Are medicines safe for ulcerative colitis during pregnancy?

Question

Hello doctor,

I am 30 and five weeks pregnant, but I have had a bad ulcerative colitis flare the past few weeks. I took Prednisone and Mesalamine regularly during this time. I did not know I was pregnant until recently.

Could all this inflammation or medication be harmful to the baby?
Should I switch medicines now that I know, or is continuing safer than another flare?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Managing ulcerative colitis during pregnancy can be challenging, but with proper guidance, many women go on to have healthy pregnancies and healthy babies.

To address your concern directly: active inflammation during early pregnancy may carry more risk to the baby than continuing most maintenance ulcerative colitis medications. Uncontrolled disease can increase the chance of complications like miscarriage, preterm birth, or low birth weight. So the priority is keeping your ulcerative colitis in remission as much as possible.

Mesalamine is generally considered safe in pregnancy. It is classified as FDA (Food and Drug Administration) pregnancy category B, and studies have not shown an increased risk of birth defects. So it is typically continued during pregnancy unless there is a specific reason to change.

Prednisone, while not ideal long-term, is often used during flares in pregnancy when needed. It does cross the placenta, and high doses or prolonged use carry small potential risks, such as cleft palate if used very early, or gestational diabetes and high blood pressure in the mother, but the benefits of controlling a flare usually outweigh these risks, especially if it is a short course.

In terms of switching medications, it is usually safer to maintain your current, effective regimen rather than risk a new flare by changing too early. You and your doctor may later consider tapering Prednisone if your disease becomes well-controlled. Biologics like Infliximab or Adalimumab are also used safely in pregnancy for moderate-to-severe cases if needed.

A few steps you should consider now:

Let your gastroenterologist and obstetrician know right away so they can coordinate your care closely.
Ask to be followed by a maternal-fetal medicine specialist if your pregnancy is considered higher-risk.
Ensure you are on adequate folic acid supplementation (higher doses are often recommended for women with inflammatory bowel disease or on certain medicines).
Monitor for signs of nutritional deficiencies or anemia, which can be more common in ulcerative colitis.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.