Things to Consider Before Trying to Conceive with IBD
Is there ever a right time to have a baby? In honesty, probably not. For regular folk, trying to conceive is stressful enough, but add IBD into the mix and it can feel impossible. Whilst many patients conceive without worry (or even by a happy accident), others need to put a little more planning in place. If that's you, here are some things to potentially consider before trying to conceive...
1. Is my disease stable?
If your disease is in remission, you are thought to have just the same chance of getting pregnant as any other woman.1 If it's active, it's thought this could hamper your fertility. For me, this is a difficult one because, for some of us, remission is not easily attainable (And something we could be waiting years for).
However, if you do try to conceive whilst your disease is active, it might take longer- or if you do get pregnant when not in remission then it is more likely that you might experience complications.1 I just want to say although this sounds scary, there are women who conceived when flaring. And there are many babies who are born healthy even if the mom has struggled during pregnancy. So if you do conceive during a flare, try not to panic and think the worst!
Of course, it's not ideal: I conceived starting Humira so was not in full remission (but I had the OK from my doctor beforehand) and I really struggled in my first trimester. Your doctor will know your body best and they will be able to advice what is a stable period for you (even if it is not complete remission). So even if you're just considering a baby, talk to your doctor NOW to get their take on things.
2. Will I need to stop medication?
The good news is that for most of us: the answer is no! Azathioprine and biologics are now considered low risk. As are steroids. Of course, an ideal situation is no medication but your doctor will help balance this risk for you and your baby. Methotrexate and Thalidomide are not safe in pregnancy and will need to be stopped beforehand.
3. Are my nutritional deficiencies taken care of?
In particular, pregnant women need to take folic acid ideally months before getting pregnant. So it's worth thinking: if I get pregnant right now, how am I in terms of nutritional deficiencies? Because baby will soon start to use these up! Get your doctor to check things like vitamin D (linked to both IBD and fertility), folic acid and Iron and address them right away. Chat with your doctor about a safe prenatal you could take.
4. How will the pregnancy impact my health?
This is a bit of a trick question because unless you have a crystal ball, nobody knows the answer. But do your research and read stories of fellow patients. Be prepared for the hurdles you may face. I had an awful first trimester (which I have read is common) but feel great now in my 2nd. Do you have a backup plan if you flare (would you consider going on medication if you're currently med-free? are you prepared to take steroids?). It's not just IBD. Pregnancy brings with it many pitfalls: morning sickness, back pain, low energy. Hopefully, you'll be glowing but is it a good time for you to manage these issues?
5. What about my life circumstances?
And finally, anyone planning pregnancy should consider their life circumstances in general. Do you have a flexible employer that's aware of your medical needs? I'm very grateful that I work from home because there is no way I could have left the house some days in the early weeks. What is the maternity situation like? Is your job or circumstances stressful? There's never a perfect time but it can be worth making sure you feel ready: both in terms of your personal and professional life so you can concentrate on taking care of you, your body and baby!
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