IBD and Pregnancy: Talking to Patients Is Key

Author:
Nirupama N. Bonthala, MD
Cedars-Sinai Medical Center, Los Angeles 

Citation:
Bonthala NN. IBD and pregnancy: talking to patients is key [published online June 26, 2019]. Gastroenterology Consultant.

Gastroenterologists need to consider several key ideas when managing a patient with inflammatory bowel disease (IBD) who is pregnant or may become pregnant. One idea is the question of what medications are safe during pregnancy. Patients who are pregnant often fear that their medications can harm their child. Reassuring patients that their medications are safe is beneficial for the long term.

While the question of whether medications for IBD are safe during pregnancy is common among patients, other questions can arise throughout pregnancy that gastroenterologists should be prepared to address.

For example, before a patient becomes pregnant, she might wonder, “Am I going to have a difficult time becoming pregnant because I have IBD?” Generally speaking, no. Women with IBD are expected to have the same success and failure rates of trying to get pregnant as other women their age from the general population.¹ The exception to this would be individuals who have had a deep pelvic surgery, such as ileoanal anastomosis. Those patients are at a higher risk for infertility. So, while a woman at higher risk can still get pregnant, she may have to use in-vitro fertilization.

A Multidisciplinary Approach

One of the biggest concerns a patient has during pregnancy is whether her providers are all on the same page. It behooves all of us to communicate with each other. We should reach out to the obstetrician, the high-risk maternal-fetal provider, and the pediatrician to avoid any discrepancies between what each of us is relaying to our patient. A successful pregnancy in IBD takes coordination and a multidisciplinary approach.

I am lucky because at Cedars-Sinai Medical Center, I am able to work with others in the combined pregnancy department. We see patients who are considering pregnancy or who are pregnant in a shared, combined clinic visit. The patients usually see the obstetrician first, then I see them to go into greater detail about their pregnancy plan. I address whether the patient can get pregnant. Then, I go through a step-by-step plan with the patient that includes addressing any flares she may experience during any trimester of her pregnancy. We have a plan in place before the patient even thinks about pregnancy so that we can be prepared on how to deliver the baby.

Communication Is Key

The postpartum period can be a challenging time in any new mother’s life. During this time, patients with IBD are not necessarily thinking about their disease but rather focusing on their newborn. Because of this, time can slip away from patients, and they can fall behind on infusions or medication. To avoid this, and especially because it is difficult for some patients to come into the office, I have my nurses call patients every 2 weeks during the postpartum period to check in.

I cannot emphasize enough how talking with patients impacts their outcome of having a child. Just one provider talking minimally about pregnancy in IBD decreases the rate of voluntarily childlessness by 72%.² The topic is one that patients may feel uncomfortable speaking about—they may feel as though they are bothering you or wasting your time—but it is in the back of their mind. Often patients with IBD believe they cannot have children.

If anybody wants to have a child, we should empower them by speaking about it. Empowering patients with the knowledge that they can be like anybody else is crucial. Reminding them that they can have a family, but that we just need to watch them more closely, makes them feel secure.

Nirupama N. Bonthala, MD, is a member of the inflammatory bowel disease faculty at Cedars-Sinai Medical Center in Los Angeles, where her clinical practice focuses exclusively on patients with IBD. Her particular specialty within the field is pregnancy and women’s health.

References:

1. Tavernier N, Fumery M, Peyrin-Biroulet L, Colombel JF, Gower-Rousseau C. Systematic review: fertility in non-surgically treated inflammatory bowel disease. Aliment Pharmacol Ther. 2013;38(8):847-853. doi:10.1111/apt.12478.
2. Huang VW, Chang HJ, Kroeker KI, et al. Does the level of reproductive knowledge specific to inflammatory bowel disease predict childlessness among women with inflammatory bowel disease? Can J Gastroenterol Hepatol. 2015;29(2):95-103.