Dealing with Inflammatory Bowel Disease and Pregnancy
Inflammatory bowel disease (not the same as the less-serious condition irritable bowel syndrome) refers to chronic inflammatory diseases of the intestines, including ulcerative colitis and Crohn’s disease. Other terms you may hear are regional enteritis, ileocolitis, and ileitis; these terms generally refer to Crohn’s disease. These diseases most often begin when people are in their twenties or thirties. These are illnesses of industrialized nations; they are also more common in whites than in people of color, and most common of all in people of Ashkenazi Jewish heritage. We don’t know why.
Inflammatory bowel disease, be it ulcerative colitis or Crohn’s disease, is characterized by a waxing and waning of disease symptoms, and the impact on a pregnancy depends on whether the disease is active at the time of conception. If not, the outlook for the pregnancy is very good. If the disease is active, there is some increase in adverse outcomes. The tendency of the disease to remain inactive during the pregnancy if it is inactive at the time of conception may be due to the natural rise in the mother’s cortisone-like hormones; the hormones may have a therapeutic effect. In women with ulcerative colitis that is active at the time of conception, the tendency is for the disease to worsen during the pregnancy. Among women with active Crohn’s disease at the time of conception, the disease activity remains fairly stable in 60 percent of cases; of the rest, about half improve and half get worse.
Overall, fertility and rates of preterm birth, stillbirth, and developmental defects are about the same as in the general population. This is good news. It is also good that sulfasalazine and steroids, commonly used in treatment of inflammatory bowel disease, are safe to use in pregnancy. Sulfasalazine does interfere with the absorption of folic acid, so women who are taking sulfasalazine should take 1 mg of folic acid twice daily.
