When a patient with Crohn’s disease is preparing to become pregnant, it is best to choose a time when Crohn’s disease is in remission. The effects of Crohn’s disease are greater than the side effects of medications. Therefore, it is still possible to use the necessary medications in order to maintain remission.
How can we keep track of the effects of the various drugs used to treat Crohn’s disease on pregnant women and fetuses? The U.S. Food and Drug Administration (FDA) classifies all medications as having an effect on fertility in five classes: A, B, C, D, and X. Class AB is relatively safe, Class CD is for effects on pregnancy, and Class X is absolutely prohibited.
Class A drugs: drugs that have been tested and proven to be safe for the first trimester of pregnancy.
Class B drugs: Drugs that have been used during pregnancy and have not been shown to cause developmental defects or other problems.
Class C drugs: have warnings that they may cause fetal or maternal problems.
Class D drugs: Apparently harmful to health, but effects outweigh the risks.
Class X drugs: can cause birth defects and clearly cannot be used during pregnancy.
If you want to get pregnant and have a baby, you definitely should not use Class X drugs. Class C and D should be used with extreme caution. The table that follows lists the grading of drugs commonly used in the treatment of Crohn’s disease with the findings of recent studies, respectively. It should be noted that since March 2008, the FDA no longer uses this grading system for newly emerging drugs. More detailed information may be forthcoming. For now, clinicians continue to use this classification scheme to guide their patients’ medication use.
Because fertility is a very important personal issue, there are many factors that affect fertility. Crohn’s patients who are planning to have children should have more discussions with their treating physician or even their obstetrician to develop a detailed plan for pre-pregnancy medication and medication use during pregnancy.
Currently, more medication guidance is given to women who are pregnant, but it is also important to be aware of the medications used for Crohn’s disease in men before conception. Methotrexate should not be taken in the first trimester of pregnancy. This is because salazosulfapyridine can reduce sperm count, which can lead to infertility. Therefore, you can switch to other 5-ASA drugs. However, this should be discussed with the treating physician.
Guideline for safe use of medication during pregnancy
Guideline for safe use of medication during pregnancy
Drug Name
FDA Classification
Pregnancy Medication Recommendations
Supplemental Lactation
Adalimumab
B
Low risk
No human study data, may be feasible
Alemtuzanide
C
Limited human data
Safety unknown
Amoxicillin/clavulanic acid methyl
B
Low Risk
licensable line
Azathioprine/6-mercaptopurine
D
Inflammatory bowel disease with transplant data confirming low risk
Limited human data, probably feasible
Balsalazide
B
Low risk
No human studies, may cause diarrhea
Budesonide
C
Low risk in pregnancy, limited human data
Viable during lactation
Certolizumab pegol
Polyethylene glycolized human anti-TNF-alpha antibody Fab fragment product
B
Limited human data, low-risk
No human data, probably feasible
Ciprofloxacin
C
Avoid: potential risk to cartilage formation
Limited human data, probably feasible
Corticosteroids
C
Low risk, may cause cleft palate, adrenal insufficiency, premature membrane rupture
Possible
Cyclosporine
C
Low risk
Limited human data, potential toxicity
Fish oil preparations
–
Low risk, potentially useful
No human information available
Class Gram
B
Low Risk
No human data, may be useful
Mesalazine
B
Low risk
Limited human data, may cause diarrhea
Methotrexate
X
Contraindicated, may be teratogenic
Contraindicated
Natalizumab
C
Limited human data, possibly low risk
No human data
Metronidazole
B
Avoid, limited usefulness for IBD, risk of cleft palate
Limited human data, potential toxicity
Olsalachant
C
Low risk
Limited human data, diarrhea potential
Rifaximin
C
Can cause malformation in animals, no human data
No human data, may be available
Risedronate
C
Limited human data
Safety unknown
Salazosulfapyridine
B
Low risk, additional folic acid supplementation 2mg/day
Limited human data, possible diarrhea
Tacrolimus
C
May be necessary if maternal health requires
Limited human data, potential toxicity
Reactivation
X
Contraindicated, teratogenic
No human information, potentially toxic