Pregnancy with CED

Although the fertility of women with a chronic inflammatory bowel disease is in many cases no different from that of healthy women, IBD sufferers are more likely to remain childless. Reasons for this may include reduced sexual activity, misinformation or fear of an unfavorable pregnancy outcome due to IBD. Even though pregnancy can be challenging with IBD, the disease is not usually a reason to avoid pregnancy. 🤗🤰

This article provides information about IBD and pregnancy, but should not be seen as a substitute for a personal consultation with your doctor.

Studies show that the fertility of patients with inflammatory bowel disease is not impaired during remission. During an active phase of the disease, however, fertility may be temporarily reduced. Surgical interventions in the pelvic area can also result in temporary or permanent infertility. In these cases, artificial insemination, for example, can be helpful, as women can carry the child to term without complications in most cases. By way of comparison, however, it should be noted that around 10% of healthy women do not become pregnant despite regular unprotected sexual intercourse.

The fertility of patients with a chronic inflammatory bowel disease is also generally not impaired. However, abscesses and fistulas in the pelvic and anal area can lead to erectile dysfunction and ejaculation problems. In addition, certain medications can also lead to temporary infertility.

If there is a desire to have children, a detailed consultation with the treating gastroenterologist is important. Among other things, the aim should be to allay patients' unfounded fears and recognize potential complications in good time. Among other things, it makes sense to discuss the current drug therapy and adjust it if necessary. In addition, inflammatory activity should be assessed and potential deficiency symptoms should be identified and compensated for accordingly. Findings that require treatment should also be clarified. If, for example, surgery is necessary, this should ideally take place before a planned pregnancy.

Many IBD patients worry about passing the disease on to their child if they are planning a pregnancy. However, as IBD is merely a genetic predisposition to develop a chronic inflammatory bowel disease under certain circumstances, it is not a hereditary disease in the strict sense and is therefore not a reason for childlessness.

Ideally, fertilization should take place during remission. If this is maintained, the course of the pregnancy usually does not differ from that of healthy women. On the other hand, the number of miscarriages, premature births and other pregnancy complications increases significantly if fertilization takes place during a phase of increased inflammatory activity. In addition, if the egg is fertilized during an active phase, the disease may persist or worsen.

In principle, an uncomplicated pregnancy can be assumed for IBD patients. As with healthy women, it is important to eat a balanced diet with an adequate intake of minerals and vitamins, taking into account individual preferences and intolerances. It is also advisable to ensure sufficient fluid intake. Regular exercise is also healthy for mother and child and not only ensures better posture, but also prevents pregnancy problems such as venous congestion, calf cramps or hemorrhoids. Endurance sports such as swimming or cycling are particularly ideal in this respect.

In most cases, women with chronic inflammatory bowel disease are also advised to give birth vaginally. However, if the patient has a pronounced fistula in the pelvic or anal area, a caesarean section may be advisable. The same applies to women with a stoma or pouch, as the risk of complications, such as prolapse of the stoma, is increased in these cases. In principle, the birth process should always be coordinated with the treating gynecologist.

As it has been shown that breastfed children have a lower risk of illness, doctors often advise breastfeeding in many cases. As a rule, this is also possible without hesitation, except when taking certain medications. Nevertheless, it is important to pay attention to the individual condition and consider alternatives if necessary. If the IBD has worsened during pregnancy, this is not a sign that this will also be the case in future pregnancies and should therefore not deter further pregnancies. 

If women with IBD wish to have children, good planning is advisable. The same applies to a comprehensive discussion with the treating physicians in order to adjust medication if necessary and to identify and compensate for potential deficiency symptoms. With good advice before, during and after pregnancy, those affected can go through pregnancy and the subsequent breastfeeding period with a good feeling and generally assume a pregnancy without complications. 

Even without CED, there are a few things to consider during pregnancy and childbirth. You can find general information on this here:

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Landry, MD, W., Mross, MD, M. (2023). Pregnancy and IBD. The Gastroenterology Portal. https://dasgastroenterologieportal.de/krankheiten/chronisch-entzundliche-darmerkrankungen-ced/schwangerschaft-ced/

Schudok, A., Russ, J. Practical recommendations for nutrition in IBD. CME 22, 35 (2025). https://doi.org/10.1007/s11298-024-4142-y

Dargel, S., Mühler, N., Groten, T. et al. Chronic diseases during pregnancy. MMW - Advances in medicine 165, 54-60 (2023). https://doi.org/10.1007/s15006-023-2567-y

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Prof. Dr. med. Dignaß, M., Honus, S. (2024). Crohn's disease and ulcerative colitis during pregnancy and breastfeeding. (12th ed.). Dr. Falk Pharma GmbH (ed.). The informed patient. https://de.drfalkpharma.com/de/download/medium/morbus-crohn-und-colitis-ulcerosa-in-der-schwangerschaft-und-stillzeit-678/

Megymorecz, S., Dejaco, C. (2024). IBD and pregnancy. Austrian Society for Gastroenterology and Hepatology. https://www.oeggh.at/wp-content/uploads/2024/09/OEGGH_CED-SSW_240911.pdf

Charite University Medicine Berlin. Chronic inflammatory bowel disease. embryotox. https://www.embryotox.de/erkrankungen/details/ansicht/erkrankung/chronisch-entzuendliche-darmerkrankungen/

AbbVie GmbH. Fertility and pregnancy in Crohn's disease and ulcerative colitis. AbbVie GmbH. https://ced-kompass.at/wp-content/uploads/2021/04/Patientenfolder-schwangerschaft-FINAL.pdfDr. 

Bach, B. (2022). Chronic inflammatory bowel disease and the desire to have children: ECCO guideline on pregnancy updated. ÄrzteZeitung. https://www.aerztezeitung.de/Medizin/ECCO-Leitlinie-zur-Schwangerschaft-aktualisiert-426984.html

Gräfe, K. A. (2021). Fertility in Crohn's disease and ulcerative colitis. Pharmaceutical Newspaper. https://www.pharmazeutische-zeitung.de/kinderwunsch-bei-morbus-crohn-und-colitis-ulcerosa-124036/