My daughter, 33, has UC and is pregnant. How to handle flares?

Question

Hi doctor,

My 33-year-old daughter has had ulcerative colitis for seven years and just found out she is pregnant, which was not planned. She was doing well on Adalimumab injections every two weeks, but now the gastroenterologist wants to switch medications because of pregnancy. She is having a bad flare right now with blood in stool six to seven times daily and has lost nine pounds in the past three weeks.

Her calprotectin level is over 800, and her hemoglobin dropped to 10.1 due to bleeding. The gynecologist is worried because she is only eight weeks along, and the ulcerative colitis symptoms are getting worse instead of better. She tried Mesalamine enemas, but they gave her cramping and did not seem to help the inflammation. Her previous gastroenterologist said stress makes flares worse, and now she is stressed about the baby and the disease both.

Can ulcerative colitis cause miscarriage or premature birth?
Also, I am worried about malnutrition affecting the baby's development since she cannot keep much food down. Are biologics safe during pregnancy, or should she try steroids instead?

She really wants this baby, but is scared the medications will cause problems.

Please advise.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com

I am deeply concerned about your worries.

Active ulcerative colitis (UC) itself, not the medications, is the bigger danger to both mother and baby. Uncontrolled inflammation increases the risk of:

Miscarriage or early pregnancy loss.
Preterm birth.
Low birth weight and poor fetal growth.
Maternal anemia and malnutrition.

So the goal is rapid control of the flare, even if that means continuing or restarting biologic therapy.

I would suggest the following management plan:

You should consult a gastroenterologist for further planning and a consultant gynecologist.

Discuss anti-tumor necrosis factor (TNF) agents like Adalimumab (Humira) and Infliximab (Remicade), as they have strong safety data in pregnancy.

They do not increase birth defect rates, miscarriage risk, or long-term infant problems according to large registries and studies.
Many guidelines recommend continuing anti-TNF therapy through most or all of pregnancy if needed for disease control.
The biologic can be continued at least through the second trimester, and sometimes through week 34 to 36, depending on disease severity and risk of flare.
The risk of stopping Adalimumab now is high: discontinuation during pregnancy often triggers severe flares like your daughter’s.

I hope this answers your query.

Feel free to ask if you have any further questions.

Thank you.