Pregnancy and IBD Part 4 - Healthy Baby

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

Guest Writer - Peter

Hi my name is Peter.  I have had Crohn's Disease since 2006; maybe a long time before that. After finding out how badly damaged my small bowel was after a number of tests and investigations, a full diagnosis was made in 2006.

The beginning of my journey with Crohn's Disease was a very bad experience, since I knew virtually nothing about the condition, to find out that this was going to be with me for  life  was a very daunting prospect.

I went through all the normal drugs and treatments but as many of you are aware some people suffer from a flare up from time to time and the first line drugs can help put you back in remission. For me these first and second line drugs  just don't cut the mustard. The most important thing I have found to deal with this condition is to keep a positive attitude and support.

So after surgery in 2007, I enjoyed a five year remission. Looking back I was very fortunate for this to happen but surgery did leave me with other problems. I was left with permanently loose stools but this was relatively easy for me to cope with in comparison to the horrible pain  I had endured before surgery.

In 2012 my Crohn's Disease came back. Six months of tests and investigations revealed inflammation and ulceration on the site of my previous surgery. During this time I decided that I would not just sit back and do nothing. IBD can leave you feeling very isolated and even depressed since you lose so much weight and fatigue starts to set in - to the point that you don't want to leave the house. So, it was time for me to try and spread the awareness of this challenging disease. How was I going to do it? I pondered for a while.

I decided to set up a website devoted to Crohn's disease. It had been fifteen years since I had last created a website but I was determined to try and create a platform for me to help people who were suffering as I was. I created a very basic website www.crohnsdiseasesupport.co.uk and followed that up with a Facebook page and Twitter account. To my amazement I got hundreds and then thousands of visitors to my site.  I was very reluctant, at first, to bare all about my condition and story to the world but I found the more I shared my journey, the more people wanted to share their experience with me. I also found it a great way to let off steam and got so involved with creating the website that I found it much easier to get through my  dark days.

The website was so successful in getting my message of support across to others that I then developed and ran my own professional website www.crohnsupport.com

The website gets over 1,000 views per month.

The website would not be as sucessful as it is without the support of my fellow Crohnie brothers and sisters.

The biggest help to me was joining a Facebook support group called Bowel Disease One Global Family. I met so many amazing patients that were willing to share their experience and knowledge with others. It was, and still is, a truly inspirational group. If you just reach out for support there are so many patients willing to support each other.

With the support of fellow patients and the IBD specialist nurse service at my local hospital,  life is now much easier. What I find heart-warming is that, even in the clutches of this disease,  I have someone to turn to for support - even if it's just a simple question of how best to prepare for an investigation. I know I will get some great advice or support whilst I am preparing.  I think it's just so important to know that I have support from patients that have been in my shoes and their advice and support is always valued.

My overall message to anyone diagnosed with IBD (Crohn's Disease or Ulcerative Colitis) is to talk to your IBD nurse if your condition worsens. Don't wait for your next appointment, these angels can get you the right care at the right time. Most of all they understand the condition, unlike many doctors. They are specially trained to care for people with IBD. Please don't be alone, get support from other patients, they know how you feel and can help you get through some of the tough times. I am very lucky to have an amazing wife, family and friends whom I can talk to but talking to another patient who is willing to share their experience with IBD is really amazing.

Thanks for reading and get some support "patient to patient is the best medicine".

Peter Buckley