The decision about delivery method for an IBD patient should be made on an individual basis by the patient and her obstetric provider1,2. The decision should be based on obstetrical reasons, while also considering the patient’s IBD condition1,2. While some studies report higher rates of caesarean section among women with IBD compared to healthy women3, other studies report no significant difference in the rate of c-section4.
There are 2 IBD-related indications for recommending c-section over vaginal delivery:
It is important for women to monitor their IBD during and after pregnancy, as physicians are currently unable to definitively predict which patients will flare postpartum. It has been reported that ulcerative colitis patients may be at increased risk for postpartum flares6. In general, the risk for postpartum flare depends on disease control during pregnancy, and on other factors that affect disease activity (eg. smoking in Crohn’s disease).
Breastfeeding is beneficial to the newborn as breast milk contains nutrients, immune proteins, and other beneficial factors. Some studies suggest that breastfeeding may have a protective effect against developing IBD7. It is thought that breastfeeding may help the newborn develop a healthy gut microbiome and immune system by helping newborns develop tolerance to certain bacteria, and thus prevent exaggerated immune responses to bacteria encountered later in life8,9.
Class of medication | Examples | Notes for breastfeeding |
Mealamine (5-aminosalicylates) | Asacol ©, Pentasa ©, Salofalk ©, Mesavant ©, Sulfasalazine (Salazopyrin©) | Medications are excreted into the breast milk in very small amounts. Risk of toxicity to the child is very small2,10. |
Corticosteroids | Prednisone (Deltasone ©), Budesonide (Entocort ©) | Steroids transfer into the breast milk in small amounts, with highest levels in the first 4 hours after taking the medication. Recommended to pump and dump the first 4 hours of breast milk after taking the medication2,11. |
Immunosuppressant | Azathioprine (Imuran ©), 6-mercaptopurine (6-MP, Purinethol ©) | These can be continued while breastfeeding. To minimize the drug levels in the breast milk, mothers can pump and dump the first 4 hours of breast milk after taking the medication2,12. |
Methotrexate (Rheumatrex ©) | MTX has teratogentic effects, and because it crosses into the breast milk, MTX is contraindicated while breast-feeding2,12. | |
Biologics | Infliximab (Remicade ©), Adaliumumab (Humira ©) | These can be continued while breastfeeding. Although they cross into the breast milk, the levels are nil to minimal2,12. |
References