9 questions you’ll want answered about pregnancy and Crohn’s disease

Let’s start off with saying that most women with Crohn's disease can and do fall pregnant, and most mothers with Crohn's have healthy babies.

Being a parent is such a beautiful thing, but research has shown that many women with Crohn's believe that it will cause troubles for their pregnancy and their new little family addition. Here, we will discuss and clarify some of the misconceptions and concerns you may have if you have Crohn’s disease and are thinking about getting pregnant, or if you’re already pregnant.

1. Can I fall pregnant if I have Crohn’s disease?

Thinking about starting a family can be a challenging decision for most couples and doing the same with a chronic condition like Crohn’s disease seems to make it all that much harder.

Research shows that women with Crohn's often overestimate the effects of their disease on fertility, with fears like they are not able to conceive or they will pass the disease to their children (see ‘Will my baby get Crohn’s disease?’ below or ask your doctor for more information).

But, fertility rates are actually similar to the general population when a woman is in remission.

So, living with Crohn’s disease does not necessarily affect your ability to bear children.

Under careful supervision from your clinical team (GP, gastroenterologist and/or obstetrician), most women can and will have a normal pregnancy.

2. Will pregnancy make my Crohn’s disease worse?

The chances of you experiencing a flare is no different to when you’re not pregnant. However, having active disease during pregnancy may pose a greater risk of complications, like miscarriage, preterm delivery, low birth weight of the baby and/or stillbirth.

If you have active disease at conception, clinicians typically use ‘the rule of thirds’ to discuss the likelihood of disease outcomes – one third will get better, one third will remain the same and one third will worsen. This is likely due to the number of changes happening as you progress through pregnancy and to your immune system, which may affect your disease course.

To sum up, disease activity is the same in pregnant women with Crohn’s as in non-pregnant women with Crohn’s – pregnancy is not a risk factor for increased flares.

3. When is the best time to conceive?

The best time to fall pregnant is when you’re in remission for at least 3–6 months and being steroid free (i.e. steroid-free remission). If you have active disease, ‘preconception counselling’ with your clinical team should aim to achieve remission in the few months prior to conception, keeping in mind that the status of your disease at conception tends to remain throughout pregnancy.

You can also help by keeping track of your medications, noting down the last dose you took, so you know when you can start planning for your new family member.

Therefore, it would be best if you and your partner discuss the intention of falling pregnant with your clinical team, so they can ensure your pregnancy will be a smooth one.

4. Will I have a normal pregnancy?

Research has shown that women who have their disease under control (with medications) have similar fertility rates to most people without Crohn's. But because of the risk of associated complications (e.g. miscarriage, preterm delivery, low birth weight, stillbirth), pregnant women with Crohn’s are often considered as high-risk mothers.

Ensuring that you’re in remission prior to conception and also that remission is continued throughout pregnancy is considered the best approach for mother and baby.

To achieve this, most women will need to continue their medications throughout pregnancy, following the guidance from their gastro.

If you have concerns over whether your medications will affect you or the baby, refer to the question ‘Will my medications harm my baby?’ and ask your gastro for more information.

5. Will my medications harm my baby?

Most women will wonder “do I need to stop my medications so my baby won’t be affected?”

Most medications used to treat Crohn’s disease are generally considered low risk for women who are pregnant. Active disease actually may cause more harm to your baby than most Crohn’s disease medications, so the benefits of treatments generally outweigh the risks. However, there are some medications that are not recommended for Crohn’s during pregnancy.

Remember, active disease poses greater risks to pregnancy, not active treatment. Your gastro and OB will be in the best position to recommend the best approach moving forward.

6. Do I need to follow a special diet while pregnant?

A diet for a mum-to-be with Crohn’s should be no more special than any other mum-to-be – eating a well-balanced diet, which includes foods from the five food groups, vegetables and legumes/beans; fruit; nuts and cooked lean meat, fish, poultry; grains and cereal; milk, certain cheeses, yoghurt and dairy alternatives.

Folic acid (or folate) supplements are recommended, as with any other pregnancy, because it offers a protective effect against the development of neural tube defects (i.e. malformations of the central nervous system) in your growing baby. Some pregnant women may also need additional iron, as it can be quite common for women with Crohn’s to have iron deficiency.

However, every person is different and your clinical team may also recommend other vitamin or mineral supplements, and additional foods to ensure you’re getting the essentials. On the contrary, if you have active Crohn’s during pregnancy, it may be recommended to stay away from certain foods that cause you discomfort. Your gastro and dietitian can give you more advice about healthy diets during pregnancy and breastfeeding.

7. If I had previous surgery, will it affect my delivery?

Thinking about natural vs caesarean delivery? Most women with Crohn’s can and do have a natural delivery, and currently there is no recommended delivery mode for mums with Crohn’s disease. Typically, mums with uncomplicated Crohn’s have a choice of either, just like the general population.

But c-sections may be considered if you have or have had certain complications (e.g. perianal fistula and abscesses of the anal and genital areas), because of potential difficulties with the healing of your birth canal. Again, your gastro and OB will be the best people to advise on this.

8. Will my baby get Crohn’s disease?

Although Crohn’s disease can be linked to your genes (amongst other factors), the condition is not inherited in a ‘Mendelian fashion’ (like blood type would). Other non-genetic factors also play a role in the development of Crohn’s disease.

It’s important to know that it’s not Crohn’s that gets passed from you to your baby, but rather the ‘tendency to develop Crohn’s’.

Scientists still do not truly know why Crohn’s disease develops, but they do know that if an individual has a genetic predisposition to Crohn’s and later encounters certain ‘unknown’ factors it will influence whether they develop Crohn’s or not.

Despite reports showing an increased risk of children inheriting Crohn’s, the actual numbers are actually very low. If you OR your partner has Crohn’s, there is a 91% chance that your baby won’t get Crohn’s.

9. Can I breastfeed?

Breastfeeding is another wonderful thing about being a mum. But, whatever you eat also has a tendency to get passed onto your breastmilk, including medications. It’s only natural to wonder whether your medications will affect your baby.

Most medications used to manage Crohn’s disease are passed onto breastmilk at low or very low levels, so the risk to your baby’s health is also considered low. But, however low the risk may be, you may want to discuss with your gastro or clinical team (as some Crohn’s medications are not recommended while breastfeeding) about balancing the potential benefits of breastfeeding versus the risk of exposure to low levels of the medication(s).

Having a baby is a big decision, so it’s completely normal to have these concerns about pregnancy, especially if you have Crohn’s disease. The best approach, no matter what stage you’re at in your pregnancy or family planning, is to discuss your intentions and concerns with your doctor, gastroenterologist and obstetrician.