I had the opportunity to interview Gastroenterologist (with specialization in IBD, preconception and pregnancy IBD management), and Clinician investigator: Dr. Vivian Huang. Dr. Huang not only works with people living with Inflammatory Bowel Disease, she also happens to be one herself. Diagnosed with Colitis during her first year of university, Dr. Huang now uses her experiences and expertise to treat and empower other IBD patients like herself.
There will be another post in the near future about Dr. Huang and her personal experiences with IBD. For now, we decided to discuss pregnancy. Pregnancy is a hot topic in the IBD community. Everyone has their own opinions on reproduction, but I wanted to talk to Dr. Huang about the facts. Below you will find my Q&A as we discuss everything from Pregnancy with Inflammatory Bowel Disease, to recommendations and Ostomy and J-pouch information!
What are some of the biggest misconceptions patients have about pregnancy with Inflammatory Bowel Disease (IBD)?– ” I cannot get pregnant because I have IBD “– ” My IBD will get better during pregnancy, so why do I have to stay on meds “– ” I need to stop all my medications when pregnant, as that is better for my baby “– ” Anyone with IBD has to have a C-section “– ” I will give IBD to my child “
Are there things a person with Inflammatory Bowel Disease should do differently from a “healthy” person during pregnancy?– Having IBD puts you into the higher risk pregnancy category because of the potential risk to flare, medications you might be on, however patients with IBD should do the SAME as “healthy person” – e.g. folic acid supplementation, vitamins, stop smoking, stop drinking, stop marijuana etc. Things patients should / may do MORE than “healthy” person: See their GI more frequently to assess disease state, ask for referral to “high risk” obstetrician or maternal fetal medicine specialist, be more aware of their body for signs of early flares and seek attention if have them so can be treated sooner, watch nutrition and ensure to be gaining appropriate weight.
What tips do you have for women with IBD who are considering having children in the near future?– Bring the topic up for discussion with your GP, your GI, your gynecologist if you have one and your family.– Ensure your IBD is as optimally treated as possible and in remission (objective and clinical).– If you need, or are recommended, to have any tests to investigate the disease – try to give some time for that before attempting to conceive as this allows you and your GI to ensure you ARE on appropriate medications, and medications that can be continued throughout the pregnancy.– If you have trouble with fertility – request a referral to fertility specialist – it may be because of scar tissue (adhesions) or damage to fallopian tubes when you had the J pouch surgery or procto-colectomy type of surgeries
Are patients With IBD who have had surgery and now live with an Ostomy or Jpouch any less likely to conceive or any more likely to have complications than other women?– Women who had deep pelvic surgery such as removal of the rectum or J-pouch surgery may find it harder to get pregnant. This is thought to be due to adhesions, or damage to the fallopian tubes preventing the egg from traveling to the uterus. – In those cases, in vitro fertilization has been successful. It is thought that laparoscopic methods may reduce the risk of forming these adhesions, however further studies are being conducted.– The surgery to create an ostomy itself does not interfere with fertility or pregnancy as it is not occurring deep in the pelvis. Women with an ostomy may run into trouble with changes in the peristomal area (e.g. blockage if the intestines are compressed as the baby grows, leakage if there are skin changes or stretching and the appliance may not stick as well) or partial obstruction related to adhesions that may have formed during abdominal surgery.
Are there any online resources for pregnant IBD patients or patients considering becoming pregnant?– There are some other sites that have some information
I created a web site – and studied it in a clinical trial – it is now published the study findings, and the website is public – has some information http://pregnancy.ibdclinic.ca, and I am trying to update it now with the newer biologics and medications.I am also leading an international steering committee to develop a pregnancy IBD decision aid for women with IBD. Also, AGA is developing resources (apparently).
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If you are someone living with Inflammatory Bowel Disease, are you considering having kids? Let’s discuss! Let me know what impacted your decision in the comments below.