Women with Crohns disease who are considering having children can be comforted to know that the vast majority of such pregnancies will result in normal children. Research has shown that the course of pregnancy and delivery is usually not impaired in women with Crohns disease.

Even so, women with Crohns disease should discuss the matter with their doctors before pregnancy. Most children born to women with Crohns disease are unaffected. Children who do get the disease are sometimes more severely affected than adults, with slowed growth and delayed sexual development in some cases. Women with ulcerative colitis have normal fertility.

In Crohns disease, fertility may be reduced when the disease is active. Sulphasalazine can cause men to become less fertile. Fertility usually returns to normal when the drug is stopped. If possible, women should try to get pregnant when the disease is in remission. Flare-ups can occur during pregnancy but they are usually mild and will respond to medical treatment. Clinical experience has shown that the risk from steroids and sulphasalazine to the baby is extremely low.

Some doctors advise women to avoid pregnancy while on azathioprine because of theoretical risks, though many successful pregnancies have been recorded while taking the drug. Some doctors would suggest that a woman with inactive Crohns disease should stop taking her medication(s) during pregnancy, resuming an appropriate regimen only if a flare-up occurs.

Others might have different advice. Any woman who has Crohns disease and wants to become pregnant should discuss the issue of treatment during pregnancy with her health-care providers, where her personal medical history and treatment requirements can be taken into account. Women with Crohns disease whose disease is in remission at the time they conceive may experience increased symptoms during their third trimester, if they have symptoms at all. Many women suffer flare-ups immediately after giving birth. Doctors believe this is due to the hormonal changes of the pregnancy and postpartum period. “If Crohns disease flares up during pregnancy, sulphasalazine and steroids are permitted. Azathioprine and metronidazole should be avoided unless advised by a specialist.

However, note that there is no convincing proof that azathioprine has been responsible for foetal abnormalities and many inflammatory bowel disease specialists now recommend continuing the drug for those patients in whom relapse would be a major problem.There is no predicatable pattern to inflammatory bowel disease in pregnancy. Patients with inflammatory bowel disease often seem to be healthier during pregnancy, but at a risk of a flare-up in the postpartum period. The chance of a flare-up is not increased by pregnancy however it is advised to wait until disease is inactive before conception.

If patients conceive during a flare of Crohns disease:
- about 1/3 get better, 1/3 get worse and 1/3 stay the same

Women with Crohns disease tend to have more preterm births and babies with lower birth weights ”

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Because the symptoms and progress of ulcerative colitis vary from person to person, treatments must be tailored to individuals. In most cases, however, drug therapy is the first line of treatment for ulcerative colitis.Drug therapy helps treat the symptoms of ulcerative colitis and prevent them from coming back. The four main categories of medication for ulcerative colitis all work by reducing inflammation. The drug categories are aminosalicylates, corticosteroids, immunomodulators and biologic therapies.

Aminosalicylates are called “5-ASA” drugs because they contain 5-aminosalicylic acid, which helps control inflammation. These drugs usually are the first treatment for people with mild or moderate colitis. Most are taken orally, though if inflammation is located low in the large intestine, they can be delivered in enemas or suppositories.

Azulfidine (sulfasalazine): a combination of 5-ASA and the sulfa drug sulfapyridine, sulfasalazine was the first aminosalicylate used widely to treat colitis. In this combination, the sulfapyridine prevents 5-ASA from being absorbed until it reaches the large intestine. But the sulfa drug can cause unpleasant side effects. Newer 5-ASA drugs, while they still have side effects, are easier for some people to tolerate. Also called steroids, these medications can relieve symptoms quickly, but they usually are not effective in preventing symptoms from returning. They also can have serious side effects. As a result, corticosteroids usually are used for short periods of time only. People with ulcerative colitis gradually taper off corticosteroids since an abrupt stop can bring on symptoms. The drugs can be taken orally, delivered in enemas, suppositories and foams, or given intravenously.

Immunomodulators reduce inflammation by suppressing the immune system. Immunomodulators are usually prescribed for people who:
•    Do not respond to other medications
•    Have become dependent on corticosteroids
•    Have active, severe cases of the disease

Because these drugs are “strong,” people must be monitored carefully for complications, including pancreatitis, hepatitis, reduced white blood cell count and infection. The drugs are taken orally, and it may take up to six months before they are fully effective.

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