Pregnancy and Fertility

Crohn's Disease is mostly diagnosed between the age of 15 and 25 which is the peak of a woman's fertility.  Women of childbearing age who live with Crohn's disease, their fluctuating condition and their treatments that manage their condition may make them believe pregnancy is not a viable option.

Well the good new is that within the same age band, women living with Crohn's Disease are just as likely to fall pregnant as women without Crohn's.  There maybe factors that can hold back fertility such as, scarring from pelvic surgery e.g. a total colectomy (removal of the large intestine).

It is best to try to conceive during a period where your symptoms are stable and under control (in remission).  However, it is best to consult with your gastroenterologist and/or a obstetrician about the pros and cons of continuing your medication throughout pregnancy and breastfeeding (if you wish to do so).


Fertility and Crohn's Disease

Having Crohn's Disease should not make it any more difficult in falling pregnant than to a woman who does not suffer from it.  However, some women with active Crohn's Disease may have problems particularly if you are underweight and eating poorly.  Severe inflammation in the small intestine can sometimes affect the normal functioning of the ovaries.  Inflammation caused by IBD can also cause adhesions that affect the fallopian tubes.  Other complications such as abscesses and fistulas may make you less likely to conceive due to the lack of interest in sex.  Severe fatigue, abdominal pain, diarrhoea and body image worries can have a similar effect.  Being in remission when you conceive may make it more likely that your Crohn's symptoms remains in remission and that you have a healthy and uncomplicated pregnancy.

It is unknown of the exact fertility problems men have with Crohn's Disease. However, there are a few studies suggesting that the sperm quality may be affected by Crohn's Disease but they are unsure whether it is the effect of poor nourishment.


Diet

It is advised during pregnancy to support your body and the unborn baby by consuming a nutritious, vitamin rich diet with extra folic acid. The extra folic acid can be found in a variety of fruits and vegetables such as, beans; broccoli; citrus fruits and peanuts.  However not everyone with Crohn's Disease can eat these fruits and vegetables as it causes problems to their digestive tract.  Most women with Crohn's Disease is given a Folic Acid tablet from the doctors to ensure they are absorbing enough for the unborn baby and prevent anaemia.

Crohn's Treatment and Pregnancy

When you fall pregnant there is usually a trio of specialists, your gastroenterologist; obstetrician and general practitioner.  Due to the nature of Crohn's it can increase your chances of complications such as, miscarriage and preterm delivery.  Due to such as complications your team usually follows your progress as a high-risk obstetrics patient.

With the special drug regimens to treat Crohn's Disease many warrant special attention when trying to conceive.  Obstetricians may recommend stopping all Crohn's medications for the health of the foetus.  However, a change of the drug regimen may affect the mother's symptoms and cause a flare up.  Gastroenterologists may advise staying on the drug regimen to prevent flare ups and stay in remission during the pregnancy.

Before conception takes place it is encouraged to put a plan into place to manage your symptoms throughout the pregnancy as you have your health as well as the baby's health to look after.  Some medications used to treat Crohn's Disease are responsible for causing birth defects.  However the majority have been proven to be a low risk and safe for pregnant women to use.  There are some medications such as Sulfasalazine, which is used to control inflammation stemming from Crohn's Disease, can affect the absorption of Folic Acid.  It is best to consult with your healthcare team about the proper dosage required during pregnancy with your Crohn's Disease.  Folate deficiency can lead to a low birth weight; slow growth and premature babies.  It can also cause Neural tube defects that can lead to malformation and can cause Spinal Bifida (spinal disorder) and Anencephaly (brain disorder).  Methotrexate should not be taken by either partner when trying to conceive or during pregnancy as it can affect the sperm production and quality but also cause severe birth defects in the unborn baby.

 Labour and Delivery

Women with Crohn's Disease are encouraged to deliver normally like every other pregnant woman.  However, if you are experiencing active Perianal Disease symptoms it is recommended to have a Caesarean Section.  C-Sections are also recommended as the best delivery option for Crohn's patients with an ileal-pouch anal anastomosis (J Pouch) which is also known as a bowel resection.  This is because they can avert future incontinence issues and protect the sphincter functionality.

During labour all drugs and alternative therapies are open to all pregnant patients with Crohn's Disease. The only reason you would be denied a drug is that it reacts you your pain relief you use for your Crohn's symptoms (if your obstetrician and gastroenterologist has allowed stronger pain relief than paracetamol).

Breastfeeding on Medications

It is recommended that you breastfeed your baby after delivery even with an Inflammatory Bowel Disease (IBD).  However, most new mothers worry about breastfeeding whilst on your medication for your symptoms.  Whether it is advisable to breastfeed while on your medication all depends on which drugs you are taking to keep your symptoms under control, and whether it passes through to the breast milk and in particular what is known about the possible side effects to the new born baby.  Most drugs used to treat Crohn's have not been shown to harm a baby who is breastfeeding.  It is best to consult with a member of your IBD team about possible problems from your medications with your baby.

My Experience

When I found out I was pregnant in August 2014 with my baby girl, my gastroenterologist had told me a few weeks prior to finding out I was pregnant my blood tests had shown a raised inflammation count and he was wanting my to start Infliximab.  When I had told my IBD nurse I was pregnant she had told me it is advisable not to start further treatment for my Crohn's to prevent a miscarriage.  They had talked together and suggested that I stayed on the Mercaptopurine at 50mg and use Prednisolone if I flared up during my pregnancy.

During my pregnancy I had a mini flare up at 28 weeks and ended up on an 8 week course of prednisolone.  Due to the steriods I had two extra growth scans to make sure my baby girl was not growing too big as a side effect. Around 36 weeks I had reduced feeling of movements and during the second growth scan they had noticed that the fluid had increased. The obstetrician had said it would be best to induce me just to be on the safe side for both myself and baby.

My baby girl and I after delivery

At 38+2 weeks on the 15th April 2015 at 5pm, my baby girl was delivered at a healthy 7lbs 3oz.  Today she is still healthy and showing no side effects of my medication or any symptoms of Crohn's Disease.