No one can deny women with inflammatory bowel disease (IBD, including Crohn’s disease [CD] and ulcerative colitis [UC]) the right to become mothers, but it is important to recognize the following facts: fertility is reduced in patients with inflammatory bowel disease (IBD) who are active or who have a history of pelvic or abdominal surgery or pelvic abscesses, and pregnancies in patients with IBD are more likely to result in preterm labor, low birth weight, smaller-than-gestational-age fetuses, congenital malformations, and miscarriages; and various medications used during pregnancy to induce or maintain remission are potentially harmful to the fetus, but the activity of the disease itself is more harmful to the fetus. The various tests and medications used to induce or maintain remission of inflammatory bowel disease during pregnancy are potentially harmful to the fetus, but the activity of inflammatory bowel disease itself is even more harmful to the fetus. The following are some suggestions for female patients with IBD: 1. When can IBD get pregnant Patients with IBD should choose to maintain remission for more than 3 months to conceive, and continue the pre-pregnancy treatment during pregnancy. If there is malnutrition, it should be actively improved before pregnancy. If methotrexate has been used, it should be discontinued for 3-6 months before pregnancy; if salicylazosulfapyridine is being used, folic acid supplementation (2-5mg/day) should be taken. Pregnancy in patients with IBD is more likely to result in abnormalities such as preterm labor (<37 weeks) and low birth weight (<2500g), which are more related to the activity of ibd disease; therefore, one should try to conceive when the disease is in remission to alleviate the impact of the disease on the fetus. Methotrexate is the only drug in common use for ibd that has sufficiently clear teratogenic effects, and patients of both sexes should stop using the drug 3-6 months before pregnancy, and women should avoid using the drug during both pregnancy and breastfeeding. If IBD patients want to get pregnant, they should fully communicate with their family members, gastroenterologists and obstetricians to try to ensure the smoothness of the condition and the safety of the fetus. 2, IBD patients using drugs during pregnancy and lactation For IBD patients, the activity of the disease during pregnancy has a greater impact on the fetus than the use of the drug itself, so even if you consider the possible risks of the drug to the fetus, you should still choose the appropriate drug according to the condition. the FDA according to the safety of the drug on the fetus is divided into five grades: A, B, C, D, X, from A to D the safety is gradually decreasing, and the X is the one that has a clear teratogenic effect. Drugs should be avoided. The use of medications during pregnancy and lactation should be analyzed by a gastroenterologist and obstetrician on a case-by-case basis. Mesalazine (FDA C) and Liuzosulfonamides (FDA B): may be used during pregnancy and lactation. Liuzosulfonamides inhibit the absorption of folic acid and are supplemented in pregnant women using this medication. It is important to note that pregnant women in general also need folic acid supplementation, but only 0.4 mg/day, whereas patients using salazosulfadiazine need 2 to 5 mg/day. There have been case reports of bloody diarrhea in infants resulting from the use of salazosulfadiazine during lactation, with the theoretical possibility of hemolysis and kernicterus in the newborn. In addition azulfidine may cause sperm deficiency in male patients. Azathioprine (FDA D): Azathioprine has teratogenic effects in animal studies and may lead to an increase in miscarriages, but the evidence that use of this drug in patients with IBD leads to adverse pregnancy outcomes is not strong. Although the drug may increase the risk of preterm labor and neonatal anemia, most experts believe that if the drug is used before pregnancy, it should continue to be used during pregnancy. The drug can be excreted in small amounts from breast milk, and some experts recommend that breast milk within 4 hours of administration should be discarded. Glucocorticoids (FDA C): Use of this drug during the first trimester of pregnancy may increase the risk of cleft lip and palate by a small amount. If used you should choose prednisone, prednisolone, and methylprednisolone and avoid dexamethasone and betamethasone. The drug can also be excreted in small amounts from breast milk, and some experts recommend that breast milk within 4 hours of administration should be discarded. Oral budesonide has been reported less frequently and is generally considered safe to use because it acts primarily locally. Antibiotics: Antibiotics commonly used in patients with IBD include metronidazole (FDA B), ciprofloxacin (FDA C), and amoxicillin (FDA B). Metronidazole may cause cleft palate in animal studies and should be avoided in the first trimester of pregnancy. Quinolones (including ciprofloxacin), tetracyclines, and sulfonamides should be avoided. Penicillins (including amoxicillin) and cephalosporins are generally considered safe to use. If metronidazole and ciprofloxacin are needed during breastfeeding, they should be used in small doses and not for prolonged periods of time. Cyclosporin A (FDA C): may cause preterm labor and low birth weight, and should be used only when necessary in heavily active patients. Infliximab (FDA B): It can be used in early to mid-pregnancy and during breastfeeding. However, the drug can cross the placenta in late pregnancy, so it is best to stop using it at 30 weeks of pregnancy or earlier. Newborns who have used this drug during pregnancy should not receive live vaccines (e.g., BCG) for 6 months after birth. Methotrexate (FDA X): a drug with sufficiently well-defined teratogenic effects, patients of both sexes should stop using this drug 3 to 6 months before pregnancy, and women should avoid using this drug during pregnancy and breastfeeding. 3, the treatment strategy during pregnancy For patients who are well maintained, try not to adjust the medication during pregnancy. Patients with disease activity during pregnancy should be relieved with regular medication, glucocorticoid and infliximab can be used, and cyclosporine A should be used cautiously only when necessary. If acute exacerbation of intestinal inflammation or life-threatening complications occur during pregnancy, they should be managed according to non-pregnant women's principles, including abdominal X-rays as necessary. The most appropriate treatment for the maternal IBD condition is the one that maximizes protection of the fetus in the womb. There is no difference in the absolute surgical indications for IBD between pregnant and nonpregnant women. Surgery can be delayed only if intensive pharmacologic therapy promotes maturation of critical fetal organs. If resection of an intestinal segment is indicated during pregnancy, an enterostomy is appropriate, and a one-stage anastomosis is preferably avoided. 4, delivery Considering IBD alone, patients with active perianal lesions in Crohn's disease and patients with ulcerative colitis who have had an ileal reservoir pouch-anal tube anastomosis should be selected for cesarean delivery. 5, IBD patients offspring will definitely get IBD? Early studies have shown that the probability of IBD offspring of patients with IBD is more than ten times that of the general population, and one of the identical twins will get IBD if the other one has a 15% to 30% chance of getting the disease, which suggests that IBD is hereditary. However, it is important to note that there are many factors that contribute to the development of IBD, and heredity is only one of them; offspring with IBD do not necessarily develop IBD. It is worth noting that the probability of IBD in non-breastfeeding offspring is increased to 1.5-2 times, and that breastfeeding offspring reduces the incidence of early-onset IBD. Breastfeeding had no effect on maternal IBD recurrence. In conclusion, the management of pregnancy in patients with IBD should be individualized and specific for the different types and stages of IBD, previous treatments, and specific changes in the disease.Patients with IBD who wish to become pregnant should be instructed and followed up by both a gastroenterologist and an obstetrician during the preparation for pregnancy, pregnancy, delivery, and breastfeeding.