saudigastro.com/patients/ibd-pregnancy
Category
Chronic
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis, which are long-term conditions where the immune system causes inflammation in the gut. IBD usually starts in young adulthood, so many patients ask about fertility, pregnancy and breastfeeding. The key message is reassuring: when IBD is well controlled around the time of conception and during pregnancy, the chances of a healthy mother and baby are high. The biggest risk to the pregnancy is usually not the medicines but active, uncontrolled disease.
How common is it?
IBD is not rare among women of childbearing age. Fertility in women whose disease is quiet is generally similar to that of other women. Fertility can be lower when the disease is active, or after some pelvic surgeries such as creating an internal pouch. Men can also be affected: a medicine called sulfasalazine may temporarily lower sperm count, which usually recovers after switching.
Why does it happen?
Pregnancy does not cause IBD to flare by itself. What matters most is how active the disease is at conception. If it is in remission (quiet, with no symptoms and no inflammation), it usually stays quiet during pregnancy. If it is active at conception, it often stays active or worsens, and this raises the risk of miscarriage, early (premature) delivery and a small baby. Stopping medicines without medical advice is a common reason for flares. IBD has a genetic component, so a child has a somewhat higher chance than average of developing IBD later in life, but most children of parents with IBD do not develop it.
Symptoms
- Symptoms of a flare during pregnancy are the same as usual: diarrhea, blood in the stool, urgency, abdominal pain
- Weight loss or poor weight gain during pregnancy
- Unusual tiredness or paleness (may mean anemia, which is low blood iron or low red blood cells)
- Fever, joint pain or mouth ulcers linked to IBD activity
- Pain, swelling or discharge around the anus in Crohn's disease
- Normal pregnancy changes (nausea, constipation, mild cramps) can look similar — always ask your team
Red flags — seek urgent medical care
Heavy bloody diarrhea, more than usual, or blood clots in the stool
A severe flare or bleeding that needs urgent assessment — go to the hospital.
Severe or constant abdominal pain, a swollen hard belly, or repeated vomiting
Could be a bowel blockage or complication — emergency care.
Fever with chills, or a painful swelling near the anus
Possible infection or abscess (collection of pus) — see a doctor urgently.
Vaginal bleeding, fluid leaking, regular contractions, or reduced baby movements
Possible pregnancy complication — contact your obstetric team or go to the hospital immediately.
Dizziness, fainting, or a racing heart
May mean blood loss or dehydration — urgent assessment needed.
How is it diagnosed?
If you already have IBD, the aim is to check how active it is. This uses your symptoms, blood tests, and a stool test called fecal calprotectin, which measures gut inflammation. Ultrasound of the bowel can also be used. If a closer look is needed, a flexible sigmoidoscopy (a short camera test of the lower bowel) can be done safely during pregnancy, usually without heavy sedation, when it will change management. MRI without contrast dye is considered safe, while CT scans are avoided where possible. Your gastroenterologist will decide which test is right for you.
What the latest science says
Current guidelines (such as those from ECCO, ACG and AGA) agree that most IBD medicines, including 5-ASA drugs, thiopurines and most biologic therapies, can be continued in pregnancy because controlling inflammation protects mother and baby. Research continues on how long biologic medicines stay in the baby's blood after birth, and this is why some experts adjust the timing of the last doses or delay certain live vaccines for the baby.
Outlook — what to expect
With planning and regular follow-up, the large majority of women with IBD deliver healthy babies. Flares can still happen and are treatable. Breastfeeding is encouraged for most patients and is compatible with most IBD medicines. Your team can help you continue treatment safely after delivery, because the postpartum months can also be a time when disease activity returns.
Treatment
Habits & Lifestyle
The best preparation starts before pregnancy. Aim to conceive when your disease has been in remission for some time, ideally with the agreement of your gastroenterologist.
- Plan the pregnancy: book a visit with your gastroenterologist and obstetrician before trying to conceive.
- Do NOT stop or change any IBD medicine on your own. Stopping can cause a flare, which is usually riskier than the medicine itself.
- Stop smoking: it worsens Crohn's disease and harms the pregnancy.
- Attend all antenatal and IBD clinic visits, and tell both teams about the other's advice.
- Report new symptoms early rather than waiting; early treatment of a flare is safer for the baby.
Diet
Good nutrition supports both your gut and your baby. Dietary needs depend on your type of IBD and whether you have a stricture (narrowing) or recent flare.
- Take folic acid before conception and in early pregnancy as advised by your doctor; some medicines or small-bowel disease may need a different plan.
- Ask whether you need checks for iron, vitamin B12 and vitamin D, which are often low in IBD.
- Eat small, regular, balanced meals with enough protein and calories for pregnancy.
- If you have a narrowed bowel, your team may advise softer, lower-fibre foods.
- Avoid herbal products and strict "IBD diets" that remove many foods unless your team agrees.
Medications
Most IBD medicines are considered compatible with pregnancy, but a few are not. Your gastroenterologist and obstetrician decide together; never start, stop or change a medicine by yourself.
- 5-ASA (mesalamine) medicines are generally considered safe; sulfasalazine is usually taken with extra folic acid.
- Thiopurines (azathioprine, mercaptopurine) are usually continued if they are keeping you well.
- Most biologics (such as anti-TNF medicines, vedolizumab, ustekinumab) are usually continued; your team may adjust the timing of late-pregnancy doses.
- Methotrexate must be stopped well before conception because it can harm the baby; your doctor will advise on timing and alternatives.
- Short courses of steroids are sometimes used to treat flares; the dose and length are decided by your doctor.
- Tell the baby's doctor about any biologic you used. Some live vaccines (for example BCG and rotavirus) may need to be delayed for the baby; ask before vaccination.
Procedures & Surgery
Procedures are only used when truly needed, because pregnancy should be disturbed as little as possible.
- Flexible sigmoidoscopy can be done in pregnancy if the result will change treatment.
- Delivery: most women with IBD can deliver vaginally. A caesarean section is usually advised for active perianal Crohn's disease or after some pouch surgery, and for the usual obstetric reasons.
- Surgery for IBD during pregnancy is rare and reserved for emergencies such as blockage or severe uncontrolled colitis.
Living with the condition
- Keep a written list of your medicines and bring it to every obstetric visit.
- Plan your postpartum care before delivery, including when to restart or continue treatment and who to call about flares.
- Most IBD medicines are compatible with breastfeeding; ask your team before stopping breastfeeding for a medicine.
- Ask for emotional support. Worry about pregnancy with IBD is very common, and talking helps.
In the Saudi context
If you are pregnant and wish to fast during Ramadan, discuss it with your obstetrician and gastroenterologist first. Dehydration, medicine timing and flare risk need individual advice. Pregnant women are permitted by religious guidance to postpone fasting when it could harm them or the baby, and your doctor can help you decide. Before travel for Umrah or Hajj, make sure you can carry enough of your medicines and a letter from your doctor.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Is my disease in remission, and how do we confirm it before I try to conceive?
- Which of my medicines should I continue, and does any need to change before or during pregnancy?
- What should I do if I have a flare while pregnant, and who should I call?
- What delivery method is best for me?
- If I used a biologic, when should my baby receive vaccines, and are any delayed?
- Can I breastfeed on my current treatment?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide