How compatible with inflammatory bowel diseases (Crohn's disease and nonspecific ulcerative colitis) with pregnancy planning, conception, pregnancy itself and subsequent feeding. Read in this article.
Content
I often have to hear questions about how compatible inflammatory bowel diseases are compatible (Crohn's disease and nonspecific ulcerative colitis) with pregnancy planning, conception, pregnancy itself and subsequent feeding. This question is less concerned about men - in fact, they are mainly interested in the question of possible heredity and the problem of the influence of medical drugs on spermatogenesis. For women, the topic of influence of inflammatory bowel disease for pregnancy, of course, is more exciting and deep.
Unfortunately, coming to doctors, they often hear ruthless «No» and tips forget about pregnancy forever. However, if you carefully examine the experience of making patients with Crohn's disease and ulcerative colitis in North America and Western Europe, it turns out that women who gave birth and focusing healthy children a lot! In no case can not put the cross and believe that you will not have children. The most important thing you should do is to find a good specialist familiar with inflammatory bowel diseases. Perhaps you should introduce the leading gynecologist and a gastroenterologist (proctologist). It is very important that you are not the first patient with inflammatory bowel diseases at the doctor.
Inflammatory bowel diseases
and pregnancy: what you need to know
Despite the emerging complex problems, women with inflammatory bowel diseases can hope and currently have successful life experience of pregnancy, child birth, and maternity. If you have Crohn's disease or nonspecific ulcerative colitis, and you want to have children, it is quite natural that you have concerns. You may ask yourself such questions:
- Will it be difficult for me to get pregnant?
- Will the pregnancy cause a deterioration of inflammatory bowel disease?
- Can the disease and my treatment rate to harm the child, before or after birth?
- Will I be breastfeeding?
This article discusses such controversial issues to give you a better idea of what should be expected. Ultimately, any of your pregnancy solutions will depend on your personal circumstances, and such decisions should be taken only in close contact with your gastroenterologist and gynecologist (midwife).
Inflammatory bowel disease and conception
Basically, women with non-specific ulcerative colitis or with crown disease in a state of remission (remission – A condition in which the symptoms of the disease subscribe and disappear) can become pregnant as easily as other women. Women with Crohn's disease in the active phase may experience difficulties when trying to get pregnant.
Inflammatory bowel disease in a man
Sulfasalazine (Salazosulfapyridine), the drug commonly used in inflammatory diseases of the intestines lowers the amount of sperm. If the couple takes attempts to conceive a child, he must stop taking sulfasalazine or go to another drug, only if the doctor approves such a drug replacement in therapy.
In no case, men and women cannot be taken by the immunosuppressive drug Methotrexate for three months before conception, and women should not accept him also during pregnancy, and during breastfeeding. This drug is highly toxic (poisonous) for developing embryo or newborn. Also, men are strongly recommended to stop receiving 6-MP and Azatiotrian for three months before conception.
Can pregnancy harm a woman with inflammatory bowel diseases
Woman should feel well before making the decision to get pregnant.
Better when pregnancy does not start during the period of exacerbation, and also if a new course has recently started, or if a woman takes steroid hormones.
If pregnancy has already come, you need to continue the course of treatment and the mode in which good health is preserved, even if it includes the reception of steroid hormones. In this case, the doctor must try to minimize (reduce as far as possible) dose of steroid hormones.
Pregnant women with inflammatory bowel diseases tend to elevated concern about the health of the child. A pregnant woman with an intestinal intestinal disease is very important to continue receiving the appointed drugs, and it is also important that her attending a gynecologist consulted with her gastroenterologist.
Often women stop taking all medicines when they find out what are pregnant, because they are afraid to harm the child with medication. But if, as a result, the exacerbation of the disease will be very difficult to take the situation under control again (to achieve remission). However, even if the exacerbation of the disease will lead to hospitalization, still a good chance to preserve pregnancy remains. Women diagnosed with Crohn's disease sometimes stop taking medicines after childbirth, as they are afraid of negative influence on the feeding of a child. It can cause a degradation of the disease in the postpartum period.
In some cases, pregnancy causes improved symptoms in inflammatory bowel diseases. This is due to an unusual feature, which is observed in the period of any pregnancy: the body is forced to suppress its own immune system so that there is no rejection of the embryo. Since the symptoms of inflammatory bowel diseases are the result of a hyperactive immune response, the muffling of the immune system during pregnancy often causes the offensive of the remission of the disease. The greater the genetic differences of the woman and the unborn child, the greater the muffling of the immune system, so as not to cause the rejection of the embryo, and, accordingly, better her well-being.
In one of the studies of women with Krone's disease, it was suggested that pregnancy could also protect against subsequent exacerbations and could reduce the need for future operations. This is due to the hormone, which is produced in the body of a pregnant woman. He protects the uterus from premature abbreviations (the start of the battle). It is assumed that relaxing also prevents the formation of scar tissue, which is often the reason for the need for a surgical operation in patients with Crohn's disease.
Effect of inflammatory bowel disease for pregnancy and child
In general, in a woman, both with Crohn's disease and non-specific ulcerative colitis, like any other woman, may be a normal pregnancy and childbirth. Problems Most often appear in pregnant women with the active stage of Crohn's disease, because due to illness they have low failure and anemia. Also in the body are created proteins (proteins), causing inflammation. These protein inflammation are circulated in the body and can influence the normal operation of many organs, and even on the embryo in the uterus. That is why there is more risk of misunderstanding, premature births or stillborn in pregnant women with the active stage of Crohn's disease. If the symptoms of the disease deteriorate to such an extent that surgery is needed, the risk for the child becomes even more.
Medicines with inflammatory bowel and pregnancy disease
Active inflammatory bowel disease, especially Crohn's disease, almost always threatens pregnancy more than many drugs used to control the disease. Therefore, drug intake mode is preserved during pregnancy. If the state of the woman is worsening, the course of drugs or their dosages must be adjusted.
Diagnostic research
If necessary, many diagnostic procedures – Including colonoscopy, rectoroscopy (sigmoidoscopy), other endoscopic studies, ultrasound examination of the abdominal cavity can be successfully and safely completed during pregnancy. MRI (magnetic resonance imaging), CT cut (computer-tomographic section), and ordinary x-ray can not be done during pregnancy, with the exception of emergency need for medical testimony. Magnetic resonance tomography is more secure than CT or X-ray cutout, but the risk still exists.
Surgical operations and pregnancy
If the patient is not critical and has the effect of treatment with drugs, the surgical operation should be postponed before the child is born. Cases of successful intestinal resection and Ileostomy (procedures in which the entire thick intestine is removed, and the ileum, this very last part of the small intestine, is carried out through the abdominal wall) performed during pregnancy. But any surgical operation in the abdominal cavity is a risk for the embryo (fetus).
Previous Surgical Intestinal Operations
Previous resections of the digestive tract probably do not have a negative impact on pregnancy women with Krone's disease. If the operation contributed to the offensive of remission (the disappearance of symptoms), it can only improve its chances of a prosperous pregnancy. Also observed successful pregnancy in women after surgery with the imposition of an ileoanal anastomosis with non-specific ulcerative colitis. With this operation, the thick and straight intestine is removed, and the ileum (the most recent part of the small intestine) joins the anus. The last study showed that women who have made an ileostomy with non-specific ulcerative colitis or crown disease have a slightly reduced fertility rate (ability to play). If there is no urgent need for this procedure and you are planning to have children, discuss with your doctor the right time for such an operation. The woman who was made by Ileostomy can also be fear of falling out (prolapse) or obstruction (obstruction) Ielestomas during pregnancy. The probability of this will be less if you wait a year after a surgical operation (resection) before you get pregnant, so that the body has done to adapt. If a woman with Crohn's disease appeared fistula (fistula) or abscesses (mini cluster) in the field of rectum and vagina, then, most likely it cannot be made of episotomy (crotch dissection) during childbirth, in order to expand the passage for the child. In such cases, it is often recommended to make caesarean motion.
Heredity
If one of the parents have Crohn's disease or nonspecific ulcerative colitis, then the child will have a 9% chance that such a state will develop. If both parents have inflammatory bowel diseases, then the chances that the child will develop inflammatory bowel disease, are 36%. The study also suggests that people receive a hereditary genetic predisposition to inflammatory bowel diseases, and the disease activity is manifested when the immune system gives too much response to bacteria and other stimuli in the intestine. People of certain ethnic groups are more inclined to the development of inflammatory bowel diseases . For example, the percentage of people with inflammatory bowel diseases among the American Jews of European origin 4 or 5 times higher than in the main population in the US.
Your emotions
Emotional stress may worsen the condition at any time, including pregnancy and postpartum period. There is no greater or less risk of postpartum depression in patients with inflammatory bowel disease. Patients with Crohn's disease or nonspecific ulcerative colitis are usually happy to successfully complete pregnancy, and become happy parents.
