VIDEO: How ulcerative colitis impacts pregnancy

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For IBD in general but I'll say UC a lens of course, but UC and Crohn's disease. The most important thing you need to do when you're managing an IBD patient who's considering pregnancy is have them in as deep as a remission as you can for at least three to six months before they start to conceive. For decades, we've known that the number one north star for a woman who wants to become a mom is that they go into conception in a remission state.

Lesson, sort of that is like at the foundation of managing IBD patients because we know that disease activity, particularly in the first trimester, is associated with a three to four fold increased risk of miscarriage. So, the most important thing is that you don't compromise the pregnancy because of the patient not being in a remitted or low disease activity state.

So, and for sure with UC, if we focus on that, there's data from the PIANO registry, et cetera, that really, being in remission with disease activity in a UC patient is very important as it relates to outcomes of pregnancy. First one I said is miscarriage. Then you don't want preterm delivery or low birth weight because baby is sort of bathed in a placenta with blood flow, with lots of inflammation, lower, nutritional value. If someone is malnourished or is not eating enough or not staying healthy enough, that's gonna impact the growth of the baby.

And then in the third trimester, we really wanna get moms to at least 34 weeks. We wanna minimize preeclampsia risk, meaning high risk of high blood pressure during pregnancy. We wanna make sure that the baby is growing. We don't want them to have intrauterine growth retardation. We wanna be able to deliver them way above past 34 weeks so that we're really focused on making sure that the baby was set up for the best environment for them to have a normal gestation. But one thing that is critical, which is really a message that I say every pregnancy clinic I do on my Wednesdays is, if mom is okay, the baby is okay.

So, my colleagues need to be really focused on seeing the baby through the mom's health. And that is where a maternal fetal medicine specialist comes into play because they see it through the lens of the mom and are sort of like, you guys are so crazy. You can do that, you can do that. And we're like, really? You know, we're sort of gastroenterologists not understanding what we can and cannot do or what's saved particularly during the first 10 weeks when is organogenesis.

After 10 weeks the organs have developed, the risk of congenital anomaly is different. And so, that's why we need to communicate with moms about the importance of staying on your meds during the first 10 weeks, particularly biologics, I'm really specifying because biologics do not even cross the placenta or communicate to the fetus until after 27 weeks of gestation.

So the organs are fully developed, the baby does not know that the mom is taking whatever biologic. The one caveat is that our small molecules, they do cross the placenta so there has to be a lot of discussion around stopping. how long before conception do you stop, do the half life of drugs? That requires someone calling me or someone who has done this and been able to transition women off of small molecules, particularly during the first 10 weeks of pregnancy for the mom's reassurance on safety.

So, it's complicated. Every Wednesday, I have long, hour long consultations but I think if you just remember the key point about disease remission, seeing the baby through the lens of the mom, you're gonna always do good for your patients.