Pregnancy, Fertility, and IBD with Sushila Dalal, MD
By Anna Gomberg
Until the middle of the twentieth century, women with Crohn’s disease and ulcerative colitis were sometimes advised to not have children, due to risks to their own health, and the complications presented by their disease. Fortunately for patients today, no such barriers exist: women with ulcerative colitis and Crohn’s disease can have healthy pregnancies and healthy babies. However, patients should keep a few key considerations in mind when planning a pregnancy, or trying to conceive.
“The most important thing is for patients to be in stable remission first, before they get pregnant. It is the best thing that a mother can do to protect herself and her baby,” says Sushila Dalal, MD, who specializes in IBD, and pregnancy and fertility.
Many patients ask whether it is safe to continue their medications when trying to conceive and while pregnant and breastfeeding. With a few specific exceptions, most commonly used IBD medications have strong clinical evidence for safety during pregnancy, including newer biologic medications, like infliximab (Remicade®), adalimumab (Humira®), ustekinumab (Stelara®), and vedolizumab (Entyvio®). Robust longitudinal research indicates that continuing these medications during pregnancy is safe for the baby and helps maintain the mother’s good health during pregnancy and beyond.
Dr. Dalal says, “Planning can make a world of difference. I start talking about pregnancy as early as possible, even saying to my younger patients, ‘by the way, I know you’re not thinking about it yet, but this medicine you are starting is safe for pregnancy’…. Because patients need to be in stable remission for three to six months before conceiving, speaking with your gastroenterologist early is key, so you can get surveillance testing (blood tests, endoscopy, etc.) done prior to getting pregnant.”
The IBD Parenthood Project – a new resource for patients from the American Gastroenterological Association (AGA) – has many recommendations for patients at all stages of family planning, from conception, to pregnancy, and delivery. The guide recommends that patients see a maternal fetal medicine specialist for their obstetric care, and that patients should not stop or change medications without speaking with their providers. AGA also includes a patient toolkit to help patients discuss pregnancy with their gastroenterologist.
“It all comes down to healthy moms, healthy babies,” says Dr. Dalal, “With the right guidance and planning, women with Crohn’s disease and ulcerative colitis can and do have healthy pregnancies and great outcomes.”