Crohn's and Pregnant - Research Summary

BACKGROUND: Crohn's disease is a chronic, long-term illness in which the intestine, or bowel, becomes inflamed. It is part of a group of diseases known as inflammatory bowel disease, or IBD. Crohn's disease can affect any area of the GI tract, but it most commonly affects the lower part of the small intestine, called the ileum. The swelling extends deep into the lining of the affected organ and can cause pain, fever and diarrhea. The disease can surface at any age, but it is most common between the ages of 15 and 30. People with Crohn's disease experience periods of severe symptoms, followed by weeks or years of remission. Treatment may include drugs, nutrition supplements, surgery or a combination of these options. The goal is to control inflammation and relieve the symptoms. Treatment can help control the disease by lowering the number of times a person experiences a recurrence, but there is no cure.

CROHN'S AND PREGNANCY: In the past, women with Crohn's were counseled against pregnancy. However, current medical management strategies have made childbearing safer for both mother and baby. Some medications are best avoided during pregnancy, but others are considered safe because of their long history of safe use by patients. Research studies have shown that some drugs commonly used for both maintenance therapy and acute flare-ups of Crohn's are safe for pregnant women to use. They include sulfasalazine (Azulfidine), forms of mesalamine (Asacol, Pentasa, Rowasa), and corticosteroids (Prednisone). Other drugs like azathioprine (Imuran, Azasan), adalimumab (Humira), certolizumab (Cimzia) and infliximab (Remicade) appear to be safe to take during pregnancy.

Methotrexate and thalidomide are two immunosuppressive drugs that should not be used during pregnancy as they have an effect on an unborn child. Methotrexate can cause abortion and skeletal abnormalities, and it should be discontinued at least three months before conception. Thalidomide is well known for causing limb defects as well as other major organ complications in a fetus.

The severity of Crohn's symptoms that are present at conception often continue throughout pregnancy. Women are encouraged to get their disease under control and in remission before conception. They can also get their bodies prepared for a pregnancy by increasing intake of folic acid, quitting smoking, getting more exercise and eating healthier.

For women with Crohn's, the biggest factor influencing a healthy pregnancy is the state of disease activity. A planned pregnancy when Crohn's is in remission has the greatest chance for a favorable outcome. To best manage all aspects of your care during and after pregnancy, work carefully with the doctor you're seeing for Crohn's disease as well as your obstetrician and your baby's pediatrician.

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