Crohn's disease and pregnancy

If you have Crohn’s disease (CD), you may be concerned about getting pregnant. Is it safe, for you and the baby? Does the chronic inflammation of the gut affect fertility?

Fertility and conception
If you're in remission and are otherwise healthy, CD will not affect your ability to conceive and carry a child. However, it may be harder to fall pregnant during a flare-up of intense symptoms. Women who have had certain surgical procedures, such as an IPAA (ileal pouch surgery) or an ileostomy may have slightly decreased fertility.

Men tend to have decreased sperm counts during acute flare-ups of CD. However, in remission, and if they're not malnourished, their sperm counts go back to normal.

You should try to conceive when your disease is in remission. CD doesn't directly harm the baby, but symptoms may prevent you from absorbing all the nutrients you need to support the foetus. If your disease is active during your pregnancy, the risk of miscarriage, premature birth, still birth or low birth weight is increased.

If you conceive during a period when you're not experiencing symptoms, you're likely to have a normal pregnancy.

If one or both parents have CD, there's a slightly increased risk that your child will develop it too.

Medications
There are two medications for CD that affect fertility: sulfasalazine and methotrexate. Methotrexate reduces sperm counts and may also cause miscarriages and foetal deformities. Sulfasalazine decreases sperm counts.

There's much debate about whether any other CD medications are safe during pregnancy. Any negative drug effects must be balanced against the mother’s need to stay healthy. If your CD flares up because you go off your medications, the possible malnutrition, inflammation, diarrhoea and dehydration that can result may be much more damaging to your baby.

Always consult with your doctor: he or she can help you weigh up the risks, especially those associated with aminosalicylates, antibiotics, antispasmodics, biologics, corticosteroids and immunosuppressants.

Make sure you eat a healthy nutritious diet while you're pregnant. Your doctor can also advise you on what supplements are sensible to take, e.g. folic acid.

Delivery and after
It may be recommended that you have an episiotomy, to avoid tearing the perineum when delivering the baby, as CD inflammation can prevent proper healing in that area. A caesarean section may be recommended if you suffer frequently from inflammation or fistulas.

If your disease is active, you may find it difficult to produce enough milk to breastfeed. Also discuss breastfeeding and medication with your doctor: there are some medicines that may pass into your breast milk and would be damaging to a baby.

- Source: Crohn’s and Colitis Foundation of Canada (www.ccfc.ca)
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