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HIBD Horizon

Part 3 · Living well with IBD · 14/22

Pregnancy and fertility

There are many misconceptions. Here is what recent international recommendations say.

Yes, you can have children with IBDThe secret: a planned pregnancy, while the disease is calm. The experts' principle: a healthy mum is what best protects the baby.

Before

Aim to have been in remission for at least 3 to 6 months before conceiving.
Talk to your gastro so the treatment can be adjusted if needed.
Start the prescribed folic acid (vitamin B9).

During

Keep taking your long-term treatment: a flare is riskier for the baby than most treatments.
Close follow-up shared between your gastro and your obstetrician.
Cortisone or a test is still possible if needed.

After

Most treatments allow breastfeeding.
Vaginal delivery most of the time; a caesarean is sometimes offered (active disease around the anus, ileoanal pouch).
Stay alert: a flare can occur after the birth.

Treatments during pregnancy

Continued during pregnancy

Mesalazine, azathioprine, anti-TNF (Remicade, Humira…), Entyvio, Stelara, anti-IL-23 (Skyrizi, Omvoh, Tremfya). Breastfeeding possible.

With caution

Salazopyrine: with a folate supplement. Cortisone: possible for the length of a flare.

Stop before conceiving

Methotrexate: at least 3 months before. JAK tablets (Rinvoq, Xeljanz, Jyseleca): at least 4 weeks before. S1P tablets: Zeposia 3 months before, Velsipity 1 to 2 weeks before. No breastfeeding with JAK and S1P tablets.

Never stop a treatment on your own when you find out you are pregnant: call your gastro.

And dads?

Most treatments do not stop you having a child. Salazopyrine can lower sperm count, reversibly. For methotrexate, talk about it beforehand.

Baby's vaccinations

If the mum received a biologic during pregnancy, tell the paediatrician: no BCG for at least 6 months (some experts say 12). The rotavirus vaccine (live) should be discussed with them. The other vaccines follow the normal schedule.

Fertility

It is normal when the disease is calm. Pelvic surgery can reduce it, but IVF works as well as it does for anyone else.

Will my child have IBD?

The risk is a little higher than average, but the vast majority of children of affected parents will not have it.