Women with inflammatory bowel disease (IBD) and other gastrointestinal conditions can face unique challenges during pregnancy. Dehydration, vitamin deficiencies, and physical changes during pregnancy can worsen pre-existing conditions, introduce new gastrointestinal symptoms, and can pose risks for the mother and the baby.
At Brigham and Women’s Hospital (BWH), we provide highly specialized care for women with gastrointestinal and inflammatory bowel disease before, during, and after pregnancy. Our multidisciplinary team of experts, including maternal-fetal medicine (high-risk pregnancy) specialists, gastroenterologists, colorectal surgeons, nutritionists, anesthesiologists, and specialized nurses, is dedicated to delivering the highest level of care for both the mother and her baby.
Pre-existing IBD and IBD arising during pregnancy may include:
Crohn’s disease occurs when there is redness, swelling (inflammation) and sores along the digestive tract. Crohn’s disease is a long-term, chronic illness that may come and go throughout life. In most cases, it affects the small intestine, most often the lower part called the ileum. In some cases it affects both the small and large intestines.
Ulcerative colitis occurs when the lining of the large intestine (the colon or large bowel) and ectum become red, swollen or inflamed. In most cases the inflammation begins in the rectum and lower intestine and moves up to the whole colon.
Other Gastrointestinal Conditions
Other examples of gastrointestinal conditions include liver disease, gastroparesis, and cyclic vomiting syndrome.
Women with inflammatory bowel disease or other pre-existing gastrointestinal conditions who are planning a pregnancy and women who develop symptoms during pregnancy require specialized care. In these cases, it is very important that a team of specialists in multiple disciplines – including maternal-fetal medicine, gastroenterology, gastrointestinal surgery, nutrition, and other specialties – be closely involved in the care of both the mother and the baby.
For women with significant pre-existing inflammatory bowel disease, including patients who have had prior surgical procedures for Crohn’s disease, ulcerative colitis, or other gastrointestinal conditions, planning with the medical team should begin before conception in order to understand how to best manage these conditions during pregnancy.
Review of management of IBD flares, nutritional status, and medications are performed at this time. Adjustments in medication, vitamin supplementation, and lifestyle are often recommended prior to conception. In addition, the mother should ideally be free of IBD flares at least three months prior to conception. Mothers should not reduce or discontinue medications on their own. As decreased fertility is common in patients with IBD, infertility services may be recommended after three months of trying to conceive.
A detailed prenatal care plan should address the mother’s individual health issues. Ideally, medication adjustments and planning are started before or early in the pregnancy. The mother’s symptoms need to be monitored and inflammatory bowel disease flares should be quickly and effectively managed by the team throughout pregnancy.
An individual delivery plan should be developed by the multidisciplinary medical team, including experts in maternal-fetal medicine, gastroenterology, gastrointestinal surgery, and anesthesiology. In general, medications that need to be given by infusion are typically timed so that they avoid the delivery timeframe. Infliximab and adalimumab are often held in the third trimester, depending upon inflammatory bowel disease activity. Women who have undergone surgical procedures for the treatment of severe Crohn’s, ulcerative colitis, and other gastrointestinal conditions also may have specific delivery needs that require the availability of experienced surgical and medical teams.
Symptoms related to Crohn’s, ulcerative colitis, and other gastrointestinal conditions may worsen after delivery, and inflammatory bowel disease flares may occur. This can happen when patients stop their medications after delivery due to stress and concern about breast feeding. The team should coordinate postpartum care with the providers for the mother and baby after delivery and discharge from the hospital.
At Brigham and Women’s Hospital, experts in maternal-fetal medicine have formed an innovative collaboration with specialists in the BWH Crohn’s and Colitis Center, a unique multidisciplinary center featuring physicians, nurse practitioners, physician assistants, nutritional services, health coaches, psychological services, mind-body medicine, stress management, educational programs, surgery, endoscopy, infusion therapy and access to the latest research, medications and clinical trials on Crohn’s disease and ulcerative colitis.
Infertility services are available through the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital, one of the premier infertility and reproductive medicine programs in the country.
To schedule an appointment or to learn more about our services, please contact us at (617) 732-4840.
Brigham and Women’s Hospital
75 Francis Street
Boston, MA 02115
Thomas F. McElrath, MD, PhD
Division of Maternal-Fetal Medicine
Sonia Friedman, MD
Division of Gastroenterology, Hepatology, and Endoscopy
For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.