Is it safe to take colitis medicines during pregnancy at 29?

Question

Hi doctor,

I am 29 years old and have had ulcerative colitis for five years. It was mostly controlled until I started a new job six months ago. The stress has made everything worse, and now I am having bloody diarrhea up to 15 times a day. My gastroenterologist increased my Mesalamine dose to 4.8 g daily and added Budesonide, but it has not helped much.

My recent colonoscopy showed pancolitis with severe inflammation throughout the entire colon. I have also been losing weight, down 22 pounds in three months. My hemoglobin is 9.4, and my ferritin is only 12, so I am severely anemic.

I also recently found out that I am six weeks pregnant, which was unplanned, and now I am panicking about my medications. My OB says Mesalamine is probably safe, but Budesonide should be stopped. The ulcerative colitis flare is so bad that I cannot work or function normally. I am also experiencing joint pain in my knees and ankles.

Do I need to stop all my ulcerative colitis medications during pregnancy? I am really scared about what this means for my baby.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

This is a challenging situation, but please know that many women with ulcerative colitis have healthy pregnancies when the condition is managed carefully.

Your symptoms, such as frequent bloody stools, severe pancolitis, weight loss, and anemia, suggest a significant flare. This poses more risk to the baby than the medications do. Active inflammation can lead to poor nutrition, preterm birth, or low birth weight, so controlling the disease is the top priority.

Regarding medications:

Mesalamine (5-ASA) is safe during pregnancy and should be continued, as it helps control inflammation.
Budesonide or other steroids may be used for the short term if the flare is severe. Your doctor may switch to Prednisolone, which is considered safe when necessary.
Avoid stopping any medication suddenly, as uncontrolled colitis is dangerous for both you and the baby.
Once you are stable, your gastroenterologist may consider safer long-term options such as Azathioprine if needed for maintenance.

What you should do now:

Continue close coordination between your gastroenterologist and obstetrician.
Treat your anemia with iron (preferably intravenous if oral iron is not tolerated).
Maintain a bland, high-calorie, low-residue diet and stay well-hydrated.
Get plenty of rest and try to manage stress- stress alone does not cause colitis, but it can worsen flares.

Do not stop Mesalamine. Allow your doctors to adjust steroid treatment as needed. Active disease is the greater threat, so controlling inflammation safely is the best way to protect both you and your baby.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.