Control of inflammatory bowel disease improves pregnancy outcomes

Women with inflammatory bowel disease (IBD) who wish to become pregnant should try to conceive when their disease is inactive, according to a leading obstetrician, Professor Michael Bennett, from Sydney's Royal Hospital for Women.

Professor Bennett will tell the Second Tri-Nations meeting in Gastroenterology, to be held in Mauritius this week, that the likelihood of delivering a healthy baby increases with prenatal planning to control the disease.

"Women with IBD are often fearful of becoming pregnant because their disease carries a 50% increased risk of the baby being born prematurely and of having low birth weight," he said. "Babies of affected women are also more likely to be delivered by Caesarian section."

Professor Bennett, who is Professor of Obstetrics and Gynaecology at the University of NSW, will discuss the latest advances in medical knowledge about the relationship between IBD, fertility and pregnancy with gastroenterologists from Australia, New Zealand and South Africa.

The two main types of IBD are Crohn's disease and ulcerative colitis. Both diseases cause inflammation, swelling and ulcers in the digestive tract and result in cramps, abdominal pain and diarrhoea. Symptoms are usually controlled with medication but sometimes surgery is needed.

"The disease affects men as well as women and occurs in most patients during the peak reproductive years from 20 to 30 years of age," Professor Bennett said.

"In the past, women with IBD were often advised not to have children but we now know that if the disease is well-controlled prior to, and during pregnancy, most women can look forward to a normal pregnancy and the full-term delivery of a healthy baby."

Women with IBD are generally as fertile as those without the disease but conception may be difficult for those with ulcerative colitis who have had surgery to control symptoms. In these women, infertility rates may be as high as 40 percent.

"Conception through IVF is often a successful alternative, particularly if the woman is aged less than 35 years. IVF usually works as well in women with IBD as those without the disease," Professor Bennett said.

Affected women are often concerned their disease may relapse during pregnancy. However, large studies have confirmed that pregnancy does not necessarily trigger a flare-up of symptoms or cause worse bouts. Neither have they demonstrated an increased risk of spontaneous miscarriage.

"In general, the outlook is optimistic," Professor Bennett says. "Advances in our understanding of the management of IBD during the pre-conception period and during pregnancy means that with good management, a healthy outcome is likely."

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