Ulcerative Colitis

INFORMATION FOR WOMEN WHO HAVE ULCERATIVE COLITIS DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is ulcerative colitis?

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that occurs within the colon and usually also the rectum (which together with the cecum and appendix comprise the large intestine). The condition is chronic it occurs over many decades, sometimes with flare-ups and remissions, and classically, it gives the person bloody diarrhea and frequent urgency to defecate. Severity ranges, from mild to whats called fulminant, depending on the number of stools per day and the amount of inflammatory illness through the body. UC often affects women and often begins at a young age, so it can coexist with pregnancy, in which case the pregnancy is considered complicated.

How common is UC during pregnancy?

Overall, inflammatory bowel disease (of which UC is one of the main forms) occurs in about 31 per 10,000 pregnant women, according to a recent study in Australia. The prevalence of such disease probably varies throughout the world, but this study result implies that UC is fairly common during pregnancy. There are particular risk factors that make UC likely. Having a first-degree relative (parent, sibling, or child) with UC, for instance, increases the risk of developing UC by 4 times, compared with the general population. Ashkenazi Jews carry a 3-5 fold risk over the general population, while African Americans and Latinos have a slightly increased risk compared with other ethnic groups, apart from Jews.

How is UC diagnosed?

Diagnosis begins with a suspicion for UC based on the patients history. Usually, there is a gradual onset of the following symptoms, which get worse as time goes on:

  • Anorexia (severely underweight)
  • Nausea
  • Vomiting
  • Diarrhea, which may be bloody and may happen at night.
  • Melena (dark stools due to the presence of blood), and there also can be overt bleeding from the rectum.
  • Abdominal pain, typically in the central or right part of the lower abdomen. Typically, the pain is during defecation.
  • There also are often many symptoms outside the digestive tract, which can include joint pain from arthritis, back pain, and eye problems.

You may have a history of bone fractures, which could give the doctor another clue. You may also experience modest fevers and on physical examination, the doctor may find that your liver and spleen are enlarged. Having family members with UC, or another inflammatory bowel disease (such as Crohn’s disease), can raise the level of suspicion. If you are an Ashkenazi Jew, UC also becomes more likely.

Various tests then will be conducted on blood samples for signs of anemia, vitamin deficiencies, parasitic infections, iron deficiency, and evidence that the immune system is attacking the body. Doctors will also order a blood test called a complete metabolic panel that shows various aspects of your blood chemistry and your kidney function. Samples of stool will be taken to look for bacterial and parasitic infections, blood, and signs of inflammation. Various genetic tests will be performed to determine whether you carry any genetic sequences that are particularly associated with UC.

Imaging studies will be conducted. These will include either something called computed tomography (CT) enterography or a similar test called magnetic resonance (MR) enterography. You may also be given either an MRI of your abdomen or a CT scan of your abdomen. If you are already pregnant, the MRI will almost always be chosen over an abdominal CT. Most importantly, the inside of your colon will be examined with colonoscopy, in which a tube-like instrument is inserted through the anus.

Does UC cause problems during pregnancy?

UC will put you at risk for nutritional deficiencies and gastrointestinal tract bleeding that can be exacerbated by pregnancy. It also will make it more likely that you will have to give birth by cesarean section. If your disease becomes very severe during pregnancy such that you require surgery on your colon it is possible that the surgery could trigger premature labor.

Does UC during pregnancy cause problems for the baby?

Loss of nutrients and blood through the gastrointestinal tract can lead to reduced growth in the developing baby. If folic acid intake is inadequate, this can also put your child at risk for neural tube defects, in which parts of the brain or spinal cord are left without a bony covering. IBD puts your developing baby at risk for various poor outcomes, such as low birth weight, congenital abnormalities, and even stillbirth.

What to consider about taking medications when you are pregnant:

  • The risks to yourself and your baby if you do not treat the UC
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat UC during pregnancy?

Several medications are given to control UC. Most of the drugs are thought to be safe during pregnancy, while others have raised concern. The drug sulfasalazine, a common, effective medication, is thought to be safe so long as you also take folic acid. 5-aminosalicylic acid (5-ASA) is the preferred treatment for mild to moderate disease. 5-ASA appears to be fairly safe in pregnancy with the exception of one brand, called Asacol HD, although the preparation is being adjusted to make it safer.

Various antibiotics can be given to control gastrointestinal infections without harm to the developing baby. Metronidazole and amoxicillin-clavulanic acid both are considered to be low risk. Another class of drugs is steroids, the safety of which is a subject of debate, but since they are very effective they are always on the list of medications that can be given during pregnancy if needed. If given for long periods, however, steroids may provoke gestational diabetes and also raise your blood pressure, but these are things that can be monitored.

There is some concern about various drugs known as biological agents (most of which are antibodies that end with the suffix mab), but studies have been very limited. Two other commonly used drugs are called azathioprine and 6-mercaptopurine. Both are considered acceptable in pregnancy, if other treatments prove ineffective or for some other reason cannot be used.

Who should NOT stop taking medication for UC during pregnancy?

If you have active UC (meaning not in remission), at the onset of pregnancy, you need to continue your treatment. However, it is possible to switch from one drug treatment to another. Work with your doctors to select the optimal treatment strategy that keeps the disease in check while minimizing risk.

What should I know about choosing a medication for my UC during pregnancy?

You may find Pregistrys expert reports about the individual medications to treat UC here. Additional
information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my UC when I am breastfeeding?

5-ASA appears to be fairly safe in breastfeeding with the exception of one brand, called Asacol HD, although the preparation is being adjusted to make it safer. Corticosteroids, such as prednisone, azathioprine, and 6-mercaptopurine all are considered safe in those who breastfeed.

What alternative therapies besides medications can I use to treat my UC pregnancy?

There are no viable alternatives to medications for UC.

What can I do for myself and my baby when I have UC during pregnancy?

Help to keep your UC in check by working with your doctors to optimize treatment and minimize risks to you and the developing baby.

Resources for UC in pregnancy:

For more information about UC during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

  • Mayo Clinic: Ulcerative Colitis
  • March of Dimes: Inflammatory Bowel Disease and Pregnancy

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.



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