Fertility and Pregnancy

You should start assembling your healthcare team before you become pregnant. Your healthcare team should include your family physician, gastroenterologist, and surgeon if your centre has one, and a high-risk obstetrician-gynecologist (OBGYN) that you see regularly.

If there is no high-risk OBGYN in your area, you should see an OBGYN regularly, but hopefully see a high-risk OBGYN at least once during your pregnancy. Your gastroenterologist and OBGYN will advise how often you need to see them before and during your pregnancy. They will refer you to a high-risk OBGYN if needed and available in your area.

Active IBD makes it harder to sustain a pregnancy because the inflammation and pain can lead to not eating enough or getting enough nutrition. Lack of adequate nutrition can lead to a higher risk of miscarriage or early pregnancy loss.

Active disease during pregnancy is also associated with increased complications, such as preterm birth and low birth weight. In fact, preterm births are three times more common among women with moderately to highly active disease than among those with inactive IBD. Active IBD can lead to increased blood pressure and pre-eclampsia.

In summary, if your disease is in remission at conception, you are more likely to stay in remission throughout pregnancy and have a more positive outcome.

There are two medications that you should not continue during pregnancy, and these are methotrexate and tofacitinib. If you are on these medications, speak with your gastroenterologist at least three months before becoming pregnant about phasing out these drugs and finding alternate medications. You should also consult with a high-risk OBGYN as soon as you can.

If you are taking corticosteroids, speak with your gastroenterologist as these may also need to be phased out and replaced with alternate medications.

All other medications used for IBD inflammation are considered safe in pregnancy.

Your age and previous obstetric history are important to your pregnancy. Women over the age of 35 or who had complications with previous pregnancies have special considerations. Consult your OBGYN in these situations.

If you have other comorbid conditions, such as diabetes, make sure to speak with your other specialists, to make sure they are under control before and during your pregnancy. Also, make sure any medications you are taking for these conditions are safe and can be continued throughout pregnancy.

Smoking can make your IBD worse, especially in Crohn’s disease, increasing the need for steroids, immunosuppressants, and surgeries.

Good nutrition is very important both before and during pregnancy. Make choices from the four food groups. Important nutrients in pregnancy include folic acid, calcium, iron, protein, iodine, vitamin C, vitamin B12, and vitamin D.

If you have been on a specific diet for IBD complications such as stricture (narrowing of your intestine), make sure to speak to a nutritionist or dietitian to ensure you will have a healthy diet for pregnancy.

Visit our Diet and Nutrition section for more information. 

Start taking prenatal vitamins before your pregnancy, and continue these until four to six weeks after childbirth. If you choose to breastfeed, continue taking these vitamins as long as breastfeeding continues.

Folic acid requirements are the same as for other women (0.4 mg/day). Take folic acid as part of a multivitamin that also contains 2.6 ug/day of vitamin B12. Other important vitamins include vitamin D and iron.

If you are taking sulfasalazine to treat your IBD, we recommend increasing your folic acid dose to 2 g per day.

Exercise before and during pregnancy is just as safe in women with IBD as it is in those without the disease. Exercise can be very helpful when you are pregnant. Speak with your OBGYN and gastroenterologist if you have special concerns or complications that you think could interfere with your ability to exercise.

You can be physically active throughout your pregnancy, but you should take precautions if you were previously inactive, have diabetes, or are overweight. Speak with your healthcare team before starting exercise, especially if you have these conditions.

Try to accumulate 150 minutes of moderate exercise each week. This should be spread out throughout the week. Incorporate a variety of aerobic and resistance training and add in some yoga or gentle stretching. Also, consider doing Kegel exercises on a daily basis to keep your pelvic muscles healthy.