IBD Medications During Pregnancy: Safe Options and What to Avoid

When you have IBD, inflammatory bowel disease, including Crohn's disease and ulcerative colitis, pregnancy doesn’t mean you have to stop treatment—but it does mean you need to know exactly what’s safe. Many women fear that their medications might harm the baby, but uncontrolled IBD can be far riskier. Studies show that keeping IBD in remission during pregnancy lowers the chance of preterm birth, low birth weight, and miscarriage. The goal isn’t to go off meds—it’s to pick the right ones.

Crohn's disease and ulcerative colitis, the two main types of IBD, often require long-term drug therapy. Some medications, like mesalamine and sulfasalazine, have been used safely for decades in pregnant women. Others, like biologics, targeted drugs like infliximab and adalimumab that block inflammation, are now considered low-risk when used in the first and second trimesters. Data from large pregnancy registries show no clear link between these drugs and major birth defects. But drugs like methotrexate and thiopurines (azathioprine/6-MP) need careful review—methotrexate is a hard no, while thiopurines can often continue under supervision. Always talk to your gastroenterologist and OB before making any changes.

It’s not just about pills. Diet, stress, and sleep matter too. A flare-up during pregnancy can lead to hospitalization, which is harder to manage when you’re expecting. That’s why many doctors recommend staying on maintenance meds—even if you feel fine. Stopping them suddenly can trigger a flare, and treating a flare mid-pregnancy is riskier than keeping things stable. If you’re on steroids like prednisone, your doctor might lower the dose or switch you to a safer alternative. And if you’re thinking about breastfeeding? Most IBD meds pass into breast milk in tiny amounts and are still considered safe.

You’re not alone in this. Thousands of women with IBD have had healthy pregnancies while staying on treatment. The key is planning—not panic. Work with your team before you conceive if you can. If you’re already pregnant, don’t wait. Review your meds now. The right treatment plan doesn’t just protect your body—it protects your future.