One of two major types of IBD, ulcerative colitis,
was most strongly linked to serious pregnancy complications,
researchers found in a study of nearly 400,000 women.
But all women with IBD can and should take precautions for a safe
pregnancy, experts said.
"A sick mother is not good for a growing pregnancy," Dr. Shannon
Clark, an obstetrician in the Division of Maternal-Fetal Medicine at
the University of Texas Medical Branch at Galveston, told Reuters
Health by email.
Crohn's Disease and ulcerative colitis are the main forms of IBD.
Both affect the digestive tract, although the Crohn's and Colitis
Foundation of America defines ulcerative colitis as a chronic
disease of the large intestine, while Crohn's disease is a chronic
inflammatory condition of the entire gastrointestinal tract.
The causes of ulcerative colitis and Crohn's disease remain largely
unknown, and there are currently no cures for the disorders. In the
U.S., approximately 200 people out of every 100,000 are affected by
Both forms of IBD have been linked with disorders of the eyes, skin,
joints and liver, the researchers point out.
And IBD in general has been tied to pregnancy complications
involving inflammation and blood flow problems, write lead study
author Dr. Darios Getahun, a researcher with Kaiser Permanente
Southern California Medical Group in Pasadena, and his colleagues in
the Journal of Perinatology.
Up to one third of all pregnant women with IBD will experience a
flare-up of the condition during pregnancy, or worsening of
symptoms, according to Clark, who was not involved in the new study.
Getahun's team wanted to see whether the type of IBD a woman has
makes a difference in her risk for pregnancy complications such as
spontaneous preterm delivery, problems with blood flow to the
placenta and placental rupture.
The researchers looked at medical records of 395,781 women who
delivered singleton pregnancies in all Kaiser Permanente Southern
California facilities between 2000 and 2012.
In 130 out of 100,000 pregnancies, the women had IBD and those women
did have higher rates of certain pregnancy complications. They were
46 percent more likely to have a child that was small for its
gestational age than women without IBD, for example.
Women with IBD were also 32 percent more likely to have a
spontaneous preterm delivery and nearly twice as likely to have a
premature rupture of the placenta.
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The early deliveries tended not to be too severe — on average, they
were around 34 to 36 weeks of pregnancy (39 to 40 weeks is
considered full term), the researchers note.
When the researchers further analyzed the results, they found the
increased risk was significant only among women with ulcerative
For that reason, Getahun and his colleagues write, doctors may want
to take into consideration the specific type of IBD a patient has
when planning for treatment during pregnancy.
"A diagnosis of inflammatory bowel disease does mean that a woman
who is pregnant would need to be on medication throughout the course
of her pregnancy to control symptoms," Clark said.
"If the symptoms of IBD are uncontrolled, or the disease is in an
‘active' state, at the time of conception, the woman will likely
continue to experience the symptoms of active disease throughout her
pregnancy," Clark said.
Dr. Leah Battista, a maternal-fetal medicine specialist at Kaiser
Permanente Southern California Medical Group, who was not involved
in the study, advised women who have inflammatory bowel disease to
make sure they're in remission at least six months before becoming
Getting IBD into remission is harder to manage during a pregnancy,
Battista said, adding that it's important to "practice safe and
effective birth control while in remission."
Clark agreed, the best preventive measure is to maintain control of
IBD symptoms prior to conceiving. "It is crucial that a woman remain
on the medications that have put her IBD in remission," Clark said.
"It may also be helpful to have pre-conceptional counseling with a
maternal-fetal medicine specialist, in conjunction with the
physician who has been managing her IBD, in order to properly plan
for the upcoming pregnancy."
Journal of Perinatology, online March
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