Pregnant and Have IBD? A GI Doc’s Help Can Be Crucial

May 16, 2022 — When Lindsay S. realized she had inflammatory bowel illness at 24 years previous, her first concern was the way it would possibly have an effect on her plans to have a household and the potential affect on a baby.

“Even when I was first being put on medication, I wanted to know what effect it would have on future children,” she says. “I was coming up on childbearing years, so I wanted to know if I got pregnant what could those meds do to a baby. I was pretty picky about what meds I wanted to start with.”

For solutions to her questions, she didn’t flip to her obstetrician and even her main care physician. Instead, she relied on her gastroenterologist – Sunanda Kane, MD, an IBD specialist on the Mayo Clinic in Rochester, MN – to assist her navigate dwelling with ulcerative colitis, a type of IBD.

Fast-forward 10 years, and Lindsay and her husband now have two wholesome boys, ages 2 and three, and he or she has been in a position to handle her IBD.

“Dr. Kane was very helpful,” says Lindsay, who lives in Greater Rochester and requested to be recognized by her first title solely to guard her privateness. “Most of the OBs that I ran across freaked out about my taking these meds for my IBD. But Dr. Kane reassured me. That made all the difference for me.”

Women with IBD face a number of considerations associated to their reproductive well being selections, from contraception to being pregnant to supply. Research reveals that IBD and sure medication can affect fertility and being pregnant and pose dangers for preterm start and small gestational age.

Lindsay’s expertise has grow to be quite common for ladies with IBD who’ve questions on being pregnant, household planning, and reproductive well being. In a examine, printed within the journal Crohn’s & Colitis 360, lead writer Traci Kazmerski, MD, and her colleagues on the University of Pittsburgh Medical Center discovered that ladies with IBD usually fear about their reproductive well being and usually flip to gastroenterologists for questions and considerations.

What’s extra, many sufferers count on their gastroenterologist to start out this dialog and that these specialists can play a important position in serving to girls have wholesome pregnancies, they mentioned.

Kazmerski and her colleagues interviewed 21 girls with IBD about their medical historical past and requested them questions on being pregnant, contraception, and household planning. The members ranged from 12 to 16 years previous once they had been identified with IBD.

At the time of the examine, the ladies had been 25 years previous, on common. Five had been pregnant prior to now, and 16 mentioned they deliberate to have kids sooner or later. Fifteen had been being handled for Crohn’s illness, and 6 had ulcerative colitis (the commonest types of IBD). Thirteen had been utilizing contraception, and 6 girls had been taking a number of IBD drugs.

During the interviews, Kazmerski and colleagues discovered:

• Women with IBD who had by no means been pregnant lacked reproductive well being information.
• Six had been unaware of IBD’s potential affect on fertility, being pregnant, and associated points.
• Many lacked readability on the position IBD would possibly play of their alternative of contraceptives and mentioned they’d not been correctly suggested on contraception choices.
• Several mentioned they had been involved in regards to the heredity of their IBD, the dangers of illness earlier than giving start, and the affect of their drugs on a future being pregnant.

“I think these results highlight the importance of pediatric gastroenterologists and primary care providers comprehensively addressing reproductive health with every person with IBD,” says Kazmerski.

Such discussions “may be a major determinant in not only the decision, but also the ability, of these women to become pregnant,” the authors mentioned.

Kane says the findings, that are consistent with different analysis, affirm what she’s seen in her personal apply and spotlight the important position a GI specialist can play in serving to girls with IBD take care of being pregnant and reproductive well being.

“I’m not really surprised by these findings,” says Kane, who can be a professor of medication on the Mayo Clinic with an curiosity in girls’s well being.

“I think it is absolutely in the appropriate wheelhouse of a gastroenterologist to talk about conception, fertility, and pregnancy. But they should do it in the context of the patient’s life in general and about their medications,” she says.

“A lot of women assume if we don’t talk about this that we don’t think it [pregnancy] is a good idea and/or that we think it’s unsafe. So, they’re going to get their advice from ‘Dr. Google’ or well-intentioned friends and family who may not understand the nuances.”

Kane says gastroenterologists could also be extra knowledgeable than different practitioners about reproductive well being for ladies with IBD. This contains contraception, which is a priority for individuals who need to have kids and are nervous in regards to the affect of IBD medication on being pregnant.

For instance, Kane says girls taking the drug methotrexate “have to absolutely be on reliable birth control” as a result of changing into pregnant whereas taking the drug is dangerous and may trigger start defects.

Kane additionally believes her sufferers with IBD could also be extra comfy talking along with her about these points than with an obstetrician or main care physician.

“There are data that oral contraceptives may actually cause IBD or exacerbate IBD, so I wouldn’t be able to tell you that Brand X is better than Brand Y,” she says. “That’s where I will tell a woman to talk to your gynecologist [to assess] the nuance of what is in the pill.”

IBD and Pregnancy: Myths and Facts

Kane says that many myths and falsehoods have raised undue considerations – and sufferers’ nervousness ranges.

“Unfortunately, whatever gets posted on the internet stays there,” she says. “There are very old data that say if you have Crohn’s disease, you shouldn’t get pregnant, and that’s just not true.”

She additionally says that “IBD is not a genetic-inheritable disease. … Just because you carry those genes, it doesn’t mean that you’re going to get the disease. That’s not how it works.”

Also, IBD shouldn’t be believed to trigger congenital issues and start defects, nor do pregnant girls with IBD have to at all times cease taking their medicine, she says.

“What will drive a complicated pregnancy is active disease,” Kane notes. “Women will stop their medicine because they’re afraid of the effect on the baby. But it’s actually their active disease that’s worse on a baby than medications.”

Vivian Huang, MD, director of the Preconception and Pregnancy in IBD medical analysis program at Mount Sinai Hospital in Toronto, agrees that managing IBD with medicine in being pregnant is important to the well being of the mom and the infant.

“Many patients are worried about taking medications preconception and in pregnancy,” she says. “They may not realize that active IBD is more harmful to pregnancy (increased risk of miscarriage, preterm birth, small for gestational age infants) than taking maintenance IBD medications,” excluding sure drugs reminiscent of methotrexate or tofacitinib.

IBD in being pregnant will increase the danger of miscarriage and preterm start, Huang says.

Jessica Barry, MD, a pediatric gastroenterologist and girls’s well being specialist on the Cleveland Clinic in Ohio, says this “gap in education” for younger girls with IBD is probably essentially the most important difficulty for GI medical doctors to deal with with their sufferers.

“Unfortunately, there is a large gap in education of our patients, per reproductive health and sexual health and body image overall, especially starting for young women and progressing into adulthood,” says Barry.

“We can educate our patients, so they know that we are their resource, and we are there to help answer those questions.”

IBD: At a Glance

IBD shouldn’t be a single illness, however a bunch of problems that trigger continual irritation, ache, and swelling within the intestines. The major forms of IBD embrace:

• Crohn’s illness, which causes ache and swelling within the digestive tract. It can have an effect on any half, from the mouth to the anus. It mostly impacts the small gut and higher a part of the big gut.
• Ulcerative colitis, which causes swelling and sores within the giant gut (colon and rectum)
• Microscopic colitis, which causes intestinal irritation detectable with a microscope

Up to three million Americans have some type of IBD. Although it impacts all ages and genders, IBD mostly happens between the ages of 15 and 30.

IBD shouldn’t be the identical as irritable bowel syndrome (IBS), a sort of digestive dysfunction whose signs are prompted and handled in a different way than these of IBD. Irritable bowel syndrome doesn’t inflame or injury the intestines the best way IBD does.

Research suggests three issues play a task within the IBD: Genetics (1 in 4 folks have a household historical past of the illness), an irregular immune system response, and environmental triggers (reminiscent of smoking, stress, drug use, and melancholy).

IBD signs vary from delicate to extreme and may flare abruptly. Patients who should not have signs are thought-about to be in remission.

IBD signs embrace:

• Belly ache, upset abdomen, and lack of urge for food
• Nausea and vomiting
• Diarrhea, constipation, and bowel urgency
• Gas and bloating
• Unexplained weight reduction
• Mucus or blood within the stool
• Fatigue
• Fever
• Joint ache
• Vision issues and purple, itchy, or painful eyes
• Rashes and sores

People with IBD have a better threat of colon most cancers in addition to issues from anemia, narrowing or an infection of the anal canal, kidney stones, liver illness, malnutrition, osteoporosis, and perforated bowel.

Medications can assist management irritation and signs.

In folks with Crohn’s illness whose drugs not work, surgical procedure could also be wanted to take away the diseased bowel phase.