Ulcerative Colitis Blog

A common question among female UC patients is how pregnancy may affect their disease course. Women with UC often wonder whether the hormonal changes associated with pregnancy will make their disease flare or if disease activity may change after delivery. Current studies indicate that the activity of a woman's colitis during pregnancy is dependent on the state of her disease at the time of conception. For women whose colitis is well-controlled at the time they become pregnant, 70-80% can expect their disease to remain quiet throughout the pregnancy. This is in contrast to those who have symptoms of active colitis at the time of conception, for whom disease relapse rates during pregnancy can be as high as 50-70%. There is no consistent evidence to suggest that different trimesters confer greater or lesser risks for flaring. Research has shown that the most common reason for relapse during pregnancy is the cessation of medical therapy for UC. As such, UC patients who are considering becoming pregnant should discuss with their physician the compatibility of their medication regimen with pregnancy. Women who have undergone colectomy with an ileoanal pouch generally do well during pregnancy, although 20-30% of patients may experience increasing numbers of bowel movements and fecal incontinence later in the gestation period. These symptoms generally resolve after delivery with resolution of pouch function.

Disease activity in the post-partum period seems to be dependent on the status of disease at the time of delivery. One study examining this issue found that only 13% of women with quiescent disease at delivery flared in the post-partum period, as compared to 53% of women who had active disease at delivery (Beniada, et al, Journal of Gynecology, Obstetrics, and Biological Reproduction 2995; 34:581-8). Furthermore, post-partum activities such a breastfeeding have not been shown to adversely affect disease activity. Similar to disease flares during pregnancy, it seems that flares post-partum are most likely attributable to discontinuation of UC medications.