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Crohns Disease in Pregnancy - Diagnosis and Effective Management

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Crohns disease is an inflammatory bowel disease commonly seen in pregnant women. It affects the stomach and intestine's inner lining.

Written by

Dr. Gayathri. N

Medically reviewed by

Dr. Ghulam Fareed

Published At December 19, 2022
Reviewed AtMarch 17, 2023

Introduction

Crohn's disease is a long-lasting disease primarily caused by hereditary and microorganisms. The risk of the disease can be controlled by keeping the disease under control for a time frame of three to six months before pregnancy occurs. Earlier, people with Crohn's disease voluntarily opted out not to get pregnant because of the adverse effects they would face after getting pregnant. Crohn's disease has a high chance of reducing pregnancy by affecting the fallopian tube and ovaries, causing inflammation.

How Does Crohn's Disease Occur?

Scientists have identified that some genes can increase the risk of developing Crohn's disease. These genes work by providing instructions for making proteins that are involved in the immune system. When these genes get disturbed, it impacts the ability of cells in the intestine to respond to bacteria that is present in them, leading to chronic inflammation and other symptoms of the disease.

Whom Should the Patient Consult?

Both gastroenterologists and obstetricians are responsible for offering the necessary support needed with proper counseling combined with other treatment measures to reduce the severity of the disease.

What Are the Symptoms and Signs Seen in a Pregnant Woman Having Crohn’s Disease?

The symptoms of the disease include:

  • Nocturnal diarrhea or diarrhea at night.

  • Abdominal pain.

  • Weight loss.

  • Fever.

  • Bleeding from the anus, otherwise known as rectal bleeding.

The signs of the disease include:

  • The individual's skin and mucous membranes become light and pale.

  • Marked weight and muscle loss leading to a condition called ‘wasting syndrome.'

  • Abdominal tenderness.

  • Perianal fissure is a tear in the anus lining which can occur in this disease due to inflammation.

  • Inflammation inside the stomach has the tendency to spread through all the layers of the intestine, which can cause small leaks and abscesses. These abscesses can make holes in the chamber, which are called fistulas. These are more commonly formed in the butt region.

  • Intestinal obstruction.

How to Diagnose?

The diagnosis of this disease is based on the endoscopic, radiographic, and pathological findings.

  • Endoscopy: This procedure is performed by inserting a thin tube that has a camera and a light source attached to it through the anus into the digestive tract to see the inside of the digestive tract to check for any signs of bleeding or ulcers.

  • Colonoscopy: In a colonoscopy, the doctor will insert a thin tube with a camera and a light source attached to it into the rectum to check for any signs of lesions or ulcers.

  • Cholangioscopy: This procedure is used to inspect the bile ducts, where an endoscope with a camera and a light source is inserted through the anus into the biliary tract to check for any signs of bleeding or inflammation.

Are These Diagnostic Procedures Safe?

These techniques are safe during pregnancy but should be used only if necessary and with caution. These procedures can be carried out during the second trimester of pregnancy. Serological studies analyzing antibodies against microorganisms like Saccharomyces Cerevisiae, antineutrophil antibodies, and outer membrane prion of E.Coli bacteria are good indicators of this disease.

What Are the Steps to Be Taken to Reduce the Severity of the Disease?

In women, the active disease reduces the chances of getting pregnant, but one in four women gets pregnant during the active phase of the disease. Disease control should be done at the earliest since if the patient has an active disease during pregnancy, there is a higher chance of miscarriage, fetal growth restriction, and preterm birth of the unborn child. Women who have active Crohn's disease at conception are at greater risk of getting affected by the disease badly.

What Nutrients Can Be Given?

  • Women with this disease tend to have iron and vitamin B12 deficiency; thus, levels must be checked, and supplements should be given accordingly. Folic acid supplements with a dosage of five mg help in neural tube development during pregnancy and should be started before conception.

How to Treat This Disease?

The main aim of this disease is to reduce inflammation which causes complications.

Therapeutic drugs can be a good option but can be given by analyzing the

  • Location of the disease, as in where it is located.

  • The severity of the disease, as in how severe the disease has been, increased.

Women who have Crohn's disease are counseled to get pregnant during the inactive stage of the disease since the chance of the disease occurring again during the phase of pregnancy is low. The drugs which are used in the management of Crohn's disease are

  • 5 aminosalicylic acid. Corticosteroids like Prednisone and Budesonide.

  • Immunomodulators (Azathioprine, six Mercaptopurine).

  • Antibiotics (Metronidazole,Ciprofloxacin).

  • Tumor Necrosis Factor(TNF) blockers are FDA-approved: Infliximab, Adalimumab, and Certolizumab pegol.

Administration of anti-TNF antibodies is safe during the pre-pregnancy and the first trimester period since IgG antibodies do not cross the placental barrier at this time. The risk happens only during the last trimester, putting the neonate at risk. A 28 year old female received infliximab throughout her pregnancy since she had Crohn's disease. After that, at three months of age, the baby was given BCG (Bacille Calmette Guerin), a vaccine for tuberculosis but died due to disseminated BCG. Thus it is now recommended that live vaccines like influenza and BCG be withheld for 12 months in neonates who had exposure to anti-TNF agents during their intrauterine life. Methotrexate, Ciclosporin, Allopurinol, and Tofacitinib are contraindicated during pregnancy and breastfeeding. A recent London study has recommended certolizumab to be compatible with breastfeeding and has a low risk of conception during pregnancy.

What Mode of Delivery Is Advisable for Patients With This Disease?

  • Vaginal delivery is considered safe for most individuals.

  • In the case of an inflamed rectum (the part of the large intestine which is present close to the anus) and perineum (a diamond-shaped structure present below the pelvic diaphragm) due to Crohn's disease, a cesarean is preferred due to perineal inelasticity.

  • A population-based survey has stated that the number of cesarean delivery is more than vaginal delivery in patients with this disease.

Conclusion

Crohn's disease during pregnancy remains a common complication. With proper counseling and guidance from gastroenterologists, this can easily be managed. The key lies in the time of getting pregnant. Women should choose to conceive when the disease is inactive. Maintenance of a disease-free phase before and during pregnancy plays a crucial role in delivering healthy offspring. Advancements in therapies and treatment techniques have made pregnancy following the diagnosis of Crohn's disease a safe option for women.

Frequently Asked Questions

1.

What Are the Affects of Chron’s Disease on Pernancy?

Miscarriage is more likely if the patient suffers from active Crohn's disease. It also increases the chance of preterm birth and stillbirth (losing a baby during delivery). On the other hand, women with inactive Crohn's disease have a slightly greater chance of miscarriage than pregnant women.

2.

What Is the Prevalence of Chron’s Disease in the United States?

According to experts, more than 500,000 people in the United States have Crohn's disease. According to statistics, Crohn's disease is becoming more prevalent in the United States and other regions worldwide. Experts are still determining the cause of this growth.

3.

What Are the RCOG Guidelines for Managing Chron’s Disease During Pregnancy?

Most women with irritable bowel disease (IBD) will have a normal pregnancy and can give birth vaginally. A pregnant woman with active perianal Crohn's disease is an absolute indication for a cesarean section, but ileal pouch surgery is a relative indication. Breastfeeding is helpful to the newborn, and most IBD drugs pose very little danger.

4.

Is It Safe to Become Pregnant While Suffering from Crohn’s Disease?

Except in women with active Crohn's disease, fertility may be expected to be normal. Pregnancy normally has a favorable result, although the risks associated with active disease are high, particularly Crohn's disease. Premature birth and low birth weight are certainly linked to the severity of the disease activity.

5.

Does Crohn's Disease Get Worse During Pregnancy?

Around one-third of women who are free of symptoms get pregnant, and symptoms flare up throughout their pregnancy. During the first trimester, relapses are most prevalent. Women who become pregnant when their Crohn's disease is active are more likely to develop symptoms.

6.

Can I become Pregnant While Suffering from Crohn's Disease?

In general, women with Crohn's disease who are in remission (must be symptom-free for three to six months) can become pregnant just as simply as other women of their age. On the other hand, women with active IBD may find it difficult to become pregnant. It is not advisable to conceive during a disease flare.

7.

Can Chron’s Disease Make It Difficult to Get Pregnant?

If you have active irritable bowel disease, particularly Crohn's disease, the chance of becoming pregnant may be slightly reduced. Severe inflammation in the small intestine might disrupt the fallopian tubes, making pregnancy more difficult.

8.

Can Crohn’s Disease Develop during Pregnancy?

Women with active disease during conception and those who develop Chron's disease for the first time during pregnancy are at the greatest risk of flare-ups and pregnancy-associated complications.

9.

Is Crohn’s Disease Present from Birth?

Crohn's disease can develop at any age. It primarily affects adults aged 15 to 35. However, Crohn's disease can affect young children. Both men and women are equally affected.

10.

Does Crohn’s Disease Disappear during Pregnancy?

When you become pregnant, if you have slightly active or inactive Crohn's or ulcerative colitis, it will likely progress during pregnancy. If you become pregnant when your condition is active, it is more likely to remain active during your pregnancy.

11.

Is Crohn's Disease Harmful to Babies?

It is possible, but not guaranteed, that a child of a parent with irritable bowel disease would also have the disease. If one parent has Crohn's disease or ulcerative colitis, the kid has a two to nine percent possibility of acquiring the condition. If both parents have IBD, the child's risk is increased to thirty-six percent.
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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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