Crohn’s disease is usually diagnosed between the ages of 15 and 25 — the peak in a woman’s fertility.
If you’re of childbearing age and have Crohn’s, you may wonder if pregnancy is an option. Women with Crohn’s are just as likely to get pregnant as those without Crohn’s.
However, scarring from abdominal and pelvic surgery can inhibit fertility. This is especially true in cases of surgical procedures like partial or total colectomy — removing a part or all of the large intestine.
Should you get pregnant?
It’s best to conceive when your Crohn’s symptoms are under control. You should be free of flares for the past 3 to 6 months and are not taking corticosteroids. You should pay special attention to your Crohn’s drug treatment when you want to conceive. Talk to you doctor about the pros and cons of continuing medication during pregnancy and breastfeeding. A Crohn’s flare during pregnancy can increase the risk of early labor and low weight babies.
Eat a nutritious, vitamin-rich diet. Folic acid is especially important for pregnant women. It’s the synthetic form of folate, a B-vitamin found naturally in many fruits and vegetables.
Folate helps build DNA and RNA. This makes it crucial for the early rapid cell division phase of pregnancy. It also prevents anemia and protects DNA from mutations that can develop into cancer.
Foods that contain folate include:
- Brussels sprouts
- citrus fruits
Some food sources of folate can be tough on the digestive tract if you have Crohn’s. Your doctor will probably recommend folic acid supplements before and during pregnancy.
Pregnancy and Crohn’s healthcare
Your medical team will include a gastroenterologist, an obstetrician, a nutritionist, and a general practitioner. They will track your progress as a high-risk obstetrics patient. Having Crohn’s disease increases your chance for complications like miscarriage and preterm delivery.
Your obstetrician may recommend stopping Crohn’s medications for the health of the fetus. But, changing your drug regimen during pregnancy may affect your disease symptoms. Your gastroenterologist can advise you on a drug regimen based the severity of your Crohn’s disease.
Work with your gastroenterologist and obstetrician before you become pregnant. They can help you create a plan to manage the disease during your pregnancy.
It’s important to learn about pregnancy and Crohn’s disease. Your healthcare team should be able to provide you with resources and information about what to expect. A recent study from the United Kingdom showed that only half of pregnant women had a good understanding of the interaction between pregnancy and Crohn’s disease.
Pregnancy and Crohn’s treatment
Most medications to treat Crohn’s have been proven safe for pregnant women. However, some may cause birth defects. Also, certain medications that control inflammation from Crohn's disease (such as sulfasalazine) can lower folate levels.
Folate deficiency can lead to low birth weight, premature delivery, and can slow a baby’s growth. Folate deficiency can also cause neural tube birth defects. These defects can lead to malformations of the nervous system, such as spina bifida (a spinal disorder) and anencephaly (abnormal brain formation). Talk to your doctor about getting the right dosage of folate.
Women with Crohn’s can have vaginal deliveries. But it they’re experiencing active perianal disease symptoms, a cesarean delivery is recommended.
Cesarean delivery is the best option for women with an ileal pouch-anal anastomosis (J pouch) or bowel resection. It will help decrease future incontinence issues and protect your sphincter functionality.
The genetic factor of Crohn’s
Genetics appear to play a role in developing Crohn’s disease. Ashkenazi Jewish populations are 3 to 8 times more likely than non-Jewish populations to develop Crohn’s. But so far, there is no test that can predict who will get it.
The highest incidences of Crohn’s are reported in Europe, North America, Australia, Japan, and the tip of South America. There are higher incidences of Crohn’s disease in urban populations than in rural populations. This suggests an environmental link.
Cigarette smoking is also connected to Crohn’s flare-ups. Smoking can make the disease worse to the point of needing surgery. Pregnant women with Crohn’s who smoke should quit immediately. This will help with Crohn’s and also to improve the course of the pregnancy.