Managing IBD before, throughout pregnancy

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I love having this discussion with patients. Family planning and IBD is really important. I like to stress to patients that before we start family planning and start discussions about conception, I like their inflammation to be under control. Because I always say that babies growing in the womb don't like inflammation. And so, if we can get their Crohn's disease and ulcerative colitis under control, their pregnancy course, generally, is well tolerated and reduces adverse outcomes in pregnancy and in labor. And so, when I'm meeting a young person who has active disease and who's really interested in starting a family, I just ask the patient to give me some time so that we can find a good treatment option that works for them. A lot of times, patients have questions about the safety and efficacy of IBD medications during pregnancy, and we discuss all available treatment options and what's going to be safe to use in pregnancy, as well as in the postpartum and lactation period.

Right, so for patients that are in remission, pregnancy doesn't really change the management of inflammatory bowel disease. I generally will continue their medication during pregnancy if we're on a therapy that is safe in pregnancy and in lactation. I will meet with patients once every trimester and I'll refer them to see a high-risk obstetric doctor to co-manage these patients. We'll continue the therapy throughout pregnancy, and then if patients don't have any perianal disease, the mode of delivery is up to the OB-GYN and what's safe for the mom and for baby. And then after delivery, we'll talk about continuing the therapy if the patient chooses to breastfeed. And generally, it's a really wonderful time, patients feel great, and I try to make myself available throughout the pregnancy so that they can feel comfortable. If patients are having active disease, the management of IBD is very important. I like to get patients into remission quickly so that we're not having more complications during the pregnancy and during the labor period. And so sometimes, we have to change medicines, sometimes we have to get patients admitted and use, sometimes, steroids to get them in remission quickly. But at that point, when patients are having a flare and they're pregnant, we're working very closely, the GI team, the OB-GYN team, and the patient, to get them feeling better quickly.

Collaborative care in pregnancy and in the preconception time period is very important. If a patient has active disease, I am generally recommending we get them into remission before we start having discussions about conception. If patients want to do fertility treatments, I'll have a discussion with the patient, their fertility provider. If patients are actively pregnant, I'll have a discussion with their OB-GYN, and with their high-risk obstetric provider. Because we all want the same thing. We all want the patient to have a healthy pregnancy and deliver a healthy baby. And so, we just generally have to work together so that the patient stays in remission and is on a therapy that's going to work for the patient, as well as when they have delivered and in the postpartum period.