Pregnancy & IBD
Can IBD impact my fertility or ability to get pregnant?
The fertility of women is not affected by IBD if the diseases are kept under control. But if the diseases are flaring, fertility may be affected and chances of becoming pregnant may be reduced.
SuIfasalazine (Azulfidine) can cause a decrease in sperm motility, so if a heterosexual couple is trying to have child, the man should not take take sulfasalazine. Other 5-ASA drugs can be prescribed, with the exception of Asacol, which was taken off the market because its coating released phthalates.
Phthalates are a group of chemicals that may adversely affect the reproductive system, particularly the male system. In addition to being used in pill coatings, they are added to plastics to make them strong and flexible.
Can my medications cause birth defects?
Most medications used to treat IBD are safe for women to take during pregnancy. The most important factor in the health of the infant is the health of the mother. So if you are on medication and doing well, in most cases you should stay on it and talk with you doctor about any concerns.
Pregnant women with IBD should be seen by obstetrician familiar with the disease. It may also be a good idea to see a gastroenterologist every two to three months, depending on severity of the disease and the medications the woman is taking.
- 5-ASAs – 5-ASA medications do not pose a risk to the infant.
- Steriods – Steroids are safe over all, although they are associated with a small increase in the risk of a cleft palate.
- 6MP and azathioprine (Imuran) – Studies of pregnant women taking immunomodulators 6MP and azathioprine (Imuran) have not found any greater risk of birth defects.
- Methotrexate – One medication that must absolutely be avoided by men and women in pregnancy is methotrexate because it is associated with a high rate of birth defects. Methotrexate also increases the risk of miscarriage. Methotrexate is a Category X medication, the FDA classfication that means studies have shown a risk of birth defects and that the risks involved outweigh the benefits.
- Antibiotics – Two common prescribed antibiotics, ciprofloxocin (Cipro) and levofloxacin (Levaquin), should not be taken in the third trimester because they can affect the bone development of the fetus. The safety data for antibiotics suggests that there use should be limited to a week.
- Anti-TNF medications – TNF blockers (Remicade, Humira, Cimzia, Simponi) are Category B drugs, which means animal studies haven’t found any birth defect risk but evidence from studies in women is lacking. Research has shown that Cimzia does not cross the placenta as readily as Remicade and Humira. We discuss with pregnant women the possibility of stopping Remicade or Humira just prior to their due date if their disease is very well controlled. The only risk to the baby from anti-TNF drugs comes with the live vaccines that are given at the age of two months. Often these live vaccines will need to be delayed for a few more months to allow any remaining anti-TNF medication to leave the infant’s body.
What if I flare during pregnancy?
Flares can increase the risk of low-birthweight babies, premature delivery, congenital malformations, and miscarriages. Studies conducted in Scandinavia have shown that when the IBD of pregnant women is controlled, these risks are no higher than the general population.
When IBD is very active, the miscarriage risk is a lot higher. If the disease is so active that surgery is required, the risk of miscarriage is close to 70% higher.