When you have inflammatory bowel disease (IBD)-whether itâs Crohnâs disease or ulcerative colitis-and youâre planning a pregnancy, the biggest question isnât just can I get pregnant? Itâs can I stay safe-for you and your baby. The truth is, the biggest danger isnât your medication. Itâs your disease being active.
Uncontrolled IBD Is the Real Threat
Many women worry that their IBD drugs might harm the baby. But research shows something more urgent: if your IBD is flaring when you get pregnant, youâre at much higher risk for serious problems. Women with active disease at conception are 2.3 times more likely to have a preterm baby, 1.8 times more likely to have a low-birth-weight infant, and 1.6 times more likely to experience stillbirth compared to those in remission. These arenât small risks. Theyâre life-changing.
Thatâs why experts now say: stay in remission. The goal isnât just to avoid symptoms. Itâs to get your gut quiet-ideally with endoscopic healing-before you even try to conceive. Most guidelines recommend being in stable, steroid-free remission for at least three months before pregnancy. Stopping your meds to âbe safeâ often backfires. A flare during pregnancy is harder to control, and steroids, which are sometimes used in flares, carry their own risks, especially in the first trimester.
What Medications Are Safe?
Not all IBD drugs are created equal when it comes to pregnancy. Some are proven safe. Others are risky. And some? Weâre still learning.
Aminosalicylates (5-ASAs) like mesalamine and sulfasalazine are the first-line go-to. Theyâve been used for decades in pregnant women with no clear link to birth defects. The Crohnâs & Colitis Foundation and European Crohnâs and Colitis Organisation (ECCO) both say you can keep taking them. But hereâs the catch: not all mesalamine brands are the same. AsacolÂŽ and Asacol HDÂŽ use a coating called dibutyl phthalate (DBP), which animal studies and some human data link to genital malformations in male babies. If youâre on Asacol, switch to Lialda, Delzicol, or Apriso-DBP-free versions-before getting pregnant. Sulfasalazine blocks folate absorption, so take a high-dose folic acid supplement (at least 0.8 mg, often 1-5 mg daily) to protect against neural tube defects.
Anti-TNF drugs like infliximab (Remicade) and adalimumab (Humira) have the strongest safety record of any biologic. Over 2,000 pregnancies tracked in the PIANO registry show no increase in birth defects, preterm birth, or low birth weight compared to the general population. These drugs cross the placenta, especially in the third trimester, so some doctors will pause dosing around week 30 to reduce drug levels in the baby. But donât stop early-keeping the drug going through most of pregnancy keeps your disease under control. Your baby will be fine. Theyâll clear the drug naturally after birth, and live vaccines (like MMR) are still safe at the usual ages.
Vedolizumab (Entyvio) is newer, but data is reassuring. The CONCEIVE study followed 103 pregnancies. No birth defects. No increased infections. Early reports showed fewer live births, but that was because many women in that group had active disease. When researchers adjusted for disease activity, the numbers looked just like the general population. Itâs now considered a solid option, especially for women who donât respond to anti-TNFs.
Ustekinumab (Stelara) has data from over 680 pregnancies. No red flags. Rates of preterm birth, low birth weight, and birth defects matched the general U.S. population. A 2023 European study of 78 infants exposed to ustekinumab found no increased risks, even when mothers got induction doses early in pregnancy. Itâs now in the âlimited but reassuringâ category.
What to Avoid Completely
Some drugs are absolute no-gos. Methotrexate is a known teratogen-it causes severe birth defects in 17-27% of exposed pregnancies. If youâre on it, you must stop at least three months before trying to conceive. Thalidomide is even worse-linked to limb deformities and other catastrophic issues. Never take it during pregnancy.
JAK inhibitors like tofacitinib and upadacitinib are trickier. Thereâs very little data. A small study of 11 pregnancies on tofacitinib showed no obvious harm, but because these drugs affect the JAK-STAT pathway-which is critical for early embryo development-experts recommend stopping them at least one week before conception (for tofacitinib) or 4-6 weeks before (for upadacitinib). If youâre on one of these, talk to your doctor about switching to a safer option before you start trying.
What About Azathioprine and 6-MP?
These immunomodulators have been used safely in pregnancy for over 30 years. Studies show no increased risk of birth defects or miscarriage. The biggest concern is low white blood cell counts in the mother, so regular blood tests are needed. But if your IBD is controlled on these drugs, thereâs no reason to switch. Stopping them increases flare risk-and thatâs far more dangerous than the drugs themselves.
Delivery and Breastfeeding
Most IBD medications are safe during delivery and breastfeeding. Anti-TNFs, vedolizumab, ustekinumab, and 5-ASAs all pass into breast milk in tiny amounts-far below levels that would affect the baby. The ECCO guidelines say you can breastfeed while on these drugs without concern. Sulfasalazine is debated, but even then, the amount in milk is minimal. No need to pump and dump. And yes, your baby can still get all their routine vaccines, including live ones like rotavirus and MMR. Exposure to your meds doesnât make them immunocompromised.
How to Plan Ahead
This isnât something to figure out the month you get a positive test. Plan at least 3-6 months before conception. That means:
- Getting your IBD into remission with your gastroenterologist
- Switching to pregnancy-safe meds if youâre on methotrexate or a JAK inhibitor
- Starting high-dose folic acid
- Setting up coordinated care between your GI doctor and OB-GYN
Many women donât realize their GI doctor should be part of their prenatal team. In fact, only 42% of community gastroenterologists could correctly list all safe IBD drugs in a 2021 survey. Donât assume your OB knows the details. Bring your medication list. Ask: âIs this safe? Should I switch?â
The Bigger Picture
The science is moving fast. The PIANO registry has tracked over 1,500 pregnancies since 2007. New studies like VERSA and PLACENTA are looking at long-term child development and how much of the drug actually crosses the placenta. By 2025, a shared decision-making tool will help patients and doctors weigh risks more clearly.
What hasnât changed: your health matters more than you think. Youâre not just a patient-youâre a future parent. And the best gift you can give your baby is a healthy, stable mom. Medications arenât the enemy. Uncontrolled inflammation is.
Can I get pregnant if I have IBD?
Yes, absolutely. Most women with IBD can have healthy pregnancies. The key is being in remission before conception. Active disease increases risks like preterm birth and low birth weight, but well-controlled IBD doesnât reduce fertility or pregnancy success.
Is mesalamine safe during pregnancy?
Yes-but only if itâs a DBP-free formulation. Avoid AsacolÂŽ and Asacol HDÂŽ because they contain dibutyl phthalate, which has been linked to genital malformations in male fetuses. Switch to Lialda, Delzicol, or Apriso before trying to conceive. These are considered safe throughout pregnancy.
Should I stop my biologics during pregnancy?
No, donât stop them unless your doctor advises it. Anti-TNFs like infliximab and adalimumab are safe and should be continued. Some doctors pause them around week 30 to reduce drug levels in the baby, but stopping earlier increases your risk of a flare. Vedolizumab and ustekinumab can also be continued safely throughout pregnancy.
Is it safe to breastfeed while on IBD medication?
Yes. Most IBD medications-anti-TNFs, vedolizumab, ustekinumab, 5-ASAs, and azathioprine-pass into breast milk in very small amounts that are not harmful. You do not need to pump and dump. Your baby can still receive all routine vaccines, including live ones.
What if Iâm on methotrexate and want to get pregnant?
Stop methotrexate immediately and talk to your doctor. Itâs a known teratogen and can cause severe birth defects. Wait at least three months after your last dose before trying to conceive. Your doctor will help you switch to a safer medication like azathioprine or a biologic.
Do I need to see a specialist before getting pregnant?
Yes. Coordinate care between your gastroenterologist and obstetrician. Many OB-GYNs arenât trained in IBD medication safety. Bring your full medication list, your last colonoscopy results, and your remission status. Planning ahead reduces risks and improves outcomes for both you and your baby.
What to Do Next
If youâre thinking about pregnancy:
- Check your current meds-especially if youâre on mesalamine, methotrexate, or a JAK inhibitor.
- Book an appointment with your GI doctor at least 6 months before trying to conceive.
- Start high-dose folic acid now, even if youâre not actively trying.
- Ask for a referral to a high-risk OB if youâve had complications before.
The goal isnât perfection. Itâs control. You donât need to be symptom-free forever. But you do need to be stable-medication and all-before you get pregnant. Your baby deserves that. And so do you.
Rupa DasGupta
December 6, 2025 AT 04:21OMG I was on Humira when I got pregnant and my OB had NO idea what to do đ I literally had to print out the PIANO registry data and show her. So glad I didnât listen to the âjust stop everythingâ crowd. Babyâs 2 now and thriving. đ¤
ashlie perry
December 6, 2025 AT 14:50theyâre lying about the drugs. the FDA knows mesalamine causes autism. they just donât want you to know. why do you think they changed the coating? to hide it. my cousinâs kid got diagnosed after she took it. theyâll cover it up. always do.
Mark Ziegenbein
December 7, 2025 AT 02:57Letâs be real here-the entire medical establishmentâs obsession with âremissionâ is a neoliberal myth designed to pathologize normal bodily variation. Youâre told to âcontrolâ your IBD like itâs a glitch in your operating system rather than an evolutionary adaptation to modern toxins. The real danger isnât inflammation-itâs the pharmaceutical-industrial complex profiting off your fear. They want you hooked on biologics so youâll never question why your gut is screaming in the first place. And donât get me started on folic acid supplementation-another corporate sop to keep you docile while they poison your microbiome with glyphosate-laden food. The truth? Your body knows what itâs doing. You just need to stop listening to the white coats and start listening to your intuition. Or better yet-go raw vegan and meditate. Thatâs what worked for me.
Juliet Morgan
December 8, 2025 AT 20:49i just want to say to anyone reading this-youâre not alone. i was terrified when i got pregnant with ibd, but my gi and ob worked together and it was the best decision i ever made. my son is 3 and heâs got the energy of a caffeinated squirrel. you got this. â¤ď¸
Katie Allan
December 10, 2025 AT 18:19This is one of the most thoughtful, evidence-based pieces Iâve read on maternal IBD care in years. The emphasis on endoscopic healing over symptom suppression is critical-and the data on vedolizumab and ustekinumab is genuinely reassuring. Too often, patients are left to navigate this alone. Kudos to the author for making the science accessible without diluting its rigor. We need more of this in patient education.
Krishan Patel
December 11, 2025 AT 02:52You people are fools. If youâre so worried about your baby, why are you even taking ANY drugs? Nature didnât design humans to be chemically dependent. My cousin had Crohnâs and just ate turmeric and yoga-she had three kids without a single medication. Youâre all brainwashed by Big Pharma. Stop being lab rats. Your body is not broken. You just need discipline.
Deborah Jacobs
December 11, 2025 AT 03:59my best friend switched from Asacol to Lialda before she got pregnant and literally cried when her OB said it was safe. sheâd been scared for years. now her daughter is 18 months old and has the most ridiculous laugh-like a tiny cartoon character. i just want to tell every woman reading this: your fear is valid, but your hope? itâs valid too. you donât have to be perfect. you just have to be prepared. and youâre already doing better than you think.
Laura Saye
December 12, 2025 AT 23:43The epistemological tension here is fascinating-between biomedical reductionism and embodied maternal agency. The pharmacokinetic data on placental transfer of anti-TNFs is robust, yet the phenomenological experience of maternal anxiety remains under-addressed. We must reconcile clinical certainty with existential vulnerability. The body is not merely a vessel for pharmaceuticals; it is a dynamic, self-regulating system in dialogue with environmental and psychological stressors. Hence, the imperative to stabilize disease activity isnât merely therapeutic-itâs ontological. Oneâs identity as a future parent is inextricably bound to the integrity of oneâs physiological baseline. Thus, medication adherence becomes not a compliance issue, but an act of radical self-acceptance within a medicalized paradigm.