Ulcerative Colitis and Pregnancy: Fertility, Medication, and More

Many women with ulcerative colitis (UC) may worry that their condition will negatively affect their fertility, pregnancy, and the health of their baby.

That isn’t always the case. “It’s definitely possible to have uneventful pregnancies, uneventful births, and completely healthy children with this disease,” says Supriya Rao, MD, a gastroenterology, internal medicine, obesity medicine, and lifestyle medicine physician and professor of gastroenterology at Tufts University in Massachusetts, who focuses on digestive disorders and women’s health.

“But getting into remission, staying on your medications, following up with your physicians, and having good lifestyle habits in place is of utmost importance,” Dr. Rao says.

Here’s what you should know about fertility, diet, medications, testing, and more if you have UC and are pregnant or want to become pregnant.

Ulcerative Colitis and Getting Pregnant

Many women with UC can conceive as easily as those without the condition. But there are still important things to consider before getting pregnant.

“As much as you can, try to plan the pregnancy,” says Sunanda Kane, MD, a professor of medicine in the department of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, where she focuses on women’s health, from fertility and conception to pregnancy and postpartum management.

That’s important for several reasons. For starters, ensuring that your UC is well managed and in remission is a key part of fertility. Women in remission have similar fertility rates as women of the same age who don’t have inflammatory bowel disease (IBD), according to research coauthored by Dr. Kane. Being in remission not only helps with fertility but also leads to a smoother pregnancy and decreased risk of complications. Having active UC symptoms, on the other hand, can negatively affect fertility.

If possible, women should aim to wait three to six months after reaching remission and being off of steroids to try to get pregnant.

Having surgeries like ileoanal anastomosis (also known as J-pouch surgery) or pelvic surgery could also hinder fertility in some women, as these surgeries can lead to scarring of the fallopian tubes.

Some women with severe UC may have anemia or altered menstrual cycles, both of which can?also negatively impact fertility, Kane notes.

What Should I Eat for a Healthy Pregnancy With Ulcerative Colitis?

“Nutrition plays a role in everything we do. So for patients with ulcerative colitis, it’s no different [when pregnant or planning to become pregnant],” Rao says.

All pregnant women, including those with UC, should eat a well-balanced diet. Your diet should be plant-forward with plenty of fruits, vegetables, and healthy sources of protein, carbohydrates, and fats, says Rao. It’s also a good idea to limit processed meats and packaged foods, which could contribute to inflammation, Rao adds.

Kane recommends that women with UC take a prenatal vitamin containing iron, folate (commonly known as folic acid when sold as a supplement), and vitamin B12 while trying to conceive and during pregnancy.

People with UC should also be monitored for levels of these and other nutrients to ensure that they’re getting enough of each one. That’s because people with UC may not absorb nutrients, vitamins, and minerals from food as easily as people without the condition. People with IBD are particularly at risk of iron and vitamin B12 deficiencies, research suggests.

Folic acid is another key nutrient for pregnant women because it helps reduce the risk of neural tube defects like spina bifida. It’s especially important for people with UC because certain UC medications, such as sulfasalazine, may hamper the body’s ability to absorb folic acid.

How Might Ulcerative Colitis Affect My Pregnancy?

Research shows that, in general, pregnant women with an IBD like UC have a higher risk of pregnancy-related complications such as preeclampsia, low maternal weight gain, and placental abruption. However, these risks are of most concern for women with active UC.

If a woman is in remission when she conceives, she most likely won’t have much additional risk of pregnancy complications, compared with a woman without UC, Kane says. This doesn’t mean there are no risks for women in remission, however.

“What we know is that a woman who has UC — even if she’s well — is likely going to deliver a child that’s small for gestational age and premature by one to two weeks,” Kane says. “But those children are healthy and they do not have an increased risk of birth defects, so that’s the important thing.”

How Might Pregnancy Affect My Ulcerative Colitis?

The body experiences several physical changes during pregnancy, including changes in hormones, immune-related changes, and changes to gut bacteria, among others. These changes can affect your UC, but it often depends on whether your symptoms are active or in remission.

You’re less likely to experience UC-related complications if you’re in remission. That said, women with UC in general have an increased risk of a flare-up during pregnancy and after birth.

If you have a stoma, tell your stoma nurse if you’re pregnant or planning to become pregnant. That’s important because being pregnant could affect the size or shape of your stoma and may lead to certain complications, such as hernia, prolapse, or in rare cases, blockage.

Also, be sure to tell your pregnancy care team if you have a stoma. Around three-quarters of women with stomas give birth via cesarean section (C-section), and these procedures are typically planned ahead of time. Your pregnancy care team can help you determine whether a vaginal birth or C-section is the best option for you.

Is It Safe to Take Ulcerative Colitis Medication While Pregnant?

Don’t stop taking your UC medication or change your regimen without talking to your doctor. It’s a common misconception among pregnant women with UC that their medication will affect their growing baby, Kane says.

“Women will say they don’t want the baby to be affected by their medicine and they stop it. But then they flare, and it’s the active disease that’s worse for their pregnancy than the medicine,” says Kane.

Drugs like mesalamine, azathioprine (when taken alone), and all biologics are safe to take while pregnant, Rao says.

That said, it’s still important to talk to your doctor about all the medications you’re taking before you conceive, if possible, so that they can adjust them if needed. Although most UC medications are safe to use during pregnancy, there are some exceptions. For example, methotrexate must be stopped at least three months before conceiving because it can lead to birth defects.

If you need to switch medications, you should try to be stable on the new medication for at least three months before trying to conceive.

Is It Safe to Undergo Testing or Surgery While Pregnant?

Pregnant women with UC may need additional testing to assess their symptoms, especially if they’re having a flare-up. Certain tests, such as endoscopy or colonoscopy, are usually considered safe during pregnancy, but they are only used if your IBD care team thinks they’re absolutely necessary.

?There are also less invasive ways to monitor UC disease activity during pregnancy, such as intestinal ultrasound or fecal calprotectin (a stool test).

Be sure to let your care team know you are or could be pregnant before undergoing any tests.

Rarely, your care team may recommend that you have surgery for UC while pregnant, if delaying the surgery is risky to you or your baby. Surgery always poses certain risks, but those risks often depend on your condition, stage of pregnancy, and related factors. Your IBD care team can discuss the risks and benefits of surgery with you.

How Will Ulcerative Colitis Affect My Baby?

Genetics are a risk factor for UC, but the overall risk of your child developing UC is low. A child has a 2 to 9 percent risk of developing the condition if one parent has it. However, those odds do increase to about 36 percent if both parents have UC.

As mentioned, most UC medications are safe to take while pregnant and won’t negatively affect your baby. Your doctor will tell you if you should stay on your current medication or switch to another one.

The Takeaway

If you have UC and want to start a family, know that it’s definitely possible to have a healthy pregnancy.
It’s important to plan ahead with your care team and aim for remission before trying to conceive, if possible, as active flares can complicate both fertility and pregnancy.
Most UC medications are safe to take during pregnancy, with a few exceptions.
Tell your doctor about all the medicines and supplements you’re taking, so that they can ensure you’re on a treatment that’s safe for pregnancy.

Resources We Trust

Cleveland Clinic: Addressing Fertility Issues and IBD
American Gastroenterological Association’s My IBD Life: The Parenthood Project
Crohn’s & Colitis Foundation: IBD and Pregnancy: What You Need to Know
Crohn’s & Colitis UK: Pregnancy and Breastfeeding
University of California, San Francisco: Pregnancy in IBD and Neonatal Outcomes (PIANO): A National Study of Women With IBD and Their Children
Mount Sinai Hospital: The Women With Inflammatory Bowel Disease and Motherhood (WIsDoM) Study: A Study Focused on Female Fertility and IBD

Yuying Luo, MD

Medical Reviewer

Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City.?She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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Carmen Chai

Author

Carmen Chai is a Canadian journalist and award-winning health reporter. Her interests include emerging medical research, exercise, nutrition, mental health, and maternal and pediatric health. She has covered global healthcare issues, including outbreaks of the Ebola and Zika viruses, anti-vaccination movements, and chronic diseases like obesity and Alzheimer’s.

Chai was a national health reporter at Global News in Toronto for 5 years, where she won multiple awards, including the Canadian Medical Association award for health reporting. Her work has also appeared in the Toronto Star, Vancouver Province, and the National Post. She received a bachelor’s degree in journalism from Ryerson University in Toronto.

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Resources

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Akiyama S et al. Pregnancy and Medications for Inflammatory Bowel Disease: An Updated Narrative Review. World Journal of Clinical Cases. March 16, 2023.
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Mahadevan U et al. Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project. Gastroenterology. April 2019.
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