Can ulcerative colitis treatment affect pregnancy?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Managing severe ulcerative colitis (UC) with active inflammation, complicated by steroids and fertility concerns, is very challenging, but with the right plan, her health and reproductive goals can be supported. Here is a detailed breakdown addressing your concerns:

Biologics and their safety around conception: Biologics commonly used in UC include:

1. Anti-TNF (tumor necrosis factor) agents: Infliximab (Remicade), Adalimumab (Humira).

2. Anti-integrin: Vedolizumab (Entyvio).

3. Anti-IL12/23: Ustekinumab (Stelara).

Safety during conception and pregnancy: Anti-TNFs (Infliximab, Adalimumab) and Vedolizumab (an anti-inflammatory agent) are generally considered safe to continue during conception and pregnancy if UC is active, as uncontrolled inflammation poses higher risks to mother and fetus. They are often continued throughout pregnancy, with some doctors timing the last dose to reduce infant exposure near delivery. Ustekinumab (a human monoclonal antibody) data are more limited but are emerging as relatively safe.

Controlling the inflammation is paramount for fertility and pregnancy health.

Your daughter should discuss with her gastroenterologist and fertility specialist to pick the best biologic for her situation.

Delay the pregnancy until UC is controlled?

Ideally pregnancy should be planned during remission or well-controlled disease, because:

1. Active inflammation increases the risks of miscarriage, preterm birth, low birth weight, and complications.

2. Fertility is often reduced during active disease due to inflammation and poor nutrition.

3. Some medications used during flares might be less safe or require adjustment.

Impact of colectomy on pregnancy and delivery:

1. Colectomy with ileal pouch-anal anastomosis (IPAA) can affect fertility:

2. Pelvic surgery may cause scarring around reproductive organs, increasing the risk of infertility.

3. Some studies show up to a 50 % reduction in fertility post-IPAA due to tubal damage or adhesions.

However, pregnancy is possible after colectomy, but the delivery is typically by cesarean section to reduce the risk of damaging the pouch or pelvic floor.

She should discuss with her surgeon and obstetrician for individualized planning.

If disease cannot be controlled medically, colectomy can improve overall health and pregnancy outcomes by removing the diseased colon.

Irregular periods and steroids: High-dose prednisone commonly causes the following things;

1. Hormonal imbalances can lead to irregular or missed periods.

2. Mood swings, weight gain, and fluid retention.

3. While tapering steroids, periods often normalize, but:

4. Hormonal therapy might be considered if irregularity persists (after discussing with her doctors).

5. Managing inflammation and reducing steroids is the key.

Risks of long-term high-dose prednisone (a type of steroid): The side effects of steroid treatment include;

1. Osteopenia or osteoporosis (already present in your daughter).

2. Increased risk of infections due to immunosuppression.

3. Weight gain, diabetes, and hypertension.

4. Mood changes, insomnia, and muscle weakness.

5. Cataracts and glaucoma risk.

You must know that for such cases, long-term steroids are a temporary measure; transitioning to steroid-sparing therapies (like biologics) is critical.

Additional supportive measures:

1. Iron deficiency anemia: Monthly infusions are appropriate; optimizing inflammation control helps reduce blood loss.

2. Nutrition: Consult a dietitian specializing in IBD for optimizing caloric and micronutrient intake to support fertility and healing.

3. Mental health support: Mood swings and chronic illness stress require psychological support or counseling.

4. Pelvic care: Managing perianal abscesses/fistulas may need surgical drainage and possibly seton placement; coordinated care with colorectal surgery is important.

Summary recommendations

1. Work closely with a multidisciplinary team: gastroenterologist, fertility specialist, colorectal surgeon, and possibly a maternal-fetal medicine (high-risk pregnancy) specialist.

2. Start or continue a biologic therapy proven safe in pregnancy to control inflammation and taper steroids as soon as possible.

3. Plan pregnancy once UC is in remission or well-controlled.

4. Discuss colectomy risks and fertility impact, balancing disease severity and future reproductive goals.

5. Address anemia, nutrition, and hormonal irregularities as part of the overall plan.

I hope this information helps you.

Feel free to ask further queries.

Thank you.