IBD Research Unit

Preconception and Pregnancy in IBD information

Are you thinking of becoming pregnant, or are pregnant, and have questions about being pregnant with IBD, and taking IBD medications?  Your health care team is there to provide support and help you manage your IBD through your pregnancy, at time of delivery, and post partum, so that you can be healthy and well to care for your infant.

Click on each module to view some basic information (developed in 2014 for the Improving Knowledge Regarding Pregnancy and IBD).    (We are in the process of updating the information to include newer IBD medications that have come onto the market in the recent years)

Ask your health care team questions about your IBD and IBD therapies before you become pregnant, and inform them once you are pregnant, as some may need to be adjusted or changed.

I have IBD, will my child have IBD?

Your child may or may not develop IBD

Having a family history of IBD and having certain genes can predispose a person to developing IBD. The risk is less than 10% if one parent has IBD, and about 20-30% if both parents have IBD¹.

There are factors other than genetics that can affect the risk of developing IBD

• The environment is important . . .
  • The environment can provide triggers that lead to the development of IBD. There is a relatively high prevalence of IBD in Western and developed countries^2,3. However, the incidence of IBD is rising in developing countries. Children who immigrate take on the risk associated with the country to which they are moving⁴. Living in an urban setting is associated with an increased risk of developing IBD – this association appears to be stronger for developing Crohn’s disease than ulcerative colitis⁴.
    
    
• Smoking may play a role . . .
  • Smoking has been reported to be a risk factor for developing and worsening of Crohn’s disease, but a protective factor for developing and for decreasing disease activity in ulcerative colitis^2,3.  However, it is not recommended to smoke to decrease the risk of developing ulcerative colitis because of the risks associated with smoking (such as lung cancer, cardiovascular disease, and other health problems).
    
    
• Diet may be important . . .
  • Although studies vary, diets rich in dietary fiber (fruits and vegetables) are thought to be protective against IBD³.  Consuming excessive meat, fish, and fats may increase the risk of developing IBD^2,3.
  • Vitamin D has been found to be low in IBD patients and Vitamin D deficiency may lead to immune deregulation and increase the risk of developing IBD⁵.
    
    
• The intestinal microbiome is important . . .
  • The intestinal microbiome is made of all the bacteria in an individual’s gastrointestinal tract. It is established in infancy and childhood.
  • The microbiome helps to maintain a healthy immune system by
    • opposing certain inflammatory cytokines
    • regulating the development of immune cells that recognize foreign- and self-compounds
    • activating T regulatory cells, which can promote tolerance to microorganisms⁶
  • The intestinal microbiome needs to be balanced for each individual to have a healthy immune system.
    
    
• Many things affect the intestinal microbiome . . .
  • The intestinal microbiome can be affected by a person’s genes, their environment (including diet), overall health, infections, and medications (such as antibiotics).
    
    
• An unbalanced intestinal microbiome can lead to a dysregulated immune response . . .
  • Multiple factors interact and can lead to a change in the intestinal microbiome. An unbalanced intestinal microbiome can lead to a dysregulated immune response resulting in inflammation characteristic of inflammatory bowel disease.
  • the “hygiene hypothesis” proposes that
    • clean environments limit microbial exposure, leading to an altered immune system that is unable to differentiate between beneficial from harmful bacteria^2,3
    • the altered immune system can predispose one to exaggerated immune responses, resulting in the chronic inflammation seen in IBD

References

1. Habal F M & Huang V W. Review Article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient. Aliment Pharmacol Ther. 2012 January; 35:501-515.
2. Aujnarian A, Mack D R, & Benchimol E I. The role on the Environment in the Development of Pediatric Inflammatory Bowel Disease. Curr Gastroenerol Rep. 2013 May;15(326).
3. Frolkis A et al. Environment and the Inflammatory Bowel Disease. CJG. 2013 Mar; 3:e18-e24.
4. Ng S C et al. Geographic variability and environmental risk factors in Inflammatory Bowel Disease. Gut. 2013;62:630–649.
5. Reich K M et al. Vitamin D improves Inflammatory Bowel Disease outcomes: Basic science and clinical review. World J Gastroenterol. 2014 May;20(17):4934-4947.
6. Petersen C & Round J L. Defining dybiosis and its influence on host immunity and disease. Cell Microbiol. 2014 May. Doi: 1111/cmi.12308

I have IBD, can I become pregnant?

Background

In a recent study conducted by The University of Alberta IBD clinic, women with IBD were surveyed on what they understood about IBD and pregnancy, and what their concerns were. More than 50% of the surveyed women had a lack of knowledge about IBD and pregnancy¹. More than 50% of surveyed women were childless, and more than 10% said they chose not to become pregnant (“voluntary childlessness”) ¹.

Our survey study and previous studies showed that the concerns women with IBD have are often based on a lack of knowledge and/or incorrect information^1,2.

 Yes, women with IBD can become pregnant

Women with inactive IBD have similar fertility rates as the general population, which varies from 1 in 10 couples to 1 in 6 couples³.

Women with active IBD or history of pouch surgery may find it harder to become pregnant

Active IBD is associated with decreased fertility^3,4 so it is important that women who are trying to become pregnant speak to their physician to ensure their IBD is controlled and inactive.

Women with colitis who have had the ileal pouch-anal anastomosis (IPAA) surgery can have decreased fertility^5,6.  The second stage of the surgery is the creation of the pouch – this stage occurs deep in the pelvis and is associated with risk of damage and scarring of the fallopian tubes (the tubes that connect the ovaries to the uterus allowing the eggs to reach the uterus to be fertilized).

Women who need to have this surgery and who plan to become pregnant afterwards should speak to their surgeon. It is often recommended to have a staged procedure where the surgeon will create a temporary ileostomy after removing the colon and create the pouch after the woman has completed her pregnancies.

However, there are factors other than IBD that can affect fertility

• Fertility decreases with age . . .
  • Women’s fertility peaks in their late teens and early 20s⁷. After the age of 35 years, fertility declines sharply and by 45 years, pregnancy is uncommon7,8. Older women also have increased odds of abnormal embryos⁷.
  • Male fertility significantly decreases after the age of 35 years⁸. The viability of sperm in the female reproductive tract decreases with age.
• Preconception health can affect fertility . . .
  • Body weight: Extremes of body weight can decrease fertility. Obesity has been associated with an increased risk of infertility because of decreased sperm concentration in men and higher incidences of miscarriages in women^9-11.
  • Nutritional Status: It is essential that people who are trying to conceive are getting enough vitamins and nutrients^9-11. This is especially true for IBD patients as their diets may be limited. The Health Canada Food Guide suggests that women take daily multivitamins with iron and folic acid¹⁰.
  • Habits (smoking, drinking): Smoking and alcohol consumption should be stopped prior to attempting to become pregnant as they can affect the eggs and sperm, and decrease fertility¹¹.
• Family and personal history before pregnancy can affect fertility . . .
  • Family history of fertility issues: A family history of fertility issues may suggest a genetic disorder^12,13.
  • Personal history of fertility issues and other medical conditions: An individual’s medical history can suggest reasons for decreased fertility. For example, polycystic ovarian syndrome14 and uncontrolled diabetes9 are associated with infertility.

References

1. Huang V et al. Does the level of reproductive knowledge specific to inflammatory bowel disease predict childlessness among women with inflammatory bowel disease. Can J Gastroenterol Hepatol 2015;29(2):95-103.
2. Selinger CP et al. IBD and pregnancy: Lack of knowledge is associated with negative views. JCC. 2012 Sep;7:206-213.
3. Habal F M & Huang V W. Review Article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient. Aliment Pharmacol Ther. 2012 January;35:501-515.
4. Ng S W & Mahadevan U. My Treatment Approach to Management of the Pregnant Patient With Inflammatory Bowel Disease. Mayo Clin Proc. 2014 March;89(3):355-360.
5. Walijess A et al. Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in Ulcerative Colitis. Gut. 2006;55(11):1575-1580.
6. Tulchinsky A et al. Restorative proctocolectomy impairs fertility and pregnancy outcomes in women with Ulcerative Colitis. Colorectal Dis. 2013;15:842-847.
7. Craig B M et al. A Generation of Childless Women: Lessons from the United States. Women Health Iss. 2014;24-1:e21-e27.
8. Dunson D B, Colombo B, & Baird D D. Changes with age in the level and duration of fertility in the menstrual cycle. Human Reproduction. 2002;17(5):1399- 1403
9. Healthy Pregnancy webpage, Health Canada. http://www.hc-sc.gc.ca/hl-vs/preg-gros/index-eng.php. Accessed March 2015.
10. Farhari N & Zolotor A. Recommendations for preconception counseling and care. Am Fam Physician. 2013. Oct 15; 88(8): 499-506
11. Sharma R et al. Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrin. 2013;11:66.
12. Shah K et al. The genetic basis of infertility. Reproduction. 2003;126:13-25.
13. Shapira S K & Dolan S. Genetic Risks to the Mother and the Infant: Assessment, Counseling, and Management. Matern Child Health J. 2006;10:S143–S146.
14. Setji T L & Brown A J. Polycystic ovary syndrome: update on diagnosis and treatment. AMJ 2014.

I have IBD, could surgery affect my ability to become pregnant?