Crohn’s Disease, Ulcerative Colitis and Inflammatory Bowel Disease (IBD): Frequently asked questions
Ulcerative Colitis and Inflammatory Bowel Disease (IBD): Frequently asked questions
How is the diagnosis made? This was made before pregnancy. All women with IBD, Crohn’s Disease or Ulcerative Colitis should receive preconception counselling to optimise their health before pregnancy.What does this mean?
For me:
You are at risk of preterm delivery and developing flares (worsening) of your symptoms. You may need to attend more hospital visits during pregnancy. You are at higher risk developing of pre-eclampsia.For my baby:
Your baby is at risk of preterm delivery.What will the medical team recommend?
You will be seen more frequently in a specialist consultant-led maternal medicine antenatal clinic.What tests will/may be considered? How often may they be needed?
You may need further tests if your symptoms worsen.What symptoms and signs should I be looking out for?
Abdominal pain, blood and/or mucus in your stool or increased frequency of passing stool (poo).What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you have a worsening (flare) of your symptoms.How are recommendations made regarding treatment options?
Most of the drugs used are safe during pregnancy. You may be on special medication (known as a biologic) for your condition. If you require these during the third trimester of pregnancy you will need to delay giving your baby live vaccines, this includes the BCG and rota virus until six months after birth. Be sure to discuss this with your medical team after the birth of your baby.How are recommendations made regarding timing of birth?
By 36 weeks your team should be working with you to plan your delivery.How may this impact my birth choices?
If you have had previous operation for your condition you may need to birth your baby by caesarean-section.How may this affect care after the birth?
A birth plan prior to delivery should have been agreed to ensure you are on medication that are safe to use during breastfeeding. Your medication may need to be increased or changed if your symptoms worsen after birth.What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Optimise your health and your symptoms between pregnancies. What will this mean for future/ my long-term health and how can I influence this? Contraception and a follow up plan should be made to optimise your health for future pregnancies.Epilepsy: Frequently asked questions
Epilepsy: Frequently asked questions
How is the diagnosis made?
You were probably diagnosed with epilepsy before you became pregnant. This condition causes seizures and these can affect the whole body with shaking and tongue biting or only affect particular parts of the body such as losing awareness and staring into space. Ideally you will have been offered pre-conception counselling to optimise your health before pregnancy.What does this mean?
For Me
Pregnancy can lower the threshold for seizures to occur so it is important that you have care under an obstetrician specialising in medical conditions and a neurologist. You will be asked to take 5mg folic acid (ideally for three months prior to your pregnancy) to reduce the risk of disorders like spina bifida for the baby and you might need to increase your medication during pregnancy or take extra medications around the time of the birth.For my baby
The medication called sodium valproate should not be taken in pregnancy but the other commonly used anti-epilepsy drugs are all safe to be used in pregnancy. It is really important that your epilepsy is treated effectively as frequent seizures in pregnancy can affect the baby’s growth.What will the medical team recommend?
You may need extra blood tests to check the level of your anti-epileptic drug in your blood and to ensure you don’t need more. You will be recommended to take 5mg of folic acid to reduce the chances of your baby having a spine abnormality. You may be offered extra scans to check your baby’s growth.What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
You must tell your medical team immediately if you have any seizures in your pregnancy so that they can ensure you are on the right level of treatment and organise tests to check your baby’s wellbeing.Your partner and close family should be shown how to place you in a recovery position if you have a seizure.
The risk of seizures is greatest around the time of the birth and in the first 24 hours after the birth.Likely recommendations
Treatment options
It is normally recommended that you stay on the same medication that you are on at the beginning of your pregnancy (but not sodium valproate) but you may need to increase the dose or add in other medication to control your epilepsy in your pregnancy. This is particularly important around the time you give birth when your sleep may be disrupted which can also increase the chance of having seizures.Timing of birth
Normally the timing of birth is not affected by your epilepsy. Your medical team may recommend having an epidural for pain relief in your labour so that you can rest and reduce your risk of becoming excessively tired.How may this impact my birth choices?
It is likely your team will recommend you give birth in the hospital and in a birth setting where doctors are readily available, such as the labour ward, in case you have a seizure during or immediately after your labour. It is recommended not to labour in water in case you have a seizure.How may this affect care after the birth?
It is really important that you follow normal epilepsy advice such as taking showers instead of baths. Additionally, you will be advised not to change your baby’s nappy on a high surface but to use a change mat on the floor. There are lots of other helpful tips available from the links below.Type 1 diabetes: Frequently asked questions
Type 1 diabetes: Frequently asked questions
How is the diagnosis made?
This will have been made before pregnancy. All women with Type 1 diabetes should be offered preconception counselling to optimise their health.What does this mean?
For me: Pregnancy can increase your risk of developing or worsening your pre-existing diabetic eye or kidney problems. In the first trimester you are at higher risk of having episodes of low blood sugar. In the second half of the pregnancy you are at higher risk of diabetic ketoacidosis and pre-eclampsia and preterm delivery. You will need to attend more hospital visits during pregnancy and you will be under the care of a specialist team. For my baby: There is a greater risk of having a miscarriage or stillbirth. There is an increased risk of congenital abnormalities (birth defects for your baby) when your blood glucose levels are high at the time of conception, and during the first trimester. In the second half of pregnancy high blood sugar levels can increase the size of your baby or there may be a growth restriction (slow growth). This can make it make the delivery of your baby more complex. Your baby is more likely to have low blood glucose after they are born and may have other health conditions requiring specialist support.What will the medical team recommend?
You will be seen in a joint diabetes and pregnancy clinic. Your first scan should take place at 7-9 weeks and you will need extra scans throughout the pregnancy. You will be asked to make changes to your diet and maintain/increase your physical activity.What tests will/may be considered? How often may they be needed?
You will be asked to measure your blood sugar levels more often. You will be given more support for blood glucose monitoring and offered a continuous glucose monitoring sensor and will be given a ketone meter. You will be reminded what your target blood glucose levels should be and you should aim to keep your blood glucose within that range at least 70% of the time. You will need regular eye check-ups during pregnancy. Your blood pressure and kidney blood tests will also be monitored very closely.What symptoms and signs should I be looking out for?
Morning sickness in the first trimester may affect your blood sugar levels. You may need anti-sickness medication if you are vomiting, so let your specialist maternity team know. Anti-sickness medication is safe to use during pregnancy. You are more likely to be unaware of your low blood sugars. You should have a glucagon pen at home and your partner/family should know how to administer this in an emergency should you become unwell.What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or unable to take your regular insulin you must attend the hospital immediately. If your baby is not moving you should attend the hospital immediately.How are recommendations made regarding treatment options?
You should be taking 5mg folic acid daily at least 3 months before conception and up to 16 weeks of pregnancy. To reduce your risk of pre-eclampsia you should take 75mg-150mg of aspirin each night from 12 weeks until 36 weeks. Your insulin doses will change during pregnancy. For example you may notice a drop in your insulin requirements in early pregnancy (typically at 8-16 weeks) and an increase in insulin requirements in the second half of your pregnancy. Be sure to discuss all treatment with your specialist team at the hospital.How are recommendations made regarding timing of birth
You will be advised to deliver around 38 weeks gestation. This may be earlier if there are concerns about you, your blood glucose levels, or your baby. By 36 weeks your team should be working with you to make a plan for the birth.How may this impact my birth choices?
You may be offered an induction of labour if your team feels it is safer to do so. You will need blood glucose monitoring throughout labour.How may this affect care after the birth?
You and your baby will need to be monitored very closely after birth. Your baby is at risk of low blood sugar levels after birth. If you are breastfeeding you may find that your glucose levels drop quickly while you are feeding, and afterwards. A birth plan prior to delivery should have been agreed to regulate your insulin requirement.What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Look after your health between pregnancies.What will this mean for future/my long-term health and how can I influence this?
Contraception and a follow up plan should be agreed before you are discharged from maternity care.Type 2 diabetes: Frequently asked questions
Type 2 diabetes: Frequently asked questions
How is the diagnosis made?
This will have been made before pregnancy. Ideally all women with type 2 diabetes should be offered preconception counselling to optimise their health.What does this mean?
For me: Pregnancy can increase your risk of developing or worsening your pre-existing diabetic eye or kidney problems. You are at higher risk of diabetic ketoacidosis and pre-eclampsia. You will need to attend more hospital visits during pregnancy and you are more likely to be delivered early (around 38 weeks of pregnancy). For my baby: There is a greater risk of a miscarriage or stillbirth. There is an increased risk of congenital abnormalities if your blood glucose levels are consistently raised at the time of conception. In the second half of pregnancy the sugar level can increase the size of your baby or there may be growth restriction slow growth). This can make it make the birth of your baby more complex. Your baby is more likely to have low blood glucose levels (hypoglycaemia) after birth and may have other health conditions requiring specialist support.What will the medical team recommend?
You will be seen more frequently in a joint diabetes and pregnancy clinic. Your first scan should take place at around 7-9 weeks and you will need extra scans throughout the pregnancy. You will be asked to make changes to your diet and maintain/or increase your physical activity.What tests will/may be considered? How often may they be needed?
You will be asked to measure your blood sugar levels at least four times a day: once before breakfast (fasting) and one hour after each meal. You will be given more support for blood glucose monitoring and may be offered a continuous glucose monitoring sensor. You will need eye check-ups during pregnancy. Your blood pressure will also be checked regularly.What symptoms and signs should I be looking out for?
Morning sickness in the first trimester may affect your blood sugar levels. You may need anti-sickness medication if you are vomiting, so let your team know. Anti-sickness medication is safe to use during pregnancy.What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or are unable to take your regular insulin you must attend the hospital. If your baby is not moving you should attend the hospital immediately.How are recommendations made regarding treatment options?
You should be taking 5mg folic acid daily at least 3 months before conception and up to 16 weeks of pregnancy. To reduce your risk of pre-eclampsia you should take 75mg-150mg of aspirin each night from 12 weeks until 36 weeks. Medications that are safe to use in pregnancy are metformin and insulin. You may need more insulin as you progress through your pregnancy.How are recommendations made regarding timing of birth?
You will be advised to deliver around 38 weeks gestation. This may be earlier if there are concerns about you, your blood glucose levels or the size of your baby. By 36 weeks your team should be working with you to make a plan for the birth.How may this impact my birth choices?
You may be offered an induction of labour if your team feel it is safer to do so. You will need blood glucose monitoring throughout labour.How may this affect care after the birth?
You and your baby will need to be monitored very closely after birth. Your baby is at risk of low blood glucose levels after birth. If you are breastfeeding you may find that your glucose levels drop quickly while you are feeding, and afterwards. A birth plan prior to delivery should have been agreed to regulate your insulin requirement.What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Look after your health between pregnancies.What will this mean for future/my long-term health and how can I influence this?
Contraception and a follow up plan should be agreed before you are discharged from maternity care.Mental health and wellbeing concerns: Frequently asked questions
Mental health and wellbeing concerns: Frequently asked questions
How is the diagnosis made?
This was made before pregnancy. Ideally all women with mental health concerns/issues should be offered preconception counselling to optimise their health before pregnancy. Your GP will notify the maternity team however it is wise for you to tell your midwife at the first appointment (Booking appointment) so that the appropriate support can be put in place for you.What does this mean?
For me:
You are at risk of your mental health worsening during pregnancy. If there is a family history of mental health you are at more risk of worsening mental health during pregnancy. It is really important that you tell your midwife if you are feeling mentally unwell and give your family permission to inform the maternity team too.For my baby:
Your baby can be at risk if you do not look after yourself.What will the medical team recommend?
You should ask to speak to someone as soon as possible if you feel your mental health is worsening.What tests will/may be considered? How often may they be needed?
Depending on your level of need you will be cared for by the local perinatal mental health team, who may make specialist referral for you.What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
Low mood and feeling hopeless, helpless or isolated.How are recommendations made regarding?
Treatment options
We can offer counselling or medication. Many medications are safe in pregnancy. If you are taking medication prior to pregnancy you should discuss your ongoing treatment with your GP and medical team before making any changes.How may this affect care after the birth?
A birth plan prior to birth should be agreed with you to ensure there is a safe plan for you and your baby after birth.What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Optimise your mental health and symptoms between pregnancies.What will this mean for future/my long-term health and how can I influence this?
Contraception and a follow up plan should be made to optimise your health for future pregnancies. This may include well-being and medication review.Chronic hypertension (high blood pressure): Frequently asked questions
Chronic hypertension (high blood pressure): Frequently asked questions
How is the diagnosis made?
You may have been told you have high blood pressure before you became pregnant and you may already be taking tablets to treat your blood pressure. Sometimes chronic hypertension is diagnosed in pregnancy as it is the first time you have had your blood pressure checked on such a regular basis and in this case, the diagnosis will be made as your blood pressure was high on two occasions before 20 weeks of pregnancy.What does this mean?
For me:
- Pregnancy can put a strain on your heart and blood vessels so your blood pressure may go up and need treatment
- High blood pressure increases your chance of having pre-eclampsia (a pregnancy condition that can cause kidney, liver and other problems
- You will be offered regular appointments to check your blood pressure and urine
- You will be recommended to give birth in hospital on the labour ward
- You will need long term follow up of high blood pressure with your GP to reduce risks of heart disease after your baby is born.
For my baby:
- There is an increased chance of your baby not growing well in the womb
- There is a higher risk of your baby being born early (before 37 weeks of pregnancy).
What will the medical team recommend?
- Care under an obstetrician alongside your midwifery team
- Regular blood pressure and urine tests 2-4 weekly and more often near the end of your pregnancy (this may be with your midwife, obstetrician or GP)
- Blood pressure tablets if your blood pressure is high
- Aspirin tablets (75 or 150mg) to reduce the risk of you developing pre-eclampsia
- Home blood pressure monitoring
- Induction of labour between 38 and 40 weeks of pregnancy. This decision will be agreed with you based on your blood pressure readings and the wellbeing of the baby, to reduce the risk of stillbirth. You will be supported to make the decision that is right for you.
What tests will/may be considered? How often may they be needed?
- When you are first diagnosed in the pregnancy, your kidney function (blood test) will be checked and you may be asked to have an ECG (heart tracing) to check if your body has been affected by the high blood pressure
- You will be offered extra scans of your baby to check your baby is growing well in your womb and how well your placenta is working
- If we suspect you are developing pre-eclampsia, we will recommend tests of your liver, kidneys and blood and we may check your placental growth factor level (which is an indicator of how well your placenta is working).
What symptoms and signs should I be looking out for?
- Headaches can occur if your blood pressure is too high or if you are developing pre-eclampsia
- Other symptoms of pre-eclampsia include: swelling in your hands and face, blurred vision, pain in your tummy, vomiting, baby not moving so well
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
- If your baby isn’t moving as normal, then you should be seen at the hospital immediately
- If you have any of the symptoms of pre-eclampsia listed above then you should contact your maternity unit immediately.
Likely recommendations
Treatment options
Tablet treatment for your blood pressure will be recommended if your blood pressure is more than or equal to 140/90 mmHg The tablets most commonly used are:- Labetalol
- Nifedipine
- Methyldopa
Timing of birth
- This will depend on how well you and your baby are in the pregnancy and on whether you develop pre-eclampsia
- If the baby is well grown and the blood pressure is well controlled, then an induction of labour is likely to be recommended between 38 and 40 weeks of pregnancy.
How may this impact my birth choices?
Continuous monitoring of your baby’s heart beat in labour will be recommended whether your labour starts naturally or is induced. This is because the placenta may be working less well and we would not want to miss changes in the heart rate that would indicate the baby is not coping well with labour. This takes place in hospital on the labour ward.How may this affect care after the birth?
- You will need to have your blood pressure checked regularly and stay in the hospital for at least 24 hours after you give birth
- Your blood pressure treatment will be switched to those suitable for breastfeeding
- You will need to see your GP for ongoing monitoring of your blood pressure and treatment.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
- High blood pressure can be reduced through diet and exercise if you are overweight or inactive
- Ensuring your blood pressure is monitored and well controlled (less than 140/90 mmHg) will reduce the risk of harm for you and/or your baby in future pregnancies
What will this mean for future/my long-term health and how can I influence this?
- Chronic hypertension increases your long term risk of heart disease including heart attacks and stroke.
- Your risk of heart disease can be reduced by eating healthily, especially by reducing your salt intake and exercising regularly
- Your risk of heart disease can also be reduced by taking your blood pressure treatment to control your blood pressure and your GP will tell you how low they would like your blood pressure to be while on treatment.
Where can I find out more information about this condition?
Information on chronic hypertension NHS High blood pressure Action on pre-eclampsia: High blood pressure High blood pressure and planning a pregnancyPre-existing conditions and pregnancy
Pre-existing conditions and pregnancy
It is important to tell your GP, obstetrician and/or midwife about any pre-existing physical or mental health conditions. This also includes any previous surgery (including cosmetic procedures) or any childhood conditions or health problems from which you have now recovered.
This information helps the team assess if anything further is needed to keep you and your baby healthy during the pregnancy. If you are under specialist care for your medical condition, it is important that you speak to them and discuss any impact your condition may have on your pregnancy.
Ask them for a summary and for this to be written in your antenatal notes. Notes don’t automatically move between maternity units and/or departments, so don’t assume that your midwife or doctor knows what your previous carers have said or recommended.
If you would like more information, please use the links below to check the safety of your medication in pregnancy.
Conditions we need to know about early (before 12 weeks) include:
Chronic hypertension and other medical conditions that may increase the risk of you developing blood pressure concerns in pregnancy
Women with chronic hypertension and certain medical conditions are at a high risk of developing pre-eclampsia and will be prescribed low dose aspirin from 12 weeks. This includes any one of the following high risk factors:- Chronic hypertension (high blood pressure).
- Pre-eclampsia during a previous pregnancy.
- Chronic kidney disease, diabetes, or an inflammatory disease, eg, Systemic Lupus Erythematosus (SLE).
- First pregnancy.
- Maternal age over 40.
- Last pregnancy was more that 10 years ago.
- Body Mass Index (BMI) of 35 or more.
- Family history of pre-eclampsia.
- Expecting more than one baby in this pregnancy.
Thyroid disease
Hypothyroidism (under active thyroid)
As soon as you are pregnant, it is usually recommended that your Levothyroxine dose is increased by 25-50 mcg daily. You should then also contact your GP to arrange blood tests.Hyperthyroidism (overactive thyroid)
You must discuss your plans for pregnancy with your endocrinologist to assess your disease status and the safety of the medications you are taking.Epilepsy
Pregnancy may affect your seizures or the effect of your medication. If you become pregnant without having had a chance to discuss your medication(s), it is recommended that you see your GP or specialist as soon as possible. Prior to this review, keep taking your anti-epileptic medicines as normal. Certain medications may need to be stopped and changed to an alternative before you become pregnant, or as soon as possible if you’re already pregnant, due to the risks they pose to your baby. Some other medications need to be increased. Your doctor will prescribe a higher dose of folic acid supplementation (5mg per day).Mental health and wellbeing concerns
It is understandable to worry about the effects of some medicines used to treat mental health conditions and concerns, but it is important not to stop taking your medications without speaking to your GP or specialist. This may lead to withdrawal symptoms, especially if stopped abruptly, could cause a recurrence of your symptoms or make your condition worse.Diabetes
Women with Type 1 and 2 Diabetes should aim to have tight control of their diabetes prior to and throughout the pregnancy to reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death. Pregnancy typically places higher demand for insulin than normal and so close monitoring and control of diabetes is important.Crohn’s Disease, Ulcerative Colitis and other forms of Inflammatory Bowel Disease (IBD)
It is important to keep Crohn’s or colitis under control during pregnancy and you should not stop taking any of your medications unless your IBD team has advised you to do so. The risk from most medication is lower than the risk of a flare up.
Crohn’s Disease, Ulcerative Colitis and Inflammatory Bowel Disease (IBD): Frequently asked questions
