Ulcerative Colitis (UC) is a form of Inflammatory Bowel Disease (IBD) that causes long-term inflammation and ulcers in the lining of the large intestine (colon). This chronic, immune-mediated disorder frequently affects women during their reproductive years. Understanding the interactions between UC and gestation is important for women planning a family or currently pregnant. This article addresses the concerns surrounding UC onset and management during pregnancy.
The Direct Relationship Does Pregnancy Trigger UC
Pregnancy is generally not considered a direct cause of Ulcerative Colitis, which involves genetic and environmental factors. However, the hormonal and immunological shifts that occur during gestation can influence the disease’s activity. New diagnoses of IBD, including UC, can happen during pregnancy or the postpartum period, collectively known as pregnancy-onset disease.
When IBD is first diagnosed around the time of pregnancy, UC accounts for a higher percentage of diagnoses compared to Crohn’s disease. Symptom onset is distributed across all three trimesters and the first year after delivery. This new onset can be challenging to diagnose because symptoms like nausea, diarrhea, and fatigue may be mistaken for common pregnancy complaints.
Managing Existing Ulcerative Colitis During Pregnancy
For women who already have a UC diagnosis, the disease course during pregnancy is heavily influenced by its activity level at conception. Approximately 80% of women who conceive while their UC is in remission will remain in remission throughout their pregnancy. If UC is active at conception, there is a substantial risk of the disease worsening.
Flares are most commonly observed during the first trimester, when hormonal changes are pronounced, and in the three months following delivery. Preconception counseling is strongly recommended to ensure the disease is well-controlled before attempting to conceive. Active inflammation places both the mother and the developing fetus at risk, making continuous disease monitoring essential.
Non-invasive tools are preferred for monitoring UC activity during pregnancy to avoid procedures that carry risk. Fecal biomarkers, such as fecal calprotectin and fecal lactoferrin, are accurate, non-invasive, and inexpensive indicators of intestinal inflammation. These tests are used periodically to check for inflammation, even in the absence of symptoms. Intestinal ultrasound, performed by a trained specialist, is another safe imaging method to assess bowel wall thickness, which correlates with disease severity.
Dietary and lifestyle adjustments play a supportive role in managing UC during pregnancy. Maintaining adequate nutrition is important because active UC can impair the absorption of necessary nutrients like iron, folic acid, and vitamin D. A higher intake of vegetables and a lower intake of added sugars have been associated with lower levels of pro-inflammatory markers. Eating a well-balanced diet and considering nutritional supplements, particularly folic acid, is routinely advised for women with UC.
Medication Safety and Treatment Planning
The primary principle guiding treatment during pregnancy is that maintaining UC remission with medication is safer for the baby than having active, untreated disease. Women are strongly advised to continue their maintenance therapy throughout pregnancy and not stop medications without consulting a specialist. Treatment plans should be developed collaboratively between a gastroenterologist and an obstetrician.
Many common UC medications are considered safe to continue throughout gestation. Aminosalicylates (5-ASAs), often a first-line treatment for mild-to-moderate UC, are considered low-risk during pregnancy. Glucocorticoids, such as prednisone, are used to treat flares and are safe for use during the second and third trimesters. The risk of adverse outcomes from active UC far outweighs the low risk associated with these therapies.
For moderate-to-severe disease, biologic therapies and immunomodulators are generally considered safe. Large-scale studies show that the use of biologics during pregnancy does not increase the risk of adverse outcomes like preterm birth or low birth weight. The goal of this treatment approach is to suppress inflammation, which protects the mother and the fetus from the complications of active disease.
Impact of UC Activity on Pregnancy Outcomes
The primary factor determining a safe pregnancy outcome for a woman with UC is the level of disease activity. When UC is in remission, the risks of adverse outcomes are comparable to those of the general population. Active UC significantly increases the likelihood of complications for both the mother and the baby.
Active UC is associated with a nearly two-fold increase in preterm birth (delivery before 37 weeks) and more than double the risk of low birth weight (under 2,500 grams). Other risks include spontaneous abortion, stillbirth, and the infant being small for gestational age. The systemic inflammation associated with active disease, which leads to poor nutrient absorption and maternal ill-health, drives these adverse outcomes.
Women with IBD are approximately 1.5 times more likely to require a Cesarean section compared to healthy controls. UC itself does not necessitate a surgical delivery unless there is significant active perianal disease or other obstetric indications. The focus remains on achieving and maintaining remission to ensure the best possible outcome for both mother and child.