Mayo Clinic Medical Edge: Should Crohn's sufferer get pregnant?

DEAR MAYO CLINIC: I have Crohn's disease and have been told by some doctors that I can get pregnant, while others tell me I shouldn't conceive. What do you recommend to women with Crohn's?

ANSWER: The majority of women who have Crohn's disease can get pregnant without undue risk to themselves or the baby.

If you're very ill, or your Crohn's symptoms cannot be controlled, then pregnancy may not be a good choice. But, for most women, pregnancy is feasible when symptoms can be controlled with treatment. Before you get pregnant, though, I recommend you talk with your doctor and plan how you'll manage the disease during pregnancy.

In Crohn's disease, a type of inflammatory bowel disease, the lining of the digestive tract becomes inflamed, usually causing diarrhea and abdominal pain. Other common symptoms include fever and fatigue. In addition, some people with Crohn's disease get disorders outside the digestive tract, such as arthritis, eye inflammation, skin disorders, and inflammation of the liver or bile ducts.

Although Crohn's has no cure at this time, medications are often used to effectively control symptoms. Many of these medications are safe during pregnancy, including prednisone and mesalamine (the generic name for several different drugs that contain mesalamine as the active ingredient).

Of course, not all medications used to control symptoms associated with Crohn's are safe to take while pregnant. If you're considering pregnancy, one drug that elicits serious caution is methotrexate (Rheumatrex or Trexall). Methotrexate is sometimes prescribed when people with Crohn's disease don't respond well to other medications. Methotrexate has been linked to birth defects. If you're taking methotrexate, discuss a replacement drug with your doctor before becoming pregnant.

Also, after stopping methotrexate, some time should elapse prior to efforts to become pregnant. Women should wait at least one ovulatory cycle before becoming pregnant. Men should stop taking methotrexate at least three months before trying to conceive.

Review your medications and your treatment plan with your doctor. Work with your doctor to become as healthy as possible. That may involve blood or other diagnostic tests to assess your overall health and determine if more treatment is necessary.

The severity of Crohn's symptoms that are present when you get pregnant often continue throughout your pregnancy. Therefore it's important to become as healthy as possible prior to pregnancy.

Pregnancy may cause symptom flare-ups, which usually can be effectively treated and usually do not endanger the baby. In addition, you can take steps that may help reduce or prevent Crohn's symptoms.

If you smoke, stop, and avoid secondhand smoke as much as possible. Smoking makes Crohn's disease worse. In addition, infections, such as traveler's diarrhea or influenza, can also aggravate symptoms. Although these illnesses can be difficult to avoid, getting a flu shot will reduce your risk, since any infection can trigger a flare-up of Crohn's disease.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may cause intestinal ulcers and can trigger Crohn's activity. Talk to your doctor about alternatives to NSAIDs.

Complications of Crohn's disease, such as bowel obstruction or ulcers, can be treated during pregnancy. Fistulas are common in people with Crohn's. These abnormal connections can occur between different parts of the intestine, between the intestine and skin, or between the intestine and other organs, such as the bladder and vagina. Also common are anal fissures -- cracks or clefts in the anus or the surrounding skin. These complications are often of particular concern to pregnant women considering vaginal delivery.

If you have fistulas or fissures, a vaginal delivery may not be the best option, particularly if an episiotomy (which involves an incision of the tissue between the vagina and the anus) is required. If that incision does not heal properly, Crohn's symptoms in that area could become much worse. In this situation, Cesarean delivery (C-section) may be the better choice. But if you don't have fistulas or fissures in this area, vaginal delivery may be fine.

To best manage all aspects of your care during and after pregnancy, work carefully with the doctor you're seeing for Crohn's disease, as well as your obstetrician and your baby's pediatrician. Collaboration among these physicians is important. They can work with you and each other to plan care designed to help ensure a healthy pregnancy and delivery. -- William Tremaine, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota

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