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. You may also be worrying about whether having a baby could affect your IBD. This series of articles looks at the questions you have about pregnancy and Crohn's/Colitis.
How can I increase the likelihood of having a healthy baby?
Maintaining remission
For women with IBD it is worth keeping in mind that if your disease is under control while you are pregnant then the baby is more likely to be healthy. So it is important to follow your treatment plan and to ensure that you are as fit as possible before and during your pregnancy. Talk to your doctor or IBD team if you have any worries about how to manage your IBD while pregnant. In particular, tell your doctor if you have a flare up of your IBD or are failing to gain weight as expected.
Diet
For any pregnant woman, a balanced and varied diet with sufficient calories, vitamins and minerals is important for the growth of their baby. NHS Choices has a range of information on how to stay healthy while pregnant, including information on diets. We also have a booklet Food and IBD that covers healthy eating for anyone with UC or Crohn’s Disease.
Having IBD, the increased nutritional needs of pregnancy may mean you need to supplement your diet, especially if you are underweight or have active disease. You may find it helpful to talk to a dietitian or your IBD team about this. Extra folic acid might be suggested. All pregnant women are now recommended to take a folic acid supplement for the first 12 weeks of pregnancy to help reduce the risk of the baby having problems such as spina bifida. The usual recommendation is 400 micrograms a day. This can be particularly important for women with Crohn’s of the small intestine, as this condition can make it more difficult to absorb folic acid.
Sulphasalazine also reduces folic acid absorption. If you are on sulphasalazine or if you have had surgery to remove part of the small intestine, it may be suggested that you increase your folic acid supplement to 2 mg (2000 micrograms) a day. Check with your doctor what level of folic acid would suit you.
If you take steroids, calcium and vitamin D supplements can be useful to help prevent bone loss.
Iron deficiency is quite common in IBD and extra iron may be needed to meet the increased demands of pregnancy. Your doctor will be able to recommend a suitable supplement. Some iron tablets can cause constipation. You may find a liquid iron supplement avoids this problem.
If you have Crohn’s Disease and have had surgery to remove the terminal ileum (the end of the small intestine), you may also need regular Vitamin B12 supplements to prevent anaemia.
Exercise
Regular moderate exercise can help to keep you healthy and is important in pregnancy. Gentle exercises such as walking, yoga and swimming can be particularly valuable. NHS Choices has more advice and tips on keeping fit while pregnant.
Smoking
Smoking when pregnant is known to harm the baby. It leads to low birth weight with a higher risk of deformity and miscarriage. It can also increase the likelihood of blood clots during pregnancy. For women with Crohn’s Disease, smoking can be especially risky. Research has shown that smoking may make Crohn’s symptoms worse and increase the chance of a flare up.
If you have Ulcerative Colitis, the likely effect of smoking on your own health is less clear. There is some evidence that people with UC who smoke tend to have milder symptoms. However, this does not mean that smoking will necessarily improve your UC - and it could cause the same direct damage to the baby as in any non-IBD pregnancy. The consensus among health professionals is that whatever type of IBD you have smoking is not recommended. For more information, see our information sheet Smoking and IBD.
In part 5 - Delivery, Affect on Your Health and Breastfeeding
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