When you have inflammatory bowel disease (IBD) and you're thinking about getting pregnant, the biggest question isn't just can I get pregnant-it's can I stay safe while doing it. The fear of harming your baby with medications is real. But here's the truth: the biggest danger isn't the drugs-it's the disease itself. Uncontrolled Crohn's or ulcerative colitis during pregnancy raises your risk of preterm birth, low birth weight, and even stillbirth by more than double compared to women whose disease is in remission.
Why Stopping Medication Is Riskier Than Taking It
Many women with IBD stop their meds when they start trying to conceive, thinking they're protecting the baby. That’s the opposite of what you should do. A 2023 global consensus from 42 experts across 15 countries, backed by data from over 1,500 pregnancies tracked in the PIANO registry, found that women who stopped their IBD medications were far more likely to flare during pregnancy-and flares lead to complications.Think of it this way: if your IBD is active, your body is in constant inflammation mode. That stress affects your placenta, your nutrient delivery, and your baby’s growth. Medications that keep you in remission? They’re doing the heavy lifting so your body can focus on growing a baby.
Dr. Uma Mahadevan, who led the global guidelines, put it plainly: “Stopping medication leads to an increase in IBD symptoms, which can make pregnancies high-risk.” These aren’t high-risk patients because they’re pregnant-they’re high-risk because their disease isn’t controlled.
Medications That Are Safe to Keep Taking
Not all IBD drugs are created equal when it comes to pregnancy. Here’s what the latest evidence says:- Aminosalicylates (5-ASAs) like mesalamine and sulfasalazine are considered safe. The Crohn’s & Colitis Foundation recommends continuing them without change. But here’s the catch: if you’re on Asacol HD or another formulation with dibutyl phthalate (DBP) coating, switch immediately. DBP has been linked to genital malformations in male fetuses in animal and human studies. Lialda, Delzicol, and Apriso are DBP-free and safe alternatives.
- Anti-TNF drugs like infliximab (Remicade) and adalimumab (Humira) have the strongest safety record of any biologic. Over 2,000 pregnancies in the PIANO registry showed no increase in birth defects, preterm birth, or low birth weight compared to the general population. These drugs are often continued throughout pregnancy, though some providers may pause them in the third trimester to reduce drug transfer to the baby.
- Vedolizumab (Entyvio) is now considered safe based on data from over 100 pregnancies. Early concerns about lower live birth rates disappeared when researchers accounted for disease activity-meaning if you’re in remission, your chances of a healthy baby are just as good as with other safe meds.
- Ustekinumab (Stelara) data has grown rapidly. Over 680 pregnancies tracked by the manufacturer show no increased risk of birth defects or complications. A 2024 European study of 78 babies born to mothers on ustekinumab found no difference in outcomes compared to those on other safe treatments.
Medications to Stop Before Conception
Some drugs are simply too risky to take while pregnant-or even trying to get pregnant.- Methotrexate is a hard no. It’s a known teratogen and can cause severe birth defects in 17-27% of exposed pregnancies. If you’re on it, you need to stop at least 3-6 months before trying to conceive. Your doctor will switch you to azathioprine or another safe option.
- Thalidomide is banned during pregnancy worldwide due to its link to limb deformities. It’s rarely used for IBD, but if you’re on it, this is non-negotiable.
- JAK inhibitors like tofacitinib and upadacitinib are newer, and while early data looks promising (no birth defects in 11 pregnancies with tofacitinib), experts still recommend stopping them 1-6 weeks before conception. Why? Because they interfere with the JAK-STAT pathway, which plays a key role in early fetal development. Better safe than sorry.
What About Steroids?
Corticosteroids like prednisone are sometimes used to bring a flare under control. But they’re not a long-term solution-and they’re especially risky in the first trimester. Studies show a 1.4 to 2.3 times higher risk of cleft lip or palate when taken during early pregnancy. If you need steroids, use the lowest dose for the shortest time possible. Your goal should be to get off them before conception and stay off them with safer maintenance drugs.
Immunomodulators: Azathioprine and 6-MP
Azathioprine and 6-mercaptopurine (6-MP) have been used safely in pregnancy for decades. Large studies show no increase in birth defects or developmental issues. The American College of Gastroenterology recommends continuing them through pregnancy, with regular blood tests to monitor your white blood cell count. These drugs cross the placenta, but the benefits of keeping your IBD quiet far outweigh any theoretical risks.What Happens After Delivery?
You might wonder: can I breastfeed while on my IBD meds? The answer is mostly yes.- 5-ASAs (mesalamine, sulfasalazine) are considered safe in breast milk. Even though sulfasalazine breaks down into sulfa, the amount passed to the baby is tiny and unlikely to cause harm.
- Anti-TNFs, vedolizumab, and ustekinumab are large proteins that don’t pass well into breast milk. Even if a trace amount does, it’s not absorbed by the baby’s gut.
- Immunomodulators like azathioprine are also considered compatible with breastfeeding.
- And yes-you can still give your baby all recommended vaccines, including live ones like MMR. Exposure to these drugs in utero doesn’t make vaccines dangerous.
Planning Ahead: The 3-Month Rule
The best time to talk about pregnancy isn’t when you miss your period. It’s 3 to 6 months before you start trying. This gives you time to:- Get your IBD into full remission-ideally confirmed by colonoscopy, not just symptoms
- Switch from unsafe meds (like methotrexate or DBP-containing mesalamine) to safe ones
- Start prenatal vitamins with extra folate (especially if you’re on sulfasalazine, which blocks folate absorption)
- Coordinate care between your gastroenterologist and OB-GYN
Too many women wait until they’re already pregnant to ask about meds. By then, you’re playing catch-up. The goal is to walk into pregnancy with your IBD under control and your meds already adjusted.
What If My IBD Flares During Pregnancy?
Flares happen-even with good planning. If you have a flare in the first trimester, don’t panic. The safest thing you can do is treat it aggressively with pregnancy-safe meds. Delaying treatment increases your risk of complications more than any medication ever could.Anti-TNFs and vedolizumab can be safely started during pregnancy if needed. Steroids may be used short-term, but again, only as a bridge-not a long-term fix. Your care team will monitor you closely, but remember: active disease is the enemy, not the medicine.
Where to Find Reliable Help
Not all doctors know the latest IBD and pregnancy guidelines. A 2021 survey found only 42% of community gastroenterologists could correctly identify all safe medications. Don’t assume your OB knows your IBD meds. Bring the PIANO guidelines with you-or print out the summary from the Crohn’s & Colitis Foundation.Ask for a joint appointment with your GI and OB. Many academic centers now offer specialized IBD pregnancy clinics. If yours doesn’t, request a referral. You deserve coordinated care.
The Bottom Line
You can have a healthy pregnancy with IBD. But it takes planning, the right meds, and the right team. The data is clear: continuing safe medications reduces your risk of complications more than stopping them ever could. Your baby’s safety isn’t about avoiding drugs-it’s about controlling your disease.Don’t let fear of medication stop you from becoming a parent. Let knowledge guide you instead.
Can I take mesalamine while pregnant?
Yes, but only if it’s a DBP-free formulation like Lialda, Delzicol, or Apriso. Avoid Asacol HD and other products with dibutyl phthalate coating, which have been linked to genital malformations in male fetuses. Mesalamine is one of the safest IBD medications during pregnancy and should be continued unless your doctor advises otherwise.
Is it safe to continue biologics like Humira or Remicade during pregnancy?
Yes. Anti-TNF biologics like adalimumab (Humira) and infliximab (Remicade) have been studied in over 2,000 pregnancies with no increase in birth defects, preterm birth, or low birth weight. Most experts recommend continuing them through pregnancy. Some may pause the last dose in the third trimester to reduce drug levels in the newborn, but this is optional and based on individual risk.
Should I stop my IBD meds if I’m trying to get pregnant?
No-not unless your medication is known to be harmful. Stopping safe meds like 5-ASAs, anti-TNFs, or azathioprine increases your risk of a flare, which is far more dangerous to your pregnancy than the medications themselves. Only stop drugs like methotrexate or JAK inhibitors, and only after talking to your doctor about safe alternatives.
Can I breastfeed while taking IBD medications?
Yes. Most IBD medications, including mesalamine, azathioprine, anti-TNFs, vedolizumab, and ustekinumab, are considered safe during breastfeeding. The amount that passes into breast milk is very low and not absorbed by the baby’s gut. You can safely give your baby all routine vaccines, including live ones like MMR.
What’s the biggest risk to my baby if I have IBD?
The biggest risk is uncontrolled IBD. Active disease at conception increases the chance of preterm birth by 2.3 times, low birth weight by 1.8 times, and stillbirth by 1.6 times. Medications used to control IBD pose significantly less risk than the disease itself. Keeping your IBD in remission is the single most important thing you can do for a healthy pregnancy.
When should I talk to my doctor about pregnancy and IBD?
At least 3 to 6 months before you start trying to conceive. This gives you time to get your disease into remission, switch to safer medications if needed, start prenatal vitamins, and coordinate care between your gastroenterologist and OB-GYN. Waiting until after you’re pregnant makes it harder to optimize your treatment safely.
Bee Floyd
December 1, 2025 AT 12:50Just read this whole thing and honestly? I wish my GI had told me this before I panicked and quit my meds. I went into my first trimester with a flare because I thought I was being "responsible." Turned out I was just being dumb. My daughter is 2 now, healthy as hell, but I still cringe thinking about how close I came to losing it all.
Don't let fear make the decisions. Let data. Let your team. Let your body breathe.
Also - DBP in mesalamine? That's wild. I had Asacol HD. Switched to Lialda after this. Zero regrets.
Jeremy Butler
December 2, 2025 AT 04:19The ontological implications of pharmacological intervention in reproductive physiology are profoundly complex. One must interrogate not merely the empirical outcomes of medication adherence, but the epistemic authority underpinning clinical guidelines derived from registries such as PIANO. The reductionist framing of risk as binary-medication versus disease-obscures the hermeneutic dimension of patient autonomy and the phenomenology of maternal anxiety.
That said, the preponderance of evidence does suggest that the cessation of immunomodulatory agents constitutes a greater threat to fetal homeostasis than their continuation, a conclusion that aligns with the Aristotelian principle of the mean: neither excessive fear nor reckless abandonment, but measured, evidence-based stewardship.
Courtney Co
December 3, 2025 AT 20:13I'm 32 and just found out I have Crohn's and I'm pregnant and I've been on methotrexate for 2 years and I just read this and I'm crying and I don't even know who to call and I'm scared I'm going to lose my baby and I didn't even know about the DBP thing and I took Asacol HD for 6 months and now I'm terrified and I don't know if I can switch in time and I'm so alone and why didn't anyone tell me this before I got pregnant and I hate that no one talks about this and I feel like I'm going to die inside.
Can someone please just tell me what to do?
Shashank Vira
December 4, 2025 AT 08:13How quaint. Western medicine, with its clinical trials and registries, presumes to hold the monopoly on truth. In India, we have centuries of Ayurvedic wisdom that recognizes the body as a dynamic equilibrium - not a machine to be dosed. Why are we so quick to trust pharmaceutical corporations over ancestral knowledge?
Have you considered turmeric? Ashwagandha? Panchakarma? The very notion that a biologic must be continued through pregnancy reveals a profound cultural arrogance - one that pathologizes the female body instead of harmonizing with it.
My cousin’s sister had IBD. She stopped all drugs. Ate organic, meditated, drank neem water. Delivered a healthy boy at 41. No drugs. No fear. Just dharma.