My daughter has ulcerative colitis. Is pregnancy possible?

Question

Hello doctor,

My 24-year-old daughter has been battling ulcerative colitis for three years and just had to drop out of nursing school because of it. She is having bloody diarrhea 15 to 20 times a day with mucus and cannot leave the bathroom for more than 30 minutes at a time.

Her last colonoscopy showed severe pancolitis with deep ulcerations throughout the entire colon. tried mesalamine suppositories and oral, but they do not do anything anymore.

Her gastroenterologist started Infliximab infusions six months ago, which helped initially, but now she has developed antibodies to it.

Her CRP is 67, and fecal calprotectin is over 1800. She lost 35 pounds and looks like a skeleton. Her hemoglobin is 8.1 due to all the bleeding.

The worst part is she is engaged and planning a wedding for next year, but how can she get married when she cannot go anywhere without having an accident?

She is on Prednisone 40 mg daily now, which is causing moon face and acne. Her doctors are talking about surgery to remove the colon, but she is only 24, and our concerns are:

Can she still have babies without a colon?
Are there any new medications for ulcerative colitis that might work?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your daughter has very severe ulcerative colitis (pancolitis). Passing blood 15 to 20 times daily, high CRP of 67 (C-reactive protein), calprotectin 1800, weight loss, and anemia (Hb 8.1) show active, aggressive inflammation. This is not a mild disease.

Mesalamine is usually used for mild cases. In her case, it is no longer enough. She initially responded to Infliximab, but developing antibodies can make it stop working. This is unfortunately common. Prednisone at 40 mg is used to control flare quickly, but it is not safe long-term.

Moon face, acne, and mood changes are steroid side effects. The goal is always to taper steroids once stronger maintenance therapy works. There are still medical options before surgery. Other biologics like Vedolizumab (gut-selective), Ustekinumab, and small molecule drugs like Tofacitinib are effective in patients who fail infliximab.

Many patients achieve remission with these. However, because she has severe disease, deep ulcers, weight loss, and anemia, surgery is sometimes lifesaving and curative for colitis.

Removing the colon cures ulcerative colitis because the disease only affects the colon. Young patients can still marry, live normally, and even have children after surgery. Many undergo colectomy with an ileal pouch (J-pouch).

Fertility is usually preserved, though sometimes slightly reduced. Pregnancy is possible, and many women deliver safely after surgery. Right now, the priority is to control bleeding, correct anemia (iron or transfusion), improve nutrition, and control inflammation quickly.

She should be managed at a center experienced in severe colitis. This is a very difficult phase, but many young patients recover their lives, whether through advanced biologics or surgery. She can still have a future, marriage, and children.

It would be better if you could tell me whether doctors are discussing J-pouch surgery or a temporary stoma. I can explain clearly what that means for her future.

I hope this information helps you.

Thank you.