What to Know About IBD and Pregnancy 

A Keck Medicine of USC gastroenterologist explains how inflammatory bowel disease can impact pregnancy — and how expert care can help. 

Pregnancy is a beautiful time, but for women with inflammatory bowel disease (IBD), there can also be moments of worry. How will the disorder affect the fetus? Will the pregnancy be smooth and safe for everyone? 

In some cases, these fears have caused some women with IBD to avoid pregnancy, even when it’s an experience they would have otherwise wanted.  

“Sometimes even providers are worried about treating a pregnant woman with IBD,” says Florence-Damilola Odufalu, MD, a gastroenterologist with the USC Digestive Health Institute, part of Keck Medicine of USC, who specializes in treating pregnant patients with IBD conditions such as Crohn’s disease, ulcerative colitis, indeterminate colitis, microscopic colitis and checkpoint-inhibitor colitis. “There’s always the lingering thought in the back of their mind that hopefully the IBD stays under control and doesn’t cause complications.” 

Dr. Odufalu adds that when a flare does develop, there are still treatment options designed to keep everyone safe and healthy. Here she explains why IBD flares happen during pregnancy, the role nutrition plays and how doctors can help in the event of a flare-up. 

How common are IBD flares during pregnancy? 

Being in remission at the time of conception seems to significantly reduce the chance of a flare-up. 

“We typically like to stress remission before conception,” Dr. Odufalu says. “When patients are in remission, meaning their IBD is not active at the start of the pregnancy, it’s often a better outcome through the pregnancy.” 

However, some patients who start pregnancy in remission will still experience a flare. Doctors aren’t sure why some patients do while others don’t, but they believe it has to do with an immune response being triggered as the body is in a state of growing and nurturing a fetus. These responses can be triggered by an infection of some sort, but the mother’s individual hormonal fluctuations can also play a role.  

Navigating nutrition during pregnancy 

“Nutrition absolutely impacts inflammatory bowel disease,” Dr. Odufalu says. “And it’s a little bit difficult to recommend one specific diet across the board because so many diets are shaped by different cultures and even food restrictions.” 

For example, the Mediterranean diet can help reduce inflammation, but sometimes even early in pregnancy, the patient can have food aversions tied to some cornerstone foods such as vegetables or fish. 

On the other side of the coin, ultra-processed foods can sometimes trigger inflammation, so it’s important for patients having flare-ups to avoid ultra-processed foods or at least cut back when possible. 

“Sometimes it’s helpful to meet with a dietitian and discuss the best foods to eat while you’re not feeling well, as well as what can keep your nutrition on track if you’re experiencing malabsorption,” Dr. Odufalu says. “It’s important in pregnancy because we definitely want both the fetus and the mom to get all the nutrition they need.” 

What can doctors do to help? 

“When a flare does occur, we try to be aggressive with treatment early on, because if there is prolonged inflammation in the gut, there can be complications during pregnancy, including preterm labor or growth restriction to the fetus,” Dr. Odufalu says. 

This makes prevention crucial.  

Dr. Odufalu prefers to see pregnant patients with IBD at least once every trimester, complete with labs for micronutrients, inflammatory markers and general well-being. (In addition to seeing patients at Keck Hospital of USC, USC Norris Cancer Hospital and USC Verdugo Hills Hospital, Dr. Odufalu sees patients at Keck Medicine’s newest Pasadena location at 590 S. Fair Oaks Ave.) 

Patients can typically stay on their regular medication unless there are contraindications, which mainly happen with Janus kinase (JAK) inhibitors, sphingosine-1-phosphate (S1P) receptor modulators and methotrexate. Fortunately, there are usually other medications that can be explored instead.  

Finally, Dr. Odufalu stresses the value of coordinated care. 

“All of my patients with inflammatory bowel disease who are pregnant are classified as a high-risk pregnancy and need to get the appropriate care that comes with that designation,” Dr. Odufalu says. “That’s when we call in maternal-fetal medicine specialists.”  

From there, the two teams — gastroenterology and maternal-fetal medicine — work together to manage the patient’s care up through postpartum. 

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