Questions have been edited to remove any possible identifying information.

QUESTIONS and ANSWERS

July 3, 2018

Question:  Can I get pregnant if I have Crohn’s disease and am taking a biologic?

Answer: Yes, you can get pregnant even if you have Crohn’s disease.  Active disease may make it harder to become pregnant, so ensure to see your gastroenterologist and make sure your Crohn’s is in remission.  Certain types of IBD surgeries may also make it harder to become pregnant.   The biologics available on the market (2018) including anti-TNF (infliximab, adalimumab, golimumab, certolizumab) are considered the “safest” because they have the longest data on use in pregnancy.  The newer biologics anti-integrin (vedolizumab) is considered “safe” but as vedolizumab was developed just for IBD, there are no prior data to look at.  The other new biologic anti-IL12/23 p40 (ustekinumab) is also considered “safe” and there are some data in pregnancy among the patients with psoriasis who became pregnant on the medication.    There are newer IBD medications that we do not know if they are safe, including teh “small molecule” Tofacitinib.

Thus it is VERY important that any woman with IBD who wishes to become pregnant or is pregnant, see their gastroenterologist, and a maternal fetal medicine or high risk obstetrician for assessment.

 

January 3, 2018

Question: Is there is some kind of relation between crohn’s disease and the cholestasis of pregnancy?

Answer:  There has been reported linkage between having IBD (Crohn’s) and liver diseases (e.g. autoimmune liver disease, primary sclerosing cholangitis). There is no clear evidence that having Crohn’s disease increases the risk of cholestasis of pregnancy, however, having an autoimmune type disease such as IBD could potentially increase one’s risk of developing complications in pregnancy. Certain medications used to treat IBD can also increase liver tests.  Pregnancy related changes in metabolism and break down of medications may also affect the levels of these medications.

Therefore, it is recommended that a woman who has crohn’s disease, and particularly if on immune medications (such as azathioprine, biologics etc) be seen and followed closely by her gastroenterologist as well as a high risk obstetrician and maternal-fetal medicine specialist, in order to adjust medications, monitor the fetal growth, and prevent or treat any pregnancy-related complications.

 

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