Ulcerative Colitis and Pregnancy

Abstract

Ulcerative colitis (UC) is characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon. It commonly involves the rectum and may extend to involve other parts of the colon. The age of onset for females is during the reproductive years, and many are likely to get pregnant after the diagnosis of the disease. Women have comparable fertility to the general population when the disease is in remission. Fertility is likely to get affected in women with active disease and in women who had undergone ileal pouch-anal anastomosis (IPAA). Assisted reproduction has improved the chances of successful pregnancy in these women whose fertility is impaired following surgery. Affected females delay pregnancy due to active disease, fear of medications affecting the fetus, and fear of transmitting the disease to the newborn. Most drugs used in the management are safe in pregnancy except for drugs such as methotrexate and tofacitinib. Congenital abnormalities are not increased in pregnancies complicated with ulcerative colitis. Preconception counseling with the objective of planning the pregnancy during remission, reviewing drug therapy, and educating on the importance of continuing medication and its safety are important for better outcomes for the mother and the baby.