Katherine Freeman, MD, is a gastroenterologist specializing in women's gastrointestinal disorders. Dr. Freeman completed her internal medicine residency at the Cleveland Clinic and her gastroenterology fellowship at SUNY Stony Brook Medical Center. She is a fellow of the American College of Gastroenterology and board certified in both gastroenterology and internal medicine and has been involved in women's clinics specializing in both internal medicine and gastroenterology. Dr. Freeman currently practices at Mount Sinai Manhasset Medical Associates.
#1: Is pregnancy possible when I have IBD?
IBD and pregnancy seems like a touchy topic, however it doesn’t have to be! Pregnant patients with ulcerative colitis or Crohn’s have a higher rate of preterm delivery and babies that are low birth weight if their colitis is active. About a third of women stay in remission during the pregnancy, a third can relapse and a third improve. But the two main goals of pregnancy in a patient with IBD is getting the colitis under control before conceiving and maintaining remission during the pregnancy.
Communication here is key! Having a high-risk obstetrician who works with your gastroenterologist is very important when discussing medications such as biologics that are safe to take during pregnancy, as well as dietary factors that will help to keep the disease to a minimum. If you need help finding the right high-risk obstetrician, I recommend finding an academic tertiary care center where you have access to a whole team of radiologists and neonatal specialists. In the greater New York City area, there are two excellent options: Columbia Presbyterian Division of Maternal Fetal Medicine and the Mount Sinai High Risk Maternal Fetal Medicine division.
#2: Ulcerative colitis, Crohn's, and pregnancy: what the heck do I eat?
Getting the right balance of nutrients during pregnancy is paramount to a healthy mother and child, especially in the setting of having ulcerative colitis. For example, some people with ulcerative colitis have trouble eating folic acid-rich whole grains and breads which would need to be swapped out for other folic acid-rich foods like rice and quinoa. Folic acid is necessary in preventing spina bifida and other neural tube birth defects. It is also doctor recommended to eat more fish because it’s high in inflammation-reducing omega 3 fatty acids which are especially beneficial to mothers with ulcerative colitis. Just stick to low-mercury fish such as salmon, canned tuna, shrimp and pollock and avoid high-mercury varieties such as swordfish and king mackerel. Finally, don’t forget your supplements; prenatal vitamins can help to replace nutrients you may not be getting from your diet or that you’re losing through diarrhea. Vitamin D, calcium, potassium and magnesium deficiencies are common to people with ulcerative colitis. Epicured’s Get More Guide is a helpful resource.
#3 What are the chances that my child will have ulcerative colitis or Crohn's?
Ulcerative colitis and Crohn's can run in families and especially amongst parents and siblings. Around 10-25 percent of people with IBD have a parent or sibling with IBD. When ulcerative colitis affects multiple family members, it tends to start at an early age. What sets off the genes is what we think is part of the puzzle. Possible triggers include infections such as viruses or bacteria like salmonella or e.coli, vitamin D deficiency, NSAIDs use, or even a lack of exposure to bacteria or germs in childhood which prevents the immune system from developing normally. The most important advice a pediatrician can give you as a new mom with IBD is to closely watch your child, and to look out for failure to thrive, iron deficiency, or altered bowel habits. If you see any of these signs, let your pediatrician or pediatric gastroenterologist know right away!
VIDEO BONUS. Dr. Freeman discusses managing IBS during each trimester.