim for at least 3 to 6 months of remission before conception. Do not stop effective therapy to try to get pregnant. (gastro.org)

• Most IBD medicines, including anti‑TNF, vedolizumab, and ustekinumab, can continue through pregnancy and breastfeeding. Avoid methotrexate, JAK inhibitors, and S1P modulators. (academic.oup.com)

• Sulfasalazine lowers sperm counts; switch to mesalamine or pause 3 months before attempting conception. Add folic acid 2 mg daily with sulfasalazine. (practicalgastro.com)

• Delivery is usually based on obstetric needs. Cesarean is advised for active perianal Crohn’s or a prior J‑pouch. (guidelinecentral.com)

• About one in three experience a postpartum flare, especially if medicines are de‑escalated. Plan close follow‑up and continue therapy. (pubmed.ncbi.nlm.nih.gov)

Planning and fertility

• Fertility is generally normal when IBD is in remission. Active inflammation, poor nutrition, and low body weight can reduce fertility. For women with a J‑pouch (IPAA), fertility is lower due to pelvic adhesions. (pubmed.ncbi.nlm.nih.gov)

• Men: sulfasalazine can cause reversible low sperm counts. Consider switching to a 5‑ASA without sulfa 3 months before trying to conceive. Paternal methotrexate appears low risk in newer data, yet many clinicians still prefer a 3‑month washout. Discuss case‑by‑case. (practicalgastro.com)

• Preconception checklist: confirm remission, update vaccines, start prenatal folate (0.4–1 mg daily; 2 mg with sulfasalazine), review medications that need washout, and align care with gastroenterology and obstetrics. Low‑dose aspirin by 12–16 weeks may reduce the risk of preterm preeclampsia. (crohnscolitisfoundation.org)

Medicines: what is safe, what to avoid

Keeping IBD quiet is safer than stopping effective treatment. Large registries and new global consensus support continuing most IBD medicines through pregnancy and lactation. (pianostudy.org)

The PIANO registry and multiple cohorts show no increase in birth defects, infections, or developmental delay with thiopurines or biologics during pregnancy or breastfeeding. (pianostudy.org)

Monitoring and managing flares

• Track symptoms plus objective markers. Fecal calprotectin remains reliable in pregnancy. Intestinal ultrasound and MRI without gadolinium are preferred imaging options. (academic.oup.com)

• Flexible sigmoidoscopy is low risk when there is a strong indication and can change care. Coordinate with obstetrics. (pubmed.ncbi.nlm.nih.gov)

• Treat flares promptly. Use the same step‑up logic as outside pregnancy. Avoid unnecessary corticosteroids, since exposure tracks with preterm birth and low birth weight. (managedhealthcareexecutive.com)

Delivery and newborn care

• Mode of delivery follows obstetric indications. Cesarean is advised for active perianal Crohn’s disease, prior rectovaginal fistula, or prior ileal pouch‑anal anastomosis. Otherwise, vaginal delivery is appropriate. (guidelinecentral.com)

• Biologic drugs can cross the placenta in the third trimester and may be detectable in infants for 1 to 6 months. This has not translated into higher infant infection rates. (pianostudy.org)

• Live vaccines: Guidance is evolving. Many US experts defer live vaccines for 6 months after in‑utero exposure to IgG1 biologics, which can mean missing rotavirus. Newer data suggest rotavirus may be safe with careful specialist input. Decisions should be individualized with pediatrics. (immunize.org)

Postpartum and breastfeeding

• One in three experience active disease within 12 months postpartum. Risk increases if therapy is stopped during or after pregnancy. Plan follow‑up and continue maintenance therapy. (pubmed.ncbi.nlm.nih.gov)

• Breastfeeding is encouraged. Levels of biologics and thiopurines in milk are very low, and infant outcomes are reassuring. Prednisone is compatible; some choose to nurse a few hours after a high dose, though this is usually unnecessary. JAK and S1P drugs are not recommended while nursing. (pianostudy.org)

• Blood clots: IBD raises venous thromboembolism risk during pregnancy and especially postpartum. Hospitals should assess risk and provide prophylaxis when indicated. (pubmed.ncbi.nlm.nih.gov)

FAQs

Is it safe to stay on biologics into the third trimester

Yes. Current global guidance recommends continuing effective biologics on schedule to prevent flares. The benefits of disease control outweigh theoretical risks of infant drug exposure. (academic.oup.com)

Can the infant get rotavirus vaccine after in‑utero exposure to anti‑TNF or other biologics

Many clinicians still defer live vaccines for 6 months after third‑trimester exposure. Emerging studies show rotavirus appears safe in exposed infants. Decisions should be made with the pediatrician, considering timing and local policy. (immunize.org)

Does having a J‑pouch change delivery planning

Yes. Many experts advise planned cesarean to reduce the chance of pouch or sphincter injury. Discuss early with obstetrics, colorectal surgery, and gastroenterology. (guidelinecentral.com)

Which drugs must be stopped before trying to conceive

Stop methotrexate at least 3 months before conception. Avoid JAK inhibitors and S1P modulators, following listed washout times. Coordinate any change with the IBD team to prevent flares. (academic.oup.com)

Do men with IBD need to stop medicines

Most do not. Sulfasalazine can reduce sperm counts, which improves after stopping or switching. Paternal methotrexate appears low risk, but many teams still prefer a 3‑month washout. Decide with the care team. (practicalgastro.com)

Editor note: source required for any local institutional policies on infant live vaccines.