Pregnancy and IBD

Pregnancy in Crohn's Disease

  • Aim to conceive during remission
  • Continue taking maintenance medication (except methotrexate)
  • Take ≈ 2mg/d Folic acid supplementation and follow a healthy diet before conception
  • Avoid teratogenic medications

Medication during pregnancy


ECCO Statement 11C (2010)

If conception occurs at a time of quiescent disease the risk of relapse is the same as in non-pregnant women [EL5, RG D]. If conception occurs at a time of active disease, two thirds have persistent activity and of these two thirds deteriorate [EL3b, RG B]. Both clinical activity and surgical interventions decline with pregnancy and parity [EL4, RG C]. Nutritional status also influences parity [EL4, RG C].

Further information

  • Pregnancy associated with reduction in subsequent disease activity and surgery
Course of disease during pregnancy

ECCO Statement 11G (2010)

Medical treatment for Crohn's disease (except methotrexate) should generally continue during pregnancy, because the benefits outweigh the risk of medication.

Further information

Stop methotrexate, otherwise continue medication

The following are safe to use in pregnancy: metoclopromide, vitamin B6, ondansetron; antacids, sucralfate, H2 receptor antagonists, certain PPI's; codeine (avoid NSAIDs and aspirin); colestyramine and (probably) loperamide (but not diphenoxylate)

Safe symptomatic treatments

  • 1 in 3 risk relapse over 9 months
Risk relapse unchanged

ECCO Statement 11F (2010)

Indications for surgery in pregnant women with Crohn's disease are the same as for non-pregnant patients: obstruction, perforation, haemorrhage and abscess. In the severely ill patient, continued illness is a greater risk to the fetus than surgical intervention [EL5, RG D].

Further information

  • 2/3 remain active
  • 2/3 of those with active disease deteriorate
  • Indications for surgery similar to non-pregnant state, preferably resulting in temporary ileostomy (avoid primary anastomosis). Only delay surgery to allow critical fetal maturation
  • Endoscopy can be used safely if necessary
Majority remain active

Effect on fertility

ECCO Statement 11A (2010)

Crohn's disease does not seem to affect fertility when the disease is inactive [EL3b, RG B];however active disease leads to reduced fertility [EL3b, RG B]. Female patients who undergo surgery are at risk for impaired tubal function [EL3b, RG B]. In male patients rectal excision may lead to impotence or ejaculatory problems;however there is no comparison with the general population [EL4, RG C]. Sulfasalazine therapy causes infertility (reversible) in male patients because of changes in semen quality [EL3b, RG B].

Effect on fertility

Quiescent disease

Active disease

Previous surgery


Fertility normal

  • Due to inflammation involving the fallopian tubes and ovaries, and perianal disease causing dyspareunia
Fertility reduced

  • Females: deleterious effect on Fallopian tubes and ovaries
  • Males: rectal excision may lead to impotence and ejaculatory problems
Fertility potentially reduced

  • Sulphasalazine reversibly reduces male fertility
  • Other medications (Mesalazine, Azathioprine, Infliximab) have no effect, though one small study showed adverse outcomes in males treated with MP within 3 months of conception
Mostly fertility normal

Effect on pregnancy

Effect on pregnancy

ECCO Statement 11B (2010)

It is advisable to strive for clinical remission before conception. Flares are best treated aggressively to prevent complications [EL3a, RG B]. Crohn's disease is a risk for preterm delivery and low birth weight [EL 1a, RG B]. Insufficient data exist about maternal morbidity and fetal mortality at surgery.

Effect on pregnancy


ECCO Statement 11E (2010)

The mode of delivery should primarily be governed by obstetric necessity and indication, but also in conjunction with the gastroenterologist and/or the colorectal surgeon. Patients with uncomplicated Crohn's disease without perianal disease or rectal involvement can deliver vaginally after obstetric evaluation has been performed [EL4, RG C]. Caesarean section should be preferred in perianal disease or rectal involvement [EL4, RG C]. An ileoanal pouch is regarded as an indication for caesarean section [EL4, RG C]. Colostomy or ileostomy patients can deliver vaginally [EL4, RG C].

Further information

  • Ensure close liaison with obstetrician
Effect on mode of delivery

Active disease at

Quiescent disease at conception

Ileostomy or colostomy. Uncomplicated disease without perianal or rectal involvement

Active perianal or rectal disease; ileoanal pouch

  • Increased rate low birth weight
  • Increased rate premature delivery
  • No increased risk congenital malformation
  • 18-40% rate foetal death if surgery required
Adverse outcomes reported

No excess adverse pregnancy outcomes

Vaginal delivery

Caesarian section

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