But despite strides in treatments, pregnant women who have IBD remain at high risk for complications, according to research presented at the 2022 Digestive Disease Week conference in San Diego last week. Research on the subject has been sparse, largely because it’s considered risky to conduct clinical trials on pregnant women, says Anoushka Dua, MD, an internal medicine resident at the University of California in Los Angeles who specializes in gastroenterology and IBD, who led the new study. Dr. Dua says that something doctors do understand for sure is that keeping inflammation controlled during an entire pregnancy — from conception to birth — can drastically reduce pregnancy risks. “It’s hard to say why pregnant women with IBD have higher risk pregnancies because a lot of the research is anecdotal evidence,” says Dua. “We do know that biologics are actually safe during pregnancy and there are no proven adverse outcomes during pregnancy. In general, if you are considering the risk and benefits, there is a much higher risk in allowing inflammation to persist during pregnancy than taking biologics.” For the study, Dua and her team found that 20 years after biologics were introduced, pregnant women with IBD are still at high risk for complications such as preeclampsia, or high blood pressure during pregnancy, preterm birth, fetal growth restriction, and getting a Cesarean section, compared with women who didn’t have IBD. The study was not peer-reviewed or published. The study included data from nearly 80,000 pregnant women with IBD — 40 percent who had UC and 60 percent who had Crohn’s — and nearly 70,000 pregnant women who did not have IBD. The data was collected over a span of 20 years, meaning researchers were able to compare pregnancy outcomes before biologics were widely used with how biologics are used currently. The research did not track whether biologics were used during pregnancy, which means the researchers could not definitely say if the drugs improved pregnancy outcomes. Still, the research adds to what researchers understand about the pregnancy risk that IBD poses, but questions remain. “It prompts us to look at why this might be the case. Is it that women are hesitant to continue biologics during pregnancy, or are certain doctors not prescribing them?” says Dua. “At the earlier point of this 20 years, we weren’t as sure. But the more data we have, the more comfortable [we are with] managing disease with medications during pregnancy,” she says. For biologics, which are protein therapies, doctors “are extremely comfortable, and they are necessary to manage the disease during pregnancy,” Dr. Philpott says, adding that most people do stay on biologics throughout pregnancy, though some do choose to stop treatment. “There’s still this persistently elevated risk of obstetric outcomes in women with IBD despite there being these novel therapies, so we need to start exploring any barriers to biologics use during pregnancy, with the goal of developing targeted interventions to mitigate these outcomes,” says Dua. “If biologics are being used, then we need to explore if there is another reason besides disease activity that could be causing these adverse outcomes.”
Is It Safe to Have a Baby?
According to the University of Alberta IBD Clinic, inactive IBD typically does not affect a woman’s ability to get pregnant, and active disease may lower your chances, but only slightly. “The research we have is sparse, but people who have IBD have generally the same rates of conception as the general population,” says Dua. According to Philpott, a subset of UC patients who have had ileoanal anastomosis surgery — or J-pouch surgery — may have a harder time conceiving naturally within a year of trying and are more likely to require reproductive assistance like in vitro fertilization (IVF). “The good news is that one study showed that IBD patients who undergo IVF are just as likely to conceive as people who do not have IBD,” she says. In the study, published in 2015 in Clinical Gastroenterology and Hepatology, more than half of the people with CD who underwent IVF had a previous CD surgery. About 35 percent of patients with UC did. Despite having IBD and IBD-related surgeries, the researchers found that the rate of conception through IVF was the same in people who had IBD and those who did not.
If You Plan to get Pregnant, Get Your IBD Under Control Before Conceiving
It’s not always possible to predict when you will get pregnant, but if you plan on having a baby, Dua says it’s important to meet with your gastroenterologist ahead of time to ensure your IBD is well managed. “Based on the findings of our research and what’s been shown in prior research, it is truly the active disease during pregnancy or conception that is most worrying,” she explains. The best thing you can do is try to reduce disease activity, or reduce your symptoms. “Disease activity at conception has an effect on disease activity during pregnancy,” Dua says. “If you are in remission during conception, you’re more likely to remain in remission during pregnancy.” On the contrary, if you’re having a flare-up during conception, you’re more likely to have flare-ups during pregnancy, which can cause complications. During a flare-up, when IBD is considered active, the digestive system can’t properly absorb nutrients, which can cause malnutrition in a growing fetus, Philpott says. Still, it’s absolutely possible to have a healthy pregnancy when you have IBD. “We just need to monitor them and take care of these patients as they deserve,” she says. It’s also important for IBD care teams to work with the obstetrics team to manage both pregnancy and delivery. C-sections are likely overused in people with IBD, Dua notes. Active perianal disease, in which the anal sphincter is damaged by inflammation, ulcers, or fistulas, is usually the only IBD-related reason a C-section is considered necessary. People who have a J-pouch may also require a C-section. “For many women with IBD, vaginal delivery is actually appropriate, so a lot of this will be based on a conversation between the patient and the doctor,” says Dua.
