Dr. Elizabeth Squirell · Gastroenterologist · Kingston Health Sciences Centre
Pregnancy and IBD
Most people with Crohn's or colitis can have a healthy pregnancy. Plan ahead, get into remission first, and keep taking safe medicines.
Key points
- Talk to your IBD team before you try to get pregnant. The best time is when your IBD has been calm for at least 3 months. Start folic acid before you try, too.
- Keep taking most IBD medicines, including biologics, through pregnancy and after birth. Do not stop on your own.
- Some pills must stop 3 months before you try: methotrexate, JAK pills (tofacitinib, upadacitinib) and S1P pills (ozanimod, etrasimod). Your team will switch you to a safe medicine first.
- Expect a stool test (calprotectin) and blood work about once each trimester, even when you feel well.
- Most people with IBD can have a vaginal birth. A C-section is advised for active disease around the bottom, a past fistula into the vagina, or a J-pouch.
- Breastfeeding is encouraged. Most IBD medicines are fine while breastfeeding. JAK and S1P pills are not.
- If you took a biologic in pregnancy, tell your baby's doctor. Most vaccines, including rotavirus, can be given on time. Avoid BCG for the first 6 months.
- Ask your obstetrician about low-dose aspirin, started at 12 to 16 weeks, to help prevent pre-eclampsia.
- Get the flu shot, a COVID-19 vaccine and Tdap in pregnancy, and plan RSV protection for your baby. These are safe on IBD medicines.
Go to emergency or call 911 if you have
- Heavy bleeding from your bottom, or you feel faint or dizzy
- Severe belly pain that does not settle
- A fever with belly pain
- Vomiting, and you cannot keep fluids down
- Bleeding from the vagina, or fluid leaking from the vagina
- A painful, swollen leg, chest pain or sudden trouble breathing (signs of a blood clot)