Can a 29-year-old woman with UC conceive safely?

Question

Hello doctor,

I am 29 years old and have had ulcerative colitis for four years. I am currently in remission on Mesalamine and Azathioprine. I have been experiencing irregular periods and pelvic cramps, and my gynecologist mentioned possible endometriosis.

I am worried if ulcerative colitis can cause fertility issues or complicate pregnancy. I want to conceive next year, but I am scared of flare-ups during pregnancy or after delivery.

Can I continue Azathioprine while trying to conceive?
My latest colonoscopy showed mild mucosal inflammation in the sigmoid region, and my CRP (C-reactive protein) was 12 mg/L. Should I wait until I am in complete remission before trying to conceive?
Do ulcerative colitis flares increase the risk of miscarriage?
Is an expected delivery possible, or is a C-section (cesarean section) safer?
Also, is the severe bloating I experience before my periods related to ulcerative colitis or hormonal changes?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

I completely understand your worries, and it is great that you are thinking ahead and planning carefully for pregnancy. Living with ulcerative colitis can be challenging, but many women with UC (ulcerative colitis) go on to have healthy pregnancies and babies. Since your condition is currently in remission with mild inflammation in the sigmoid region, that is a positive sign.

Ideally, it is best to conceive when your UC (ulcerative colitis) has been in stable remission for at least three to six months, because active disease at conception can increase the risk of flares during pregnancy and may slightly raise the chance of complications such as preterm birth or low birth weight.

Azathioprine can generally be continued while trying to conceive and during pregnancy, as studies have shown it to be relatively safe when prescribed under close medical supervision. Stopping it suddenly can trigger a flare, which poses a greater risk to both you and your baby than the medication itself. Mesalamine is also safe and commonly continued throughout pregnancy.

Your CRP (C-reactive protein) level of 12 mg/L indicates mild inflammation, so your gastroenterologist may want to optimize your treatment before you try conceiving to achieve complete remission if possible. Flares during pregnancy can increase the risk of miscarriage and preterm delivery, so keeping your UC well-controlled is very important.

Most women with UC (ulcerative colitis) can have a standard vaginal delivery unless severe rectal involvement or prior surgery is affecting the anal area, in which case a C-section (cesarean section) might be safer. Your obstetrician and gastroenterologist will work closely together to determine the best course of action for you near the time of delivery.

The bloating and cramps you experience before periods are often hormonal, but UC and endometriosis can both contribute to pelvic discomfort. Hormonal changes can sometimes trigger mild UC symptoms, but this does not necessarily mean a flare. It would be wise to discuss with your gynecologist further evaluation for endometriosis, as it is more common in women with inflammatory bowel disease.

With close monitoring and a stable treatment plan, you have an excellent chance of having a healthy pregnancy and delivery.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.