Are my IBD medicines safe in pregnancy, or will they harm the baby?
This is one of the most common fears, and the general message may surprise you: for most people, staying on their IBD medicine through pregnancy is safer for the baby than stopping it. That is because a flare during pregnancy carries real risks, so keeping the disease quiet usually protects both of you. Many IBD medicines are considered compatible with pregnancy, but not all are. A few must be avoided, the clearest example being methotrexate, which can cause birth defects and needs to be stopped well before conceiving. Which medicines you continue, switch or stop is a decision to make with your IBD team before you start trying, not on your own.
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The instinct when you are expecting is often to stop every drug "just in case." With IBD, that instinct can be the riskier choice, and it is worth understanding why.
Staying in remission usually protects the baby
Crohn's & Colitis UK explains that "many women will be advised to keep taking their medicines during pregnancy" to keep the disease under control (Crohn's & Colitis UK). Stopping treatment can increase the risk of a flare, and a flare during pregnancy "could increase the risk of pregnancy complications, such as premature birth, low birth weight" and, in some cases, stillbirth or miscarriage (Crohn's & Colitis UK). So keeping the disease quiet is usually the goal.
Many medicines are compatible, but not all
A lot of IBD medicines are considered compatible with pregnancy, which is why they are often continued. A few are not. The clearest example is methotrexate: the NHS states it "is not recommended in pregnancy, as it can cause birth defects," and that anyone planning a pregnancy should "speak to your doctor" about "changing to a different medicine before you stop using contraception" (NHS). Because a drug like this needs to be stopped well in advance, planning matters.
The key move: plan with your team first
This is not a decision to make alone or by reading a leaflet. Crohn's & Colitis UK advises speaking to your IBD team "as early as possible before you start trying for a baby" so they can review each of your medicines with you (Crohn's & Colitis UK).
- Do not stop or change a medicine on your own because you are pregnant or hoping to be.
- Raise your plans with your IBD team before conceiving if you can.
- Ask specifically about each medicine you take, since the advice differs from drug to drug.