Subfertility is commonly linked to chronic medical disease, but 1VIahadevan (2006a) cited a normal fertility rate for inflammatory bowel disease unless severe disease warranted surgery. Similarly, Alstead (2003) reported that decreased female fertility from active Crohn disease returned to normal with remission. For women requiring surgical resection, laparoscopic anastomosis has a higher subsequent fertility rate (Beyer-Berjot, 2013). With colectomy, however, even though fertility is improved, up to half of women will be persistently infertile (Bartels, 2012). Sexual function and fertility are only modestly afected by ileal pouch-anal anastomosis (Hor, 2016). Subfertility may also be partially due to sulfasalazine, which causes reversible sperm abnormalities (Feagins, 2009).
Because ulcerative colitis and Crohn disease are relatively common in young women, they are encountered with some frequency in pregnancy. In this regard, a few generalizations can be made. First, consensus supports that pregnancy does not increase the likelihood of an inlammatory bowel disease flare (.1ahadevan, 2015). Indeed, in a 10-year surveillance of women in the European Collaborative on Inflammatory Bowel Disease, the likelihood of a lare during pregnancy was decreased compared with the preconceptional rate (Riis, 2006). Although most women with quiescent disease in early pregnancy do not have relapses, when a lare develops, it may be severe. lso, active disease in early pregnancy increases the likelihood of poor pregnancy outcome, which is discussed subsequently. In general, most usual treatment regimens may be continued during pregnancy. Diagnostic evaluations should be undertaken if needed to direct management, and surgery should be performed if indicated. For women who successfully complete pregnancy, about half experience improvement in their health-relate.d q uali ty of life (Ananthakrishnan, 2012).
At first glance, it appears that adverse pregnancy outcomes are increased with inflammatory bowel disease (Boyd, 2015; Cornish, 2012; Getahun, 2014). Initially, this was attributed to the fact that most studies included women with either form of disease. Specifically, Crohn disease was noted to be linked to excessive morbidity (Dominitz, 2002; Stephansson, 2010). But, according to Reddy (2008) and others, these adverse outcomes were in women with severe disease and multiple recurrences. Indeed, in the prospective European case-control ECCO-EpiCom study of 332 pregnant women with inflammatory bowel disease, Bortoli and coworkers (2011) found similar outcomes in women with ulcerative colitis or Crohn disease compared with normally pregnant women. Importantly, perinatal mortality rates are not appreciably increased.
Ulcerative Colitis and Pregnancy. Ulcerative colitis does not signiicantly alter the course of pregnancy in afected women. In one review of 755 pregnancies, colitis that was quiescent at conception worsened in approximately a third of pregnancies (Fonager, 1998). In women with active disease at the time of conception, approximately 45 percent worsened, 25 percent remained unchanged, and only 25 percent improved. hese observations are similar to those previously described in an extensive review by Miller (1986) and a later report from Oron and colleagues (2012).
Osteoporosis is a signiicant complication in up to a third of these women, and thus vitamin D-800 IU daily-and calcium-1200 mg daily-are given. Folic acid, 4 mg orally daily, is recommended preconceptionally and during the first trimester for neural-tube defect prevention. his high dose counteracts the antifolate actions of sulfasalazine. Flares may be caused by psychogenic stress, and reassurance is important.