Inflammatory Bowel Disease

Inflammatory Bowel Disease (IBD) and Pregnancy

Inflammatory bowel disease (IBD) is a term used to describe conditions that cause chronic inflammation of the digestive tract.

The two most common IBD conditions are:

• Ulcerative colitis – inflammation and ulcers in the colon and rectum
• Crohn's disease – inflammation and ulcers throughout the digestive tract

Inflammatory bowel disease increases the risk of pregnancy complications. To reduce those risks, women with IBD are advised to try and time their pregnancy when they are in remission – meaning they aren’t experiencing any symptoms of their disease.

If you have IBD and are pregnant or considering pregnancy, you may be referred to a maternal-fetal medicine physician, an OB/GYN who specializes in high-risk pregnancies.

Potential Pregnancy Complications

Women with IBD are at increased risk of pregnancy complications that include:

• Premature birth
• Low birth weight
• Inadequate pregnancy weight gain
• Gestational diabetes (in women exposed to steroid treatment)
• Blood clots (thromboembolic disease) during pregnancy and postpartum
• Need for a cesarean delivery (C-section)
• Miscarriage

The Importance of Preconception Planning

Studies show the best predictor of a woman’s inflammatory bowel disease during pregnancy is the state of her disease at conception. If your disease is active or “flaring up,” it will likely remain active during pregnancy. If you are in remission, you will likely remain in remission during pregnancy.

Talk to your health care providers before getting pregnant to:

• Assess your risks
• Achieve and maintain disease remission
• Time your pregnancy, generally 3 to 6 months after your most recent flare
• Adjust your IBD medications, if needed, to avoid harm to the fetus
• Begin prenatal vitamins to help prevent birth defects

Treatment of Pregnancies with Inflammatory Bowel Disease

Treatment for pregnancies involving IBD should be tailored to the type, severity and extent of the woman’s disease, her unique pregnancy and preferences, and the health of her unborn baby.

In general, treatment will include:

• Specialized obstetric care
• Close monitoring to maintain disease remission
• More frequent visits with your gastroenterologist
• Immediate treatment should flare-ups occur, to minimize risks to the fetus
• More frequent ultrasounds to monitor fetal growth
• Nutritional supplements to prevent maternal malnutrition
• Blood thinners, if needed
• Carefully planned delivery based on disease symptoms, including health of the tissues around the vagina and anus, and prior colorectal surgeries
• A multidisciplinary health care team that may include gastroenterologists, maternal-fetal medicine specialists, nutrition consultants, pediatricians and colorectal surgeons

Benefits of Specialized Care

Texas Children’s Pavilion for Women offers specialized care to help women with IBD achieve the healthiest possible pregnancy. Our obstetrics providers are trained and experienced in managing these pregnancies, carefully assessing and balancing the treatment needs of the mother with the health and safety of her unborn baby.

We offer: 

• Preconception counseling to assess and reduce maternal and fetal risks
• Prenatal consultations, evaluations and treatment tailored to each woman’s condition and pregnancy
• State-of-the-art fetal imaging to monitor your baby’s development
• Proven experience coordinating the multidisciplinary medical and surgical care required to optimize maternal and fetal outcomes
• Immediate access to Texas Children’s Hospital for babies who need extra care and monitoring, including Texas Children’s Fetal Center® and Texas Children’s Newborn Center, home of our level IV neonatal intensive care unit (NICU)
• Close collaboration with your current health care providers