Crohn’s disease and pregnancy: what you need to know

If you suffer from this chronic disease, it is better to plan your pregnancy when it is in remission.

Crohn’s disease is one of the chronic inflammatory bowel diseases (IBD) which, as the name implies, are diseases characterized by a chronic inflammatory process of the intestinal wall. These include ulcerative colitis (UC or RCU) and indeterminate colitis.

They generally affect at a young age, mostly between 15 and 30 years. Crohn’s disease can theoretically affect the entire digestive system, from the mouth to the anus. It is a chronic disease that can have a family predisposition, but also be linked to a series of triggering environmental factors, first of all smoking.

Fertility and Crohn’s disease

One of the biggest fears of women with Crohn’s disease is that they will not be able to fulfill their dream of becoming mothers. Fortunately, if managed correctly, this and other chronic inflammatory bowel diseases are compatible with pregnancy.

With regard to Crohn’s disease in particular, it seems that affected patients are characterized by reduced fertility compared to the healthy female population, but the causes have not yet been clarified.

No risk if the disease is in remission

The disease, if in the active phase during pregnancy, certainly constitutes a potential risk for the unborn child. For this reason it is important to plan pregnancy during the remission phase.

The presence of an acute inflammatory state, in fact, increases the risk of rupture of the membranes and detachment of the placenta and therefore of possible premature birth. In addition, a higher incidence of underweight births was observed, also related to the activity status of the disease.

If the disease is in clinical remission, the probability of carrying the pregnancy to term and that the baby is healthy is comparable to that of the general population. Pregnancy also does not affect the course of the disease, which indeed tends to remain in the same state (of remission or activity) present at the time of conception.

Regarding the risk of transmission of the disease to the unborn child, Crohn’s disease, like other IBD, is not considered communicable genetic diseases, although some studies have shown a familial predisposition. In the case of Crohn’s disease there is in fact a greater risk (equal to 5%) of developing this pathology if a member of the family suffers from it.

The use of drugs

The most used medicines to counteract the manifestations of Chron’s disease are corticosteroids and immunosuppressants. Their administration can be continued even in pregnancy, on whose course they have no effect, except for methotrexate, not recommended during gestation.

For some time now, monoclonal antibodies for the treatment of Crohn’s disease have also been available in Italy, which target certain proteins involved in the inflammatory process, produced by the cells of the immune system. However, there are still not enough studies to demonstrate their toxicity or not while waiting: their administration during pregnancy is therefore contraindicated.

As for instrumental examinations, exposure to X-rays should be avoided during pregnancy, while magnetic resonance imaging is considered safe, as well as ultrasound. Ultrasound scans can also be safely performed.

Of course, pregnancy must be followed both by the gynecologist (with a particular obstetric control in the third trimester) and by the gastroenterologist, preferably in contact with each other.