Can Crohn's disease medications affect pregnancy?

Question

Hi doctor,

I am 28 and have been diagnosed with Crohn's disease for two years, but I am having trouble finding the right treatment. My symptoms include severe diarrhea, abdominal cramping, and fatigue that comes and goes unpredictably.

I have been on several medications - first Mesalamine, then Prednisone, and now I am on Azathioprine. The Prednisone helped temporarily, but the side effects were terrible: weight gain, mood swings, and insomnia. I am constantly worried about infections because my immune system is suppressed.

The unpredictability of flares is affecting my career and relationships. I never know when I will have a good day or a bad day. My gastroenterologist mentioned biologic drugs, but they are incredibly expensive and require regular infusions.

I am also concerned about starting a family.

Will my medications affect pregnancy?
Can I pass this condition to my children?
What are the newest treatment options available?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

Living with Crohn's disease can be incredibly frustrating, both physically and mentally. I am suggesting a multi-therapy approach. Since you are already on Mesalamine, Prednisone, and Azathioprine, I recommend considering biologics such as:

Anti-TNF agents (tumor necrosis factor inhibitors, e.g., Infliximab).
Anti-integrin agents (e.g., Vedolizumab).
Anti-IL-23/IL-12 agents (interleukin-23 or interleukin-12 inhibitors, e.g., Ustekinumab and Risankizumab).
JAK inhibitors (Janus kinase inhibitors) can be taken orally in monthly doses.

Biologics like Adalimumab, Infliximab, and Ustekinumab are generally considered safe during pregnancy. It is important to control your disease before becoming pregnant, as uncontrolled Crohn's can lead to low birth weight, miscarriage, and preterm birth.

There is also a small 10 to 15 % chance that it could affect the child. The probable causes of Crohn's include genetic factors, environmental influences, autoimmune responses, and changes in gut microbiota.

Investigations to be done include:

Complete blood count (CBC).
C-reactive protein (CRP).
Upper gastrointestinal endoscopy.
Colonoscopy.
Barium studies.

I suggest this treatment plan:

Start on newer biologics after consulting with your gastroenterologist. Avoid triggering factors and foods.
Modify your job for more flexibility.
Seek psychological counseling.
Regular follow-ups with your gastroenterologist are essential.
Engage in therapy (e.g., cognitive-behavioral therapy) to reduce stress and anxiety.
Aim for at least 30 minutes of outdoor activities daily.
Incorporate yoga and meditation into your routine.

I hope this answers your query. Feel free to reach out anytime.

Thank you.