Crohn’s Disease and Pregnancy: What to Discuss With Your Doctor Before and During Pregnancy

Can you have a healthy pregnancy with Crohn’s disease?

Yes. Many people with Crohn’s disease have healthy pregnancies and healthy babies, particularly when their disease is well controlled.[1,2]

Crohn’s does mean pregnancy may require additional planning and follow-up.

People with IBD have higher rates of some pregnancy complications compared with people without IBD. Active disease is particularly important because it is associated with outcomes including preterm birth and low birth weight.[1,2]

Current international consensus guidance therefore recommends that IBD is in documented remission and medically optimized before an elective conception.[1]

The aim is not to make pregnancy feel risky or frightening. It is to identify factors that can be discussed and planned for before and during pregnancy.
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When is the best time to get pregnant with Crohn’s disease?

When pregnancy can be planned, the preferred time to conceive is when Crohn’s disease is in remission and treatment is stable.[1]

The 2025 Global Consensus Statement recommends preconception counseling and says IBD should ideally be in remission for approximately 3–6 months before conception.[1]

Why does timing matter?

Active disease around conception predicts a greater likelihood of disease activity during pregnancy and is associated with less favorable pregnancy outcomes. In contrast, people whose IBD is inactive when they conceive are more likely to remain in remission during pregnancy.[1]

A preconception appointment can therefore be useful even if pregnancy is still several months away.

It provides an opportunity to review:

• current Crohn’s activity
• medications
• recent blood and stool test results
• nutrition
• folic acid and other supplements
• previous bowel or pelvic surgery
• perianal disease
• vaccination history
• other health conditions
• smoking
• your questions about pregnancy, delivery, and breastfeeding.

Pregnancy cannot always be planned. If you become pregnant while Crohn’s is active or while taking medication, contact your healthcare team rather than changing treatment yourself.

Does Crohn’s disease affect fertility?

Many people with Crohn’s disease can conceive naturally, particularly when their disease is in remission, but disease activity and some previous surgeries can affect fertility.[1,2]

Several factors may influence fertility.

Active inflammation can affect general health, nutrition, sexual wellbeing, and menstrual cycles. Some people may also avoid sex because of abdominal pain, perianal symptoms, fatigue, or concerns about pregnancy.

Previous pelvic surgery can be relevant too. Certain operations may affect fertility, which is one reason future pregnancy plans can be useful to discuss when surgery is being considered.[2]

Current international guidance also recognizes that women with IBD may have reduced fertility compared with women without IBD, including through effects on ovarian reserve.[1]

Fertility is highly individual, however. Having Crohn’s disease does not mean you will have difficulty becoming pregnant.

Why does Crohn’s disease activity matter before pregnancy?

Active Crohn’s disease at conception increases the likelihood that disease will remain active during pregnancy and is associated with greater pregnancy risks.[1]

This is one of the most important reasons for discussing pregnancy with your gastroenterologist before trying to conceive.

The aim is usually to establish stable disease control rather than stopping effective treatment simply because pregnancy is planned.

Current global consensus guidance recommends confirming remission using both symptoms and objective measures where appropriate. These may include inflammatory markers such as C-reactive protein (CRP) and faecal calprotectin.[1]

Your gastroenterologist can explain which assessments are relevant to your situation.

Should you stop Crohn’s medication before getting pregnant?

Do not stop prescribed Crohn’s medication because you are trying to conceive or have discovered you are pregnant without discussing it with your healthcare team.

This is an important point.

Fear about medication exposure can sometimes lead people to stop treatment. But stopping an effective medication can allow Crohn’s disease to become active, and active disease itself carries pregnancy risks.[1,2]

Many commonly used IBD medicines can be continued during pregnancy when clinically appropriate.

Other medications require different planning.

Your gastroenterologist can review the exact medication, dose, disease history, and pregnancy plans with you. Ideally, this conversation happens before conception.

Which Crohn’s medications need to be discussed before pregnancy?

Every medication should be reviewed individually because pregnancy recommendations differ between Crohn’s treatments.

The medication landscape has also changed over time, so advice from an old leaflet, forum post, or previous pregnancy may no longer reflect current evidence.

Biologic medicines

Many biologic therapies used for IBD can be continued during pregnancy when needed to maintain disease control.[1]

Current international consensus supports continuation of biologic therapy through conception and pregnancy for appropriate patients.[1]

The exact medicine matters, however. Your gastroenterologist can discuss its pregnancy evidence, timing, and what it may mean for care after birth.

Thiopurines

Thiopurine maintenance therapy can generally be continued during pregnancy when clinically appropriate.[1]

Pregnancy is not the time to change a stable Crohn’s treatment without a clear clinical reason.

Your healthcare team can review whether your existing treatment remains appropriate.

Corticosteroids

Corticosteroids may sometimes be needed to manage active IBD during pregnancy, but repeated or prolonged steroid exposure is generally something clinicians try to minimize.[1]

This is another reason steroid-free remission before conception is desirable when achievable.

If you already take corticosteroids, do not stop them suddenly without medical guidance.

Methotrexate

Methotrexate should not be used during pregnancy and requires advance pregnancy planning.[2,3]

If you take methotrexate and are considering pregnancy, discuss this with your healthcare professional before trying to conceive. They can advise on discontinuation timing and an appropriate alternative strategy for maintaining Crohn’s control.

If pregnancy occurs unexpectedly while taking methotrexate, contact your healthcare team promptly for individualized medical advice.

Newer oral therapies

Some newer small-molecule medicines used in IBD have pregnancy restrictions and require specific planning before conception.[1]

For example, pregnancy recommendations differ for medicines such as JAK inhibitors compared with many established biologic therapies.

This is why it is safer to review the exact medicine with your gastroenterologist rather than assuming that all Crohn’s treatments follow the same pregnancy rules.

What should you discuss with your doctor before trying to conceive?

A preconception conversation should cover disease activity, medications, nutrition, previous complications, and how Crohn’s will be followed during pregnancy.

Useful topics include:

• Is my Crohn’s currently in remission?
• Do I need any tests before trying to conceive?
• Are my current medications appropriate during pregnancy?
• Does any medication need to be changed in advance?
• How much folic acid is appropriate for me?
• Are my iron, vitamin B12, folate, and vitamin D levels adequate?
• Does previous bowel surgery affect my pregnancy planning?
• Does my history of perianal Crohn’s affect delivery planning?
• Which healthcare professionals will follow me during pregnancy?
• What should I do if Crohn’s symptoms worsen?
• What is the plan for my medication after delivery?
• Are there considerations for breastfeeding or infant vaccinations?

You do not need to solve every possible pregnancy scenario before conception.

The aim is to know who to contact and have a plan for the issues most relevant to your Crohn’s disease.

Which nutritional issues matter during Crohn’s pregnancy?

Pregnancy increases nutritional demands, while Crohn’s disease can make some nutrient deficiencies more likely.

The exact risks depend on disease location, previous surgery, diet, and current disease activity.

Nutrients that may deserve particular attention include:

• folate
• iron
• vitamin B12
• vitamin D
• calcium
• protein and overall energy intake.

Iron deficiency and anemia are common in IBD and can contribute to fatigue. Vitamin B12 deficiency is particularly relevant for people with Crohn’s affecting the terminal ileum or after certain small-bowel resections.

Folic acid is important before and during early pregnancy. Some medications and individual circumstances may influence the amount recommended.

Your healthcare team can advise on appropriate supplementation rather than relying on high-dose supplements without guidance.

If maintaining a balanced diet is difficult because of nausea, diarrhea, pain, food restrictions, or active Crohn’s symptoms, an IBD dietitian may also be useful.

What happens if Crohn’s flares during pregnancy?

A Crohn’s flare during pregnancy should be discussed promptly with your IBD team because controlling active inflammation remains important during pregnancy.[1]

Pregnancy does not mean that Crohn’s disease cannot be investigated or treated.

If symptoms change, your healthcare team may consider whether they are related to Crohn’s disease, pregnancy itself, an infection, anemia, medication, or another cause.

Changes worth discussing can include:

• increasing diarrhea
• blood in the stool
• worsening abdominal pain
• persistent vomiting
• fever
• unexplained weight loss
• worsening perianal symptoms
• difficulty maintaining nutrition
• marked fatigue or weakness.

Do not stop or change Crohn’s treatment yourself during a suspected flare.

Your gastroenterology and obstetric teams can consider appropriate assessment and treatment based on your individual situation.

Can Crohn’s disease be monitored during pregnancy?

Yes. Crohn’s disease can still be assessed during pregnancy, although clinicians choose investigations with pregnancy in mind.[1,2]

Depending on the situation, assessment may include:

• symptoms and clinical examination
• blood tests
• stool tests such as faecal calprotectin
• intestinal ultrasound
• selected endoscopic procedures
• MRI when clinically appropriate.

Current international guidance considers endoscopy during pregnancy relatively low risk when it is needed to answer a question that could change management.[1]

The need for any investigation is considered individually.

Pregnancy itself can also change some laboratory values, so results need to be interpreted in the appropriate clinical context.

Do you need extra pregnancy care if you have Crohn’s disease?

People with Crohn’s disease may benefit from coordinated care between their gastroenterology and obstetric teams.[1,2]

The level of additional follow-up depends on disease activity, medications, previous complications, nutritional status, surgery, and the pregnancy itself.

Your care may involve:

• a gastroenterologist
• an obstetrician
• an IBD nurse
• a maternal-fetal medicine specialist in some circumstances
• a dietitian
• a colorectal surgeon when relevant.

Good communication between these teams can be particularly important if Crohn’s becomes active during pregnancy or medication decisions need to be made.

Can you have a vaginal birth with Crohn’s disease?

Many people with Crohn’s disease can have a vaginal birth, but the appropriate mode of delivery depends on obstetric factors and certain Crohn’s complications.

Crohn’s disease alone does not automatically mean you need a Caesarean section.

However, active perianal disease, including certain fistulas or abscesses around the anus or vagina, can influence delivery planning.[2]

Previous surgery may also be relevant.

If you have current or previous perianal Crohn’s disease, discuss delivery planning with your gastroenterologist and obstetric team before the final weeks of pregnancy.

The decision can then take both Crohn’s disease and obstetric factors into account.

What if you have a perianal fistula and are planning pregnancy?

A history of perianal Crohn’s disease is worth discussing before and during pregnancy because active fistulas or abscesses can influence management and delivery planning.[2]

Tell your obstetric team about:

• previous perianal abscesses
• current or previous fistulas
• setons
• previous perianal surgery
• rectovaginal fistulas
• current drainage, pain, or swelling.

Having had a fistula in the past does not by itself determine how you will give birth.

Current disease activity and anatomy matter.

For more detail, see our guide to perianal Crohn’s disease and fistulas.

Can you breastfeed while taking Crohn’s medication?

Breastfeeding is possible with many IBD medications, but the exact medicine should be reviewed with your healthcare team.[1]

Current international guidance supports breastfeeding for people with IBD and recognizes the compatibility of many established therapies.[1]

However, medication-specific recommendations differ.

Discuss breastfeeding before delivery if possible so you know whether your existing treatment can continue and whether any adjustments are necessary.

Avoid stopping an effective Crohn’s treatment after delivery simply because you plan to breastfeed unless your healthcare professional has advised you to do so.

Do Crohn’s medications affect a baby’s vaccinations?

Some medications taken during pregnancy can influence recommendations around certain infant vaccines, so the baby's healthcare team should know about relevant medication exposure during pregnancy.

This is particularly relevant to some biologic medicines that can cross the placenta.

Recommendations have evolved as evidence has grown and may differ according to the specific drug and vaccine.

Before leaving maternity care, make sure your baby's healthcare team knows which Crohn’s medicines you received during pregnancy. Your gastroenterologist, obstetric team, and pediatric healthcare professional can provide medication-specific guidance.

Can pregnancy make Crohn’s disease worse?

Pregnancy does not inevitably make Crohn’s disease worse, and disease activity around conception is an important predictor of what happens during pregnancy.[1]

If Crohn’s is in remission when pregnancy begins, remission is more likely to continue.

If disease is active at conception, it is more likely to remain active or worsen during pregnancy.[1,2]

This is why preconception disease control is emphasized so strongly in current guidelines.

If pregnancy happens during a flare, however, that does not mean something will necessarily go wrong. It means early communication with your healthcare team becomes particularly important.

What happens to Crohn’s disease after giving birth?

Crohn’s care continues after delivery, when medication, recovery, breastfeeding, sleep, nutrition, and possible disease activity all need consideration.

The weeks after birth can be physically demanding.

Medication plans should ideally be discussed before delivery so you know what should continue or restart after birth.

It can also help to know who to contact if digestive or perianal symptoms change postpartum.

If you have had a Caesarean section, significant perianal disease, or previous bowel surgery, your teams may have additional recommendations for recovery.

What information can you organize before a pregnancy appointment?

Bringing together your Crohn’s history, medications, recent results, and pregnancy questions can make preconception and antenatal conversations easier.

You could record:

• your current Crohn’s medications and doses
• when your last flare occurred
• recent symptoms
• previous hospital admissions
• previous bowel or perianal surgery
• any history of fistulas or abscesses
• recent colonoscopy or imaging results
• recent CRP or faecal calprotectin results
• previous anemia, iron deficiency, or vitamin B12 deficiency
• supplements you currently take
• previous pregnancies
• questions about medications, delivery, or breastfeeding.

If several specialists are involved in your care, having the same basic information available for each appointment can also reduce the need to reconstruct your medical history from memory.

How can mama health support you while planning pregnancy with Crohn’s?

mama health can help you organize your health information, understand medical terminology in simpler language, learn from others living with chronic conditions, and prepare for conversations with your healthcare team.

Pregnancy planning with Crohn’s can involve several healthcare professionals and a lot of information: medication names, blood tests, reports, previous procedures, questions for your gastroenterologist, and questions for your obstetrician.

With mama health, you can:

• Find specialists and care near you. Search for relevant doctors and clinics and explore information about their areas of focus.
• Learn from others living with the same condition. Explore questions and experiences from people who understand what living with a chronic condition can be like. Individual experiences vary and do not replace medical advice.
• Understand labs and medical reports in simpler language. Blood tests and medical reports can contain unfamiliar terminology. mama health provides educational explanations that can make this information easier to understand and discuss with your healthcare team.
• Prepare a structured report for an appointment. Bring together symptoms, questions, results, medication experiences, and other information you choose to record into a summary you can take to your gastroenterology or pregnancy appointments.

For someone planning pregnancy with Crohn’s disease, this could mean keeping your current medication list, recent test results, previous procedures, and questions about pregnancy together before meeting your healthcare team.

mama health provides information and organization for your own understanding and appointment preparation. It does not determine whether a medication is safe for your pregnancy, assess pregnancy risk, or decide which Crohn’s treatment is appropriate for you.

What questions could you ask your doctor about Crohn’s and pregnancy?

Useful questions focus on disease control, medications, nutrition, monitoring, delivery, and the period after birth.

For example, you could ask:

• Is my Crohn’s currently well controlled enough to start trying for pregnancy?
• Do we need to confirm remission before conception?
• Are my current medications appropriate when trying to conceive?
• Are my medications appropriate during pregnancy?
• Is there anything that needs to change before I start trying?
• What folic acid dose is appropriate for me?
• Should my iron, B12, folate, or vitamin D levels be checked?
• How will my Crohn’s disease be followed during pregnancy?
• Who should I contact if my Crohn’s symptoms worsen?
• Does my previous surgery affect pregnancy or delivery?
• Does my history of perianal disease affect delivery planning?
• What is the plan for my medication after delivery?
• Are my medications compatible with breastfeeding?
• Does medication exposure during pregnancy affect my baby's vaccination schedule?

You do not need to ask every question at once. Choosing the issues most relevant to your own Crohn’s history can make the conversation more manageable.

Frequently asked questions about Crohn’s disease and pregnancy

Is pregnancy high risk if you have Crohn’s disease?

Crohn’s disease can increase some pregnancy risks, particularly when disease is active, but many people with Crohn’s have healthy pregnancies.[1,2]

Current international guidance recommends coordinated pregnancy care and optimizing IBD control before conception.[1]

Can Crohn’s disease cause miscarriage?

People with IBD have an increased risk of some adverse pregnancy outcomes, and active disease is an important risk factor.[1,2]

An individual person's risk cannot be determined from the Crohn’s diagnosis alone. Disease activity, general health, age, medications, obstetric history, and other factors all matter.

Should I stop biologics if I become pregnant?

Do not stop biologic treatment simply because you discover you are pregnant without discussing it with your healthcare team.

Current international consensus supports continuing biologic therapies through pregnancy when clinically appropriate because maintaining disease control is important.[1]

Recommendations should still be reviewed for your specific medicine and situation.

Can Crohn’s disease affect the baby?

Most people with Crohn’s disease can have healthy babies, but active IBD is associated with increased risks including preterm birth and low birth weight.[1,2]

Maintaining disease control is therefore an important part of pregnancy care.

Will my baby inherit Crohn’s disease?

Having a parent with Crohn’s increases a child's genetic susceptibility to IBD, but inheritance is not inevitable.

Crohn’s disease develops through a complex interaction between genetics, the immune system, the gut microbiome, and environmental factors. Having Crohn’s does not mean your child will necessarily develop it.

Can I have a normal delivery with Crohn’s disease?

Many people with Crohn’s can have a vaginal birth.

Delivery planning may differ when active perianal disease, certain fistulas, previous surgery, or obstetric factors are present. Your gastroenterology and obstetric teams can discuss the appropriate options for your situation.

What if I get pregnant while Crohn’s is active?

Contact your gastroenterology and pregnancy care teams so that disease activity and treatment can be reviewed.

Active disease at conception is associated with a greater chance of continued activity during pregnancy, but this does not determine the outcome of an individual pregnancy.[1]

Do not stop prescribed Crohn’s medication without medical advice.

Thinking about pregnancy when you have Crohn’s disease can bring up a long list of questions.

Will Crohn’s affect the pregnancy? Is my medication safe? What happens if I have a flare? Do I need different tests? Can I have a vaginal birth? What happens with treatment after the baby arrives?

These are reasonable questions to discuss before pregnancy when possible.

The reassuring part is that many people with Crohn’s disease have healthy pregnancies and healthy babies.[2] However, disease activity matters. Active inflammatory bowel disease (IBD) around conception and during pregnancy is associated with a greater risk of adverse pregnancy outcomes.[1]

This makes pregnancy planning less about stopping treatment and more about entering pregnancy with Crohn’s as well controlled as possible and having a clear plan with your healthcare team.