If you have Inflammatory Bowel Disease (IBD) and are thinking of having a baby, you may be concerned about how your condition might affect your pregnancy. This series of articles answers some of the most commonly asked questions about pregnancy and IBD. We also have an information sheet, Fertility and IBD, which looks at IBD and conception.
Should I keep taking my medicines while I am pregnant?
In general, the evidence suggests that active Crohn’s or UC may do more harm to the growing baby than most IBD medicines. So most women will be advised to continue taking their IBD medication during pregnancy. This is particularly important if you have had a recent flare-up and are trying to get it under control.
However, a small number of the drugs used for IBD are not recommended or should not be used at all by pregnant women. This means that if you are, or are planning to be, pregnant, it is important to check with your IBD team whether you need to change your drug treatment. More details on how the most common IBD drugs might affect your pregnancy are given below.
How safe is my medication in pregnancy?
Aminosalicylates (5-ASAs)
- Sulphasalazine (Salazopyrin)
- Mesalazine (Asacol, Ipocol, Mesren, Pentasa, Salofalk),
- Olsalazine (Dipentum)
- Balsalazide (Colazide)
These drugs are used to treat mild to moderate flare ups of IBD and to maintain remission. They have been taken by women during pregnancy for many years and are generally considered to be safe at doses up to 3g a day. There is less evidence about the safety of higher doses of 5ASAs. If you are concerned about the dose you have been prescribed, discuss this with your doctor.
Also, sulphasalazine can reduce the body’s ability to absorb folic acid, a vitamin known to be important to foetal development. So, if you are pregnant and on sulphasalazine, you will be advised to take higher levels of folic acid supplements.
Corticosteroids (steroids)
- Prednisolone
- Budesonide (Entocort)
Steroids are frequently prescribed to treat flare ups of IBD and are usually considered to be safe in pregnancy. Some early research linked prednisolone treatment with a slightly increased risk of cleft palate, but more recent studies have not supported this finding. Research on the use of budesonide by pregnant women with IBD is currently very limited, but what there is suggests it may be a good option for women with Crohn’s Disease.Steroid enemas and suppositories are also safe to use up until the third trimester (months 7-9).
Immunosuppressants
- Azathioprine (Imuran)
- Mercaptopurine (6-MP) (Purinethol)
Immunosuppressant drugs make the body’s immune system less responsive. This has the effect of reducing the inflammation typical of IBD. However, a less responsive immune system can make you more susceptible to infections. Most doctors now recommend the continued use of these drugs during pregnancy, as there may be more risk to the baby if the mother becomes unwell. A large number of studies have looked at the effects of azathioprine and mercaptopurine on women with IBD in pregnancy. The general consensus is that these drugs are safe and well tolerated. If you do have any concerns, talk to your specialist about the
possible risks and benefits, so that your decision can be based on your own health.
- Ciclosporin
This is a strong immunosuppressant usually prescribed for people with active Ulcerative Colitis that has not responded to steroids. It can be very effective and help to reduce or avoid the need for surgery. Ciclosporin often has quite severe side effects however, including hypertension (high blood pressure). So, although ciclosporin appears to be safe for the unborn baby, it is not recommended in pregnancy unless there is a real risk that the mother will need an urgent colectomy (surgery to remove the bowel).
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- Tacrolimus
This is another immunosuppressant originally used to treat transplant patients. There is very little evidence about its safety in IBD except for one case study. In this a woman with UC who took tacrolimus throughout her pregnancy stayed in remission and delivered a healthy baby.
- Methotrexate
Methotrexate can increase the risk of birth defects if taken by women at conception or during pregnancy. It can also affect sperm production and quality. So, it should not be taken by either partner when trying to conceive, or by women when pregnant. Because traces of methotrexate can remain in body tissue for some time, couples are usually advised to use reliable contraception while being treated with methotrexate and to avoid pregnancy for at least 6 months after stopping treatment with this drug.
If you do conceive while on methotrexate you might be advised to terminate the pregnancy because of the risk of severe damage to the baby. If you would not consider a termination, high dose folic acid treatment for the remainder of the pregnancy may slightly reduce the risk.
- Mycophenolate Mofetil
This immunosuppressant may also cause miscarriages or birth defects if used during pregnancy. Women being treated with this drug who want to become pregnant are usually advised to stop taking mycophenolate mofetil at least 6 weeks before conception.
Biologics (Anti-TNF drugs)
- Infliximab (Remicade)
Infliximab is a relatively new drug that affects the immune process. It is usually used in severe cases of Crohn’s Disease or UC when other drugs have not worked. The evidence about the safety of infliximab in pregnancy is still fairly limited. Some of the research has suggested that it may be low risk. Several studies have found that the birth outcomes for women with IBD who have taken infliximab while pregnant have been very similar to those for women not on infliximab. Research is still continuing, especially into the long term effects of infliximab on the baby. It has been found that although infliximab does not cross the placenta to the baby in the early stages of pregnancy, it can cross the placenta in the third trimester.
Because of the lack of clear evidence, the manufacturers of infliximab do not recommend that it is used during pregnancy. However, some doctors consider that if the infliximab treatment is keeping active disease in check it may be better to continue with it, at least until the end of the second trimester (months 4-6). Recent guidelines have suggested that doctors should discuss the risks and benefits with each woman on an individual basis, and you may find it helpful to talk through your own options with your specialist IBD team.
- Adalimumab
This works in a similar way to infliximab and is also thought to cross the placenta in the third trimester. Research is ongoing into its effects on women with IBD. There have been a number of successful pregnancies in women with Crohn’s who were exposed to adalimumab before conception or during their pregnancy. Evidence is still limited however, especially about its long term effects on the baby.
Again the manufacturers do not recommend using adalimumab while pregnant. But, as for infliximab, some doctors consider that the benefits of adalimumab treatment can outweigh the risks, and may advise continuing with it, until the end of the second trimester.
Antibiotics
- Metronidazole
- Ciprofloxacin
These antibiotics are sometimes used to treat infections linked to Crohn’s Disease. Metronidazole has been considered safe in pregnancy after the first trimester (months 1-3), but recent research suggests that it may be linked to pre-term delivery, so should be used with caution. There is no evidence that ciprofloxacin is harmful while pregnant.
Antidiarrhoeals
- Cholestyramine (Questran)
This is a bile salt drug often used to treat diarrhoea associated with surgery for Crohn’s. It is safe to take during pregnancy.
- Diphenoxylate (Lomotil)
- Loperamide (Imodium, Arret)
Loperamide is probably safe, but lomotil is not usually recommended for use in pregnancy, as it is unclear whether it crosses the placenta to the baby.
Antispasmodics
- Hyoscine butylbromide (Buscopan)
This over-the-counter medicine is best avoided during pregnancy.
For more information on drugs and medicines for IBD see our booklet Drugs used in IBD and our specific drug treatment leaflets.
In part 3 - Treatment during pregnancy
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