This guide covers what to think about before you start trying, and the questions worth bringing to your gastroenterologist.

Key points

• • Most people with IBD have healthy pregnancies, especially when their disease is in remission at conception.
  • Active inflammation is the main cause of pregnancy complications, so staying on effective treatment is usually safer than stopping.
  • Most IBD medicines can be continued, but a small number must be stopped months before trying to conceive.
  • Talk to your gastroenterologist three to six months before you plan to start trying.

Will IBD affect my chances of getting pregnant?

For most people whose IBD is in remission, fertility is similar to people without IBD. Active disease can make conception harder, and some types of pelvic surgery can also affect fertility, so it is worth discussing your history with your specialist.

IBD medicines can matter for partners too. One older anti inflammatory medicine can temporarily lower sperm quality in men. Switching to a different medicine at least three months before trying usually allows sperm to return to normal.

Why does remission matter so much?

Active IBD during pregnancy is linked to a higher risk of complications, including miscarriage, premature birth and low birth weight. The inflammation itself is the main concern, far more than most of the medicines used to control it.

That is why the aim is to be in stable remission before you conceive, and to stay there throughout pregnancy. It is also why stopping treatment without advice, often out of a wish to protect the baby, can carry more risk than continuing it.

Which IBD medicines are safe during pregnancy?

Most IBD medicines are considered safe to continue during pregnancy. This includes many anti inflammatory medicines, some immune suppressing tablets and many biologics. Steroids can be used for flares when needed. Your specialist may adjust the timing of some biologic doses later in pregnancy.

A small number of medicines are not safe. Methotrexate can cause birth defects and needs to be stopped at least three months before trying to conceive, whether you or your partner is taking it. Some newer oral medicines are also usually avoided. Never stop or change an IBD medicine on your own. Your specialist can plan a safe switch if one is needed.

Folic acid is important for everyone planning a pregnancy. Start it at least four weeks before trying and continue for the first 12 weeks. Some IBD medicines affect how your body uses folate, so ask whether you need a higher dose.

What happens after my baby is born?

If you take certain biologics during pregnancy, small amounts cross the placenta. This does not usually harm the baby, but it can affect which vaccines they should have in their first months. In particular, the rotavirus vaccine is a live vaccine and may need to be skipped. Make sure your baby's doctor knows which medicines you took during pregnancy.

Most IBD medicines are also compatible with breastfeeding. Check with your specialist or pharmacist before your baby arrives, so you can plan with confidence.

What should I ask at my planning appointment?

Bring these questions to your gastroenterologist:

• • Is my disease in remission, and how do we confirm it?
  • Do any of my medicines, or my partner's, need to change? When?
  • What dose of folic acid should I take?
  • Will the timing of my biologic change later in pregnancy?
  • Who will manage my IBD during pregnancy, and how will they share information with my obstetric team?
  • Is there anything about my disease that affects how I should give birth?
  • Which of my medicines are safe while breastfeeding?

How Ace can help

Pregnancy planning brings a lot of medicine questions at once. Ace pharmacists can review everything you take, including supplements and over the counter products, for pregnancy safety, check your folic acid dose, and keep your IBD treatment arriving on time so remission is never put at risk by a gap in supply. Get started with Ace.

References

Crohn's and Colitis Australia. Fertility, pregnancy and IBD.

Crohn's and Colitis Australia. Diet for preconception and pregnancy with IBD.

healthdirect. Crohn's disease.

healthdirect. Ulcerative colitis.

This article is for general information only and does not constitute medical advice. Plan any pregnancy with your gastroenterologist and obstetric team, and never stop an IBD medicine without their advice.