Could anemia be worsening my UC symptoms or fatigue?

Question

Hello doctor,

I am 31 years old and have had ulcerative colitis for four years. My current treatment is mesalamine and, intermittently, steroids during flare-ups. Recently, my symptoms have worsened, with five to six loose stools per day, and sometimes blood. Moderate inflammation was found on colonoscopy last month.

My spouse and I are thinking about starting a family, but I am anxious about how flare-ups of Ulcerative Colitis would affect my pregnancy and my baby’s health.

Should I wait till my condition is more stable before trying to conceive?

I also would like to know if there is any harm to the fetus from medications like mesalamine or steroids.

I have been feeling weak lately, and my hemoglobin is 9.8 g/dL. Could anemia be worsening my UC symptoms or fatigue?
Does rectal inflammation from UC make it more likely that I would need a C-section during delivery?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com

I have read your query and understand your concern.

I would also appreciate advice on diet or ways to manage stress that could help lower the number or severity of flare-ups.

You have asked some important questions, and it’s good to see you planning for pregnancy while managing ulcerative colitis. Here’s an overview based on the latest evidence to help address your concerns:

Ideally, conception is recommended when your UC is in remission. Pregnancy outcomes are generally better when conception occurs during a stable, inactive phase of the disease.

Active disease at the time of conception can increase the risk of:

Temporary difficulty conceiving during flares.
Miscarriage.
Preterm delivery.
Low birth weight.
Disease flares during pregnancy.

Recommendation: Aim for at least three to six months of remission before trying to conceive, if possible. Working closely with your gastroenterologist to optimize disease control beforehand is strongly advised.

Mesalamine

Generally considered safe during all trimesters and while breastfeeding
Has minimal systemic absorption
Has not been shown to significantly increase the risk of birth defects

In most cases, continuing mesalamine is recommended because uncontrolled disease activity poses greater risks to both mother and baby than the medication itself.

Corticosteroids (such as prednisolone)

This medication is commonly used when flare control is required.
The placenta inactivates most of the medication, which limits fetal exposure.
Use during the first trimester may slightly increase the risk of gestational diabetes, hypertension, or, in rare cases, cleft lip or palate.

Still, when steroids are needed for medical reasons, the risks of not controlling inflammation are usually seen as more serious than the risks of using steroids for a short time.

A hemoglobin level of 9.8 g/dL shows anemia. This is common in UC because of long-term blood loss, inflammation, and the body not absorbing nutrients well.

Anemia can lead to:

Fatigue and weakness
Reduced energy levels
Feeling generally unwell and taking longer to recover

Anemia does not make UC worse on its own, but it often shows there is still inflammation or a lack of nutrients. These issues should be treated before pregnancy.

Management options may include the following:

Oral iron supplements (if tolerated)
Intravenous iron if oral supplementation worsens gastrointestinal symptoms
Folate and vitamin B12 supplementation as indicated

Correcting anemia before conception is important for both maternal health and pregnancy outcomes.

I hope these suggestions are helpful.

Take care, and feel free to reach out if you need further guidance.

Thank you.