June 9, 2020

By Emeline Mugisha, M.S.N., M.P.H., R.N.

Most people discover that they have inflammatory bowel disease (IBD) in their 20s and 30s. This means that the diagnosis of IBD commonly affects women who either are pregnant or may become pregnant. So, if you are a new mom with IBD, you are not alone. Many questions may naturally arise about IBD in pregnancy, and we’re going to walk you through just a few of them.

What is Inflammatory Bowel Disease (IBD)?

Inflammatory bowel disease (IBD) is a group of conditions that cause long-lasting (chronic) inflammation of your digestive tract. The digestive tract is a pathway through your body that begins at the mouth and ends at the anus. It includes organs-such as the stomach, small intestine, and large intestine (colon)-that break down food, take in nutrients, and sort out wastes. Ongoing inflammation of these organs results in damage to the digestive tract.

The two main types of IBD are:

• Crohn's disease. This type of IBD can affect any part of your digestive tract (mouth to anus) and spread deep into multiple layers of the lining of your digestive tract. Damaged areas look like patches that are near areas of healthy tissue.

• Ulcerative colitis. This type of IBD only affects the inner (top) lining of your colon and rectum. Damaged areas are continuous, or do not appear in patches.

Symptoms of IBD range from mild to severe, depending on the amount of inflammation and where the inflammation occurs. In both types of IBD, there are times when symptoms are present, and when symptoms stop. A “flare” (also known as “active disease”) is the period when symptoms are present. "Remission" is the period when symptoms stop. A flare can last for days to weeks, while remission can last for months to years.

Common symptoms of IBD flares include:

• Persistent diarrhea
• Abdominal pain
• Rectal bleeding or bloody stools
• Weight loss
• Fatigue

What do I need to know about IBD during and after pregnancy?

It’s natural to have fears about IBD and pregnancy. Will my pregnancy influence my IBD? Will my IBD and its treatments affect my pregnancy or baby? Pregnancy itself does not necessarily change IBD (pregnant women have a similar risk of flares as nonpregnant women). However, IBD flares during pregnancy increase the risk of health problems for both mom and baby.

Studies suggest that IBD flares cause health complications in about 1 in 3 pregnancies. Additionally, 1 in 3 moms with IBD may experience a flare in the first year after childbirth. Stopping IBD medications increases the risk of flares both during and after pregnancy.

How do I manage IBD flares during and after pregnancy?

Management of IBD in pregnancy and after childbirth may seem like an overwhelming task. Fortunately, you don’t have to face it alone. A variety of providers are available to help coordinate your care and offer health guidance. These include your primary care provider, gastroenterologist, obstetrician/gynecologist (OB/GYN), midwife, or maternal-fetal medicine specialist. Nutritionists, lactation counselors, and surgeons may also be involved as needed.

While you cannot completely prevent IBD flares, options are available to treat your symptoms and reduce discomfort. The goals of IBD management are to keep your condition in remission as long as possible and to create the best conditions for achieving your health goals.

The following options can help you manage IBD flares during and after pregnancy:

• Take your medications regularly. The key to keeping your IBD in remission and improving outcomes during a flare is taking medication only as directed by your healthcare provider. Understandably, taking IBD medications during pregnancy may cause a significant amount of anxiety for new moms. Several types of medications may treat IBD. Based on available data and balancing the health risks of flares, options are available that are considered safe for pregnancy and breastfeeding.

• Communicate with your healthcare provider regularly. Management of IBD is a partnership between you and your provider, so it's essential to stay in close communication with them. Having a flare may indicate that a medication change is needed, or something else. Your provider may order tests to determine why you have developed symptoms or recommend changes to your treatment plan.

* Follow recommendations for IBD tests and procedures. In addition to routine blood tests, other options for flare management include diagnostic imaging, diagnostic procedures (such as an endoscopy), or surgery. Your provider may recommend surgery if medications or other treatments don't relieve your IBD symptoms.

• Consult a nutritionist. Because IBD can affect your body’s ability to absorb nutrients, you may need to see a nutritionist after giving birth. If recommended, be sure to speak with your provider about which supplements are safe for you.

Ultimately, achieving optimal health for yourself and your baby is best met with the power of information, partnership, and shared decision-making. As always, be sure to discuss any questions or concerns about your symptoms or medications with your provider.

Sources:

Inflammatory Bowel Disease (IBD): What Is It? (2018, May 18). Retrieved from https://www.cdc.gov/features/inflammatory-bowel-disease/index.html

Yu, A., Friedman, S., & Ananthakrishnan, A.N. (2020). Incidence and predictors of flares in the postpartum year among women with inflammatory bowel disease. Inflammatory Bowel Diseases, izz313. Advance online publication. Retrieved from https://doi.org/10.1093/ibd/izz313

Mahadevan, U., Robinson, C., Bernasko, N., Boland, B., Chambers, C., Dubinsky, M., Friedman, S., Kane, S., Manthey, J., Sauberan, J., Stone, J., & Jain, R. (2019). Inflammatory bowel disease in pregnancy clinical care pathway: A report from the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology, 156(5), 1508-1524. Retrieved from https://doi.org/10.1053/j.gastro.2018.12.022



Emeline Mugisha, M.S.N., M.P.H., R.N. - Emeline Mugisha is an award-winning, master's-prepared nurse with over a decade of experience in community/public health and clinical health services at the field and management levels. She has co-authored two professional manuscripts in Women's Health Issues and the Journal of Midwifery and Women's Health. She has an M.S. in Public Health Nursing and an M.P.H. from Johns Hopkins University.