IBD & Pregnancy

Pregnancy is usually possible and safe for most people with inflammatory bowel disease (IBD) when the condition is well controlled. The biggest factor for a healthy pregnancy is disease remission at the time of conception and throughout pregnancy, not stopping medicines. This article explains how IBD affects fertility, which medications are considered safer, and what to expect before pregnancy, during each trimester, and after birth.

Key Takeaways

• Most people with well controlled IBD can have healthy pregnancies and healthy babies.

• Being in remission before conception lowers risks like miscarriage, preterm birth, and low birth weight. (guidelinecentral.com)

• Many IBD medicines, including 5‑ASA, thiopurines, and most biologics, are usually continued in pregnancy. (guidelinecentral.com)

• Some medicines, such as methotrexate, JAK inhibitors, and S1P modulators, must be stopped well before conception. (guidelinecentral.com)

• Pregnancy in IBD is considered “high risk,” so shared care between gastroenterology and obstetrics is important. (journals.lww.com)

• After delivery, flare risk, blood clot risk, and mental health all need planned follow‑up and support. (journals.lww.com)

Why pregnancy planning matters in IBD

IBD often begins during the reproductive years. Active inflammation at conception or during pregnancy is linked with higher rates of miscarriage, preterm birth, low birth weight, and complications for the pregnant person. (journals.lww.com)

When IBD is in clinical and objective remission, pregnancy outcomes are much closer to those of people without IBD. The main goal before pregnancy is therefore stable remission for several months, with a treatment plan that can safely continue through pregnancy and breastfeeding.

Multidisciplinary care is ideal. A gastroenterologist, obstetric provider (often high‑risk or maternal‑fetal medicine), IBD nurse, dietitian, and sometimes a mental health professional can all contribute to safer care across the perinatal period. (ecco-ibd.eu)

Fertility and preconception planning

Fertility in people with IBD

IBD itself usually has only a modest effect on fertility when disease is well controlled. However, fertility can be reduced when: (guidelinecentral.com)

• Disease is active or severe.

• There has been prior pelvic surgery, especially an ileal pouch‑anal anastomosis (IPAA or J‑pouch).

• There is undernutrition, low body weight, or significant anemia.

Fertility treatments such as in vitro fertilization (IVF) appear to work about as well in people with IBD as in those without IBD, especially when disease is stable. (guidelinecentral.com)

Preconception checklist

Before trying to conceive, the IBD team usually aims to:

• Confirm remission using symptoms plus tests (blood work, fecal calprotectin, and sometimes endoscopy or imaging). (guidelinecentral.com)

• Review the medication list, stopping or switching unsafe drugs.

• Optimize nutrition, weight, iron, B12, folate, and vitamin D levels.

• Update vaccines and infection screening, especially for anyone on immunosuppressive therapy.

• Discuss smoking cessation, alcohol, and substance use.

Folic acid supplementation is important for all pregnancies. Higher doses are often used for people on certain medicines such as sulfasalazine or with prior neural tube defects in the family. Methotrexate is strictly unsafe in pregnancy and must be stopped well before conception, usually at least 3 months. (guidelinecentral.com)

Partners’ health also matters. Sulfasalazine can lower sperm quality but this is usually reversible, and alternative 5‑ASA medicines may be considered if needed.

Medication safety in pregnancy and breastfeeding

Continuing effective treatment is usually safer than stopping it. Flares often pose more risk to pregnancy than most IBD medicines. (guidelinecentral.com)

Common IBD medication groups

*Breastfeeding decisions should be individualized with the care team.

Infant vaccines after biologic exposure

Biologics given in later pregnancy can cross the placenta, and drug may be detectable in the baby for months. Inactivated (non‑live) vaccines are considered safe on the usual schedule. For live vaccines such as rotavirus, guidance is evolving. Many experts still delay live vaccines for about 6 months in biologic‑exposed infants, although emerging data suggest rotavirus may be safe in many cases. (pubmed.ncbi.nlm.nih.gov)

Planning with the pediatrician early in pregnancy is important so that vaccine timing reflects local guidelines and the specific drug used.

Managing IBD during pregnancy

Pregnancy in IBD is considered “high risk,” but most pregnancies still go well with careful monitoring. (journals.lww.com)

Typical elements of care:

• Regular review of symptoms, weight gain, and general wellbeing.

• Blood tests and often fecal calprotectin to track inflammation. (guidelinecentral.com)

• Endoscopy only when results would change management, using the safest approach and sedation. (journals.lww.com)

• Imaging with intestinal ultrasound or MRI without contrast when needed, instead of CT. (guidelinecentral.com)

If a flare occurs, treatment is similar to non‑pregnant care, except that clearly unsafe medicines are avoided. This may involve steroids, optimizing existing biologics, antibiotics for infections, or in rare cases surgery. Surgery should not be delayed when clearly necessary, regardless of trimester. (guidelinecentral.com)

People with IBD have increased risk of blood clots during pregnancy and especially in the 6 weeks after delivery. Hospitalized or severely flaring patients often receive preventive blood thinners. (journals.lww.com)

Delivery planning

Mode of delivery is usually based on obstetric reasons. Vaginal birth is often safe. Cesarean delivery is more strongly considered for: (journals.lww.com)

• Active perianal Crohn’s disease or prior complex perianal fistulas.

• Prior IPAA / J‑pouch surgery.

• Rectovaginal fistulas, current or past.

Decisions are best made jointly by the obstetric and IBD teams late in pregnancy.

Postpartum care and breastfeeding

The months after birth are a time of higher flare risk, particularly if medicines were stopped or doses were delayed around delivery. Early follow‑up with the IBD team, usually within 4 to 12 weeks postpartum, helps adjust therapy, check labs, and address symptoms.

Blood clot risk and mental health also need attention. Pregnancy and IBD together increase the chance of venous thromboembolism, especially after delivery, so risk assessments and, in some situations, preventive blood thinners are used. (journals.lww.com)

Postpartum depression and anxiety can be more common in those with chronic illness. Screening, open discussion, and referral to mental health support are important parts of care.

Most IBD medicines, including many biologics, are considered compatible with breastfeeding, with only tiny amounts found in breast milk and minimal absorption by the infant. (pmc.ncbi.nlm.nih.gov) Decisions about feeding method should focus on parental preferences and overall health, with medication choices tailored to support both disease control and infant safety.

FAQs

Does IBD increase the chance that a child will develop IBD?

Children with a parent who has IBD do have a higher lifetime risk of IBD than the general population, but most children will not develop IBD. (guidelinecentral.com)

Is pregnancy ever discouraged in IBD?

Pregnancy is usually possible, but it may be delayed or discouraged during periods of uncontrolled severe disease, shortly after major surgery, or when using strongly teratogenic medicines such as methotrexate. Decisions are individualized with the care team. (guidelinecentral.com)

When should contraception be discussed?

Contraception should be discussed at diagnosis and again whenever treatment changes, especially with any medication that is unsafe in pregnancy. Long‑acting reversible methods are often preferred for reliable protection. (guidelinecentral.com)