IBD & Pregnancy
Pregnant women with new symptoms of IBD or those suffering a flare may be evaluated for diagnostic imaging, endoscopy, or surgery if the results change management. Considerations for endoscopy and surgery, such as anaesthesia type, use of sedative medicines for operations, and gestational age at the time of the procedure, should be made in conjunction with an OB/GYN or MFM (maternal-foetal medicine) expert, as well as an anesthesiologist. Throughout pregnancy, a flexible sigmoidoscopy can be conducted without sedation or preparation. A recorded conversation with the patient concerning foetal monitoring and the possibility of an emergency caesarean delivery is required for every sedated operation performed after 24 weeks (around the period of viability). Furthermore, the patient should be carefully placed in the left lateral tilt position to minimise compression of the inferior vena cava and aorta, which may result in maternal hypotension and impaired placental perfusion.
In an IBD-complicated pregnancy, the manner of delivery—caesarean vs. vaginal delivery—should be based on standard obstetric considerations. In most cases of IBD, a patient can have a vaginal birth unless there is an active perineal illness at the time of delivery or there are unusual patient circumstances. Vaginal birth has not been shown to alter the risk of IBD development in children. Care should include sufficient anaesthesia and the reserving of a vacuum or forceps for operative delivery based on standard obstetric grounds for patients experiencing labour and intended vaginal delivery.
Biologics may be restarted 24 hours after vaginal birth and 48 hours following caesarean delivery if there is no sign of infection and the dose interval is acceptable. We recommend utilising prepregnancy weight to establish the appropriate dose when adopting weight-based dosing for biologics and thiopurines during pregnancy and the immediate postpartum period. As needed, dosing can be changed depending on disease activity, blood medication concentrations, and prolonged postpartum weight gain. Other IBD-specific drugs, with the exception of methotrexate, should be maintained during the postpartum period.
Women with IBD should receive proper pain treatment and monitoring after birth. Short courses of opioids can be used to address postpartum pain in conjunction with OB/GYN and paediatrician evaluation. The least-favoured agents are codeine and tramadol. Because of the increased risk of baby sedation or respiratory depression, several opioids should be avoided during nursing. Because opioids might cause constipation, concurrent treatment to maintain normal stool consistency (for example, with osmotic agents) should be addressed. Nonsteroidal anti-inflammatory medicines (NSAIDs) can be taken for a short period of time (1-2 weeks); however, long-term NSAID therapy has been related to IBD flares and should be avoided. A more extensive explanation of drug transmission during breastfeeding may be found in the section on Post-Delivery Care for Babies.
Finally, before discharge, a talk about contraceptive plans to minimise unwanted pregnancy and short inter-pregnancy intervals, where appropriate, should take place.
Breastfeeding mothers with IBD should follow conventional dietary guidelines. This entails boosting their caloric intake by 450–500 kcal/d and supplementing their diet with 200–300 mg/d omega-3 fatty acids. Staying hydrated and well-nourished, on the other hand, may be challenging for women with IBD, particularly those with an ostomy or active illness who are losing weight. In such circumstances, the mother should be given dietary advice. If the mother feels the need to improve her milk production, the galactogogue fenugreek should be avoided since diarrhoea and bleeding are typical adverse effects. In non-IBD women, parenteral corticosteroids have been documented to produce a self-resolved, transient reduction in milk production. There are no recognised IBD therapies, including standard-dose oral or rectal corticosteroids.
In the last 15 years, there has been an explosion of therapy alternatives for women with IBD who want to be healthy enough to have a child. However, due to a lack of proper information and poor communication among physicians, the patient has received limited and sometimes inconsistent advice. While we recognise that more research is always needed and that recommendations may change over time, we hope that any woman with IBD who is contemplating or is pregnant now has access to standardised, up-to-date, evidence-based guidelines that are agreed upon by her gastroenterology and obstetric providers, who are working together to provide the best pregnancy possible.
Navigating Inflammatory Bowel Disease (IBD) during pregnancy requires a delicate balance, and Dr. Kiran Peddi, a seasoned gastroenterologist, adeptly guides patients through this journey. His expertise in managing IBD's complex nuances during pregnancy reassures expecting mothers, offering a tailored approach that prioritises both maternal well-being and foetal health. Dr. Peddi's comprehensive strategies encompass medication adjustments, monitoring, and close collaboration with obstetricians, ensuring harmonious co-management that addresses potential flare-ups while minimising risks to the baby. His compassionate care, coupled with extensive knowledge, empowers women with IBD to embrace pregnancy confidently, fostering a sense of comfort and security throughout this unique medical experience.
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Flexible sigmoidoscopy can be safely performed during pregnancy without sedation or bowel preparation if necessary. For more advanced endoscopic procedures after 24 weeks, careful planning is required, including discussions about fetal monitoring and the possibility of emergency delivery if needed. These procedures are usually done in coordination with an obstetrician, maternal-fetal medicine (MFM) specialist, and an anesthesiologist. Positioning the patient in a left lateral tilt also helps reduce risks like low blood pressure in the mother.
The choice of delivery method is usually based on standard obstetric reasons rather than IBD alone. Vaginal delivery is generally preferred unless there is active perineal disease or other specific complications. Studies show that vaginal delivery does not increase the risk of IBD in children. If a vaginal birth is planned, adequate pain management and assisted delivery methods like vacuum or forceps may be used when necessary.
Biologic medications can usually be restarted 24 hours after a vaginal delivery or 48 hours after a caesarean section, provided there are no signs of infection and the dosing schedule allows it. Doctors typically use the pre-pregnancy weight for dosing and adjust treatment based on disease activity and postpartum changes. Most IBD medications can be continued after delivery, except for methotrexate, which is avoided.
Short-term use of certain pain medications, including mild opioids, may be considered after discussing with an obstetrician and pediatrician. However, drugs like codeine and tramadol are generally avoided due to potential risks to the baby. NSAIDs can be used for a short duration (1–2 weeks), but long-term use should be avoided as they may trigger IBD flare-ups. Contraception should also be discussed before discharge to allow proper spacing between pregnancies.
Breastfeeding women with IBD are usually advised to increase their calorie intake by about 450–500 kcal per day and include healthy fats such as omega-3s (around 200–300 mg daily). Staying well hydrated is also important. If the disease is active, or if there is weight loss or an ostomy, personalized dietary guidance is essential. Most IBD treatments, including standard corticosteroids, are considered safe and do not affect milk production.
