Pregnancy is a privilege that can become difficult when one is afflicted with a series of health problems. Especially difficult are those health issues that are chronic or recurrent, such as ulcerative colitis. Ulcerative Colitis is an autoimmune disease that affects the colon (large intestine) and rectum. It commonly begins during adolescence and early adulthood and afflicts men and women equally. Currently there are approximately 500,000 to two million people in the United States that suffer from this disease.
Ulcerative Colitis is a form of inflammatory bowel disease in which ulcers and inflammation of the inner lining of the colon cause a patient to have symptoms including, but not limited to, diarrhea, abdominal pain, nausea, vomiting, loss of appetite, weight loss and rectal bleeding. These are the more common symptoms of the disease. Other symptoms may include lesions on the skin, dehydration, fatigue, loss of nutrients in the body, and anemia.
It is difficult enough to have to deal with the changes that your body goes through when you are pregnant. Having a disease like ulcerative colitis on top of this can make pregnancy even harder. Being pregnant will not cause a woman to have a flare-up of her disease any more than a woman who is not pregnant. If a flare-up is to occur it will typically happen during the first trimester and symptoms will more than likely continue throughout the remainder of the pregnancy.
One of the biggest concerns that women have about their pregnancy and ulcerative colitis is miscarriage. Premature delivery (pre-term birth) and spontaneous abortion are two to three times more frequent in women who suffer from ulcerative colitis and Crohn’s Disease, another form of inflammatory bowel disease, than in healthy women. However, the birth weight and stature of the babies born to these mothers is equal to those of mothers who are healthy. It is also important to note that the presence of this illness does not increase the chances of other complications during pregnancy such as pre-eclampsia, gestational diabetes, hypertension, still birth, and congenital abnormalities.
Research has shown that there is a chance of infertility being increased in both men and women who have active ulcerative colitis. Those who are in remission, periods of time when the disease is not active, generally do not have issues with fertility. Some women may experience a decrease in their fertility not because of the disease itself but because of the medications they might be using to treat it. One of these medications is sulfasalazine, a 5-aminosalicylic acid that is mainly used to treat inflammation. 5-ASA compounds are commonly used to treat both ulcerative colitis and Crohn’s Disease. Sulfasalazine has been shown to reduce sperm count and motility.
Once a couple has achieved conception their chances of having a normal pregnancy and delivery are reasonable and most medications used to treat the disease, including 5-ASA compounds and corticosteroids, are not likely to have an impairing effect on the pregnancy. Examples of corticosteroids are prednisone, budesonide, cortisone and dexamethasone. These drugs are generally used to decrease inflammation in the intestines. All medications that are being used to treat ulcerative colitis should be discussed with your physician. Although some of these medications are safe to take during pregnancy there is always the chance that they may not be safe to continue taking if you are planning on breastfeeding your baby.
Sources
Saibil, Fred. Crohn’s Disease and Ulcerative Colitis: Everything You Need to Know. Tonawanda, New York: Firefly Books, 2009.
Sklar, Jill. The First Year: Crohn’s Disease and Ulcerative Colitis: An Essential Guide for the Newly Diagnosed. Jackson, TN: De Capo P; Revised Edition, 2007.
Douglas, Ann. The Mother of All Pregnancy Books: The Ultimate Guide to Conception, Birth, and Everything in Between. Hoboken, NJ: Wiley Publishers, 2002.
