Can Crohn’s stress flares affect pregnancy or fertility?

Question

Hello doctor,

I am a 29-year-old woman with Crohn's disease, which was diagnosed when I was a teenager. Fortunately, treatment has put my disease into remission. As I prepare for my wedding next year and begin to really consider raising a kid, I have various questions and worries regarding how Crohn's illness may affect my reproductive health and potential pregnancy.

I have discovered that my Crohn's symptoms flare up at times of emotional stress, so I am anxious about how wedding planning and pregnancy may affect my health or fertility.

In addition, I have had painful menstrual cycles and wonder whether I have endometriosis. I have heard that there may be a link between inflammatory bowel disease and endometriosis, and I would like to know if it is feasible to have both disorders simultaneously.

Nutritional deficiencies and their possible effects on fertility also worry me. I want to make sure I am in the best possible condition before attempting to conceive because I have previously battled vitamin B12 and iron deficiencies as a result of Crohn's disease.

My gastroenterologist also noted that several of my current medications may not be deemed safe during pregnancy, therefore I would like to know when I should start talking or arranging any treatment changes.

More specifically I want to find out:

• Is Crohn’s connected to endometriosis? Can I have both?

• How can I best optimize my nutrition and repair any vitamin or mineral deficiencies in preparation for pregnancy?

• When should I start taking about medication modifications if I am planning to get pregnant?

• Can Crohn’s flares caused by emotional stress from important life events impact fertility or pregnancy?

• What are the normal effects of Crohn’s disease on pregnancy and fetal growth?

• What kind of monitoring or coordinated care should I expect between my gastroenterologist and OB/GYN during preconception and pregnancy?

Thank you for your time and guidance.

I appreciate any recommendations you may have as I begin planning for this next stage of my life.

Thank you for your guidance.

Answer 1

Hi,

Welcome to icliniq.com

Thank you for sharing your concerns.

If you have Crohn's disease, planning a pregnancy might seem hard. But many women with Crohn's disease are able to have healthy pregnancies and babies with the right care and medical help.

Pregnancy may provide additional complications due to hormonal changes and the physical stress of pregnancy, but Crohn’s disease is not a contraindication for pregnancy. Pregnancy is best planned at a period of stable remission, usually for at least three to six months before conception. Women with stable illness during conception are more likely to remain stable during pregnancy.

It is also vital to examine your prescriptions well before you try to conceive. Some medicines used to treat Crohn’s disease may not be safe in pregnancy. You may need to stop taking them around three months before you get pregnant. Your gastroenterologist can switch you to drugs that are safe in pregnancy that will still handle your symptoms well while protecting your baby’s development.

Folic acid supplementation is also strongly suggested for women contemplating pregnancy, particularly in those with Crohn’s disease who may be at increased risk of folate deficit due to malabsorption. Folic acid is important in the early development of the foetus, so the best time to start taking it is at least three months before conception.

There is data suggesting a relationship between Crohn’s disease and endometriosis in relation to your concern about endometriosis. But painful periods alone are not sufficient for a diagnosis of endometriosis. To evaluate if these disorders might coexist a proper gynecological evaluation would be necessary.

Crohn’s disease itself does nOt interfere with pregnancy, but active disease can increase the chance of problems, such as miscarriage, premature birth, anemia during pregnancy and preeclampsia. That is why it is so vital to be in remission before conception and during pregnancy.

My recommendation would be to schedule a preconception consultation about four to six months before you expect to start trying for pregnancy. This provides you with enough time to check your nutritional state, review your medications, treat any vitamin or iron deficiencies, and plan treatment with your gastroenterologist and (Obstetrician-Gynecologist).

With careful planning, close monitoring, and good disease control, pregnancy outcomes for women with Crohn’s disease are often very positive.

Wishing you the very best as you plan this exciting next chapter in your life.

I hope this answers your questions.

Please feel free to follow up whenever needed.

Thank you.