The following is an Editorial Resource from YourTotalHealth.
How might you handle the situation of pregnancy with the possibility of no medication?
I was just recently diagnosed with Crohn's disease and have been placed on medications. Though I am thrilled to feel like myself again, I'm not so thrilled about the possible side effects of these drugs. I'm concerned about the effects of being on these medications long term and about being on medication during pregnancy.
It is common to be concerned about the safety and possible side effects with any medication, but especially those that are being recommended for long-term use. It is even more common to have questions and be concerned about the use of these medications during pregnancy. This is a routine conversation in our practice, and I'm happy to shed some light on the situation. The following comments apply to ulcerative colitis patients too.
1. If your Crohn's disease is in stable remission, your fertility (ability to become pregnant naturally) is the same as the general population. If your Crohn's is not under good control, your fertility is decreased.
2. The biggest predictor of pregnancy outcome in Crohn's disease is the health of the mother. If you are sick or your Crohn's disease is active during pregnancy, you are more likely to have complications, including pre-term labor.
3. The best predictor of what your Crohn's disease will do during the pregnancy is whether the disease is under control at conception. If you get pregnant while flaring from your Crohn's, it is more likely to get worse during the pregnancy. If you get pregnant while in remission, you are more likely to stay healthy.
4. The biologic anti-TNF therapies approved for Crohn's disease, infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia) are all Pregnancy Class B. This means that they are thought to be safe in pregnancy based on animal studies and some human data. However, there is mounting evidence and even a U.S. national registry of Crohn's and pregnancy that have all consistently demonstrated that these agents are safe to the mother and to the babies during pregnancy. In fact, it appears that infliximab and adalimumab do not even cross the placenta until the third trimester, and certolizumab pegol may not actively cross the placenta throughout the pregnancy. Some clinicians try to modify the infliximab schedule so the last infusion is right at the beginning of the third trimeester. I also would refer you to the Crohn's and Colitis Foundation of America site.
5. It's tempting to try a dietary management strategy for your Crohn's disease, but I must emphasize that if you needed infliximab and methotrexate to get this condition under control, you are taking great risks in stopping your therapies. There are many anecdotal studies of dietary "cures" and claims on the Internet. I must warn you against this. It certainly makes sense and sounds good, but alas, we have been unable to prove this so far, and it often causes much more harm than good.
6. It is absolutely true that you can not get pregnant on methotrexate. This is Pregnancy Class X and is an abortive agent (it was the original morning after pill). This drug must be stopped when you decide it's time to expand your family, but infliximab, in my opinion and those of my expert colleagues, should not.
7. I can't emphasize enough how important it is that you stay on stable maintenance therapies and keep your Crohn's under control. Taking risks by stopping effective therapies raises your likelihood of needing surgery. In large studies assessing the risks in Crohn's disease, the biggest risks for serious infections and even death were active moderate to severe Crohn's, corticosteroids and narcotics and not infliximab or the other immune drugs that we use routinely to control the disease and to, as you say, give our patients their lives back.
?Dr. Rubin
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