When you have inflammatory bowel disease (IBD) and are planning a pregnancy, the biggest question isn’t just about getting pregnant-it’s about staying healthy while keeping your baby safe. Many women worry that their IBD meds might harm the baby. But here’s the truth: uncontrolled IBD is far more dangerous to your pregnancy than most medications. Active disease increases your risk of preterm birth, low birth weight, and even stillbirth by more than double. The goal isn’t to stop all drugs-it’s to pick the right ones and keep your gut calm.
What IBD Medications Are Safe During Pregnancy?
The safest and most recommended drugs for IBD during pregnancy are the 5-aminosalicylates, or 5-ASAs. These include mesalamine and sulfasalazine. If you’re on these, keep taking them. They’ve been studied in thousands of pregnancies and show no increase in birth defects. But there’s a catch: not all mesalamine brands are equal. Some, like Asacol HD, use a coating called dibutyl phthalate (DBP), which has been linked to urogenital problems in male babies in animal studies and rare human cases. Switch to a DBP-free version like Lialda or Delzicol before you get pregnant. Your doctor can help you make the switch safely.
Sulfasalazine is also safe, but it blocks folate absorption. That’s why you need extra folic acid-4 mg daily, starting at least three months before conception. This isn’t just a suggestion; it’s a must. Folic acid cuts the risk of neural tube defects like spina bifida, which is especially important if you’re on sulfasalazine.
Biologics: Anti-TNFs, Vedolizumab, and Ustekinumab
If 5-ASAs aren’t enough, biologics are your next best option. Anti-TNF drugs like infliximab and adalimumab have the most data. Over 2,000 pregnancies tracked in the PIANO registry showed no increase in birth defects, preterm birth, or miscarriage compared to the general population. These drugs cross the placenta, especially in the third trimester, so some doctors adjust dosing near delivery to reduce drug levels in the baby. But stopping them risks a flare-and flares are riskier than the medication.
Vedolizumab is newer, but data is reassuring. A study of 103 pregnancies found no increase in birth defects or serious infections in babies. Early reports suggested lower live birth rates, but that was because many women in the study had active disease. When disease activity was controlled, birth rates matched those of other groups. It’s now considered a top choice for women who don’t respond to anti-TNFs.
Ustekinumab has data from over 680 pregnancies. No increased risk of birth defects, preterm birth, or low birth weight has been found. Even women who got the drug during early pregnancy had healthy babies. It’s now classified as a low-risk option by European and U.S. guidelines.
What to Avoid: Methotrexate, Thalidomide, and JAK Inhibitors
Some IBD drugs are absolute no-gos during pregnancy. Methotrexate and thalidomide cause severe birth defects-think missing limbs, brain malformations, heart problems. If you’re on either, you must stop at least three months before trying to conceive. These are not negotiable.
JAK inhibitors like tofacitinib and upadacitinib are newer and more controversial. A small study of 11 pregnancies on tofacitinib didn’t show birth defects, but experts still recommend stopping it at least one week before conception. Why? Because JAK proteins play a role in early embryo development. Even though no harm has been proven, the risk isn’t zero. Upadacitinib has data from 98 pregnancies with no red flags, but guidelines still advise stopping it 4-6 weeks before trying to get pregnant. It’s a precaution, not a panic.
Why Disease Control Matters More Than Drug Fear
Here’s what every woman with IBD needs to hear: stopping your meds to protect your baby often backfires. A 2024 review of 15 studies found that uncontrolled IBD increases the risk of bad pregnancy outcomes by more than three times compared to medication exposure. If you’re in remission when you get pregnant, your chances of a healthy baby are nearly the same as someone without IBD.
Doctors used to think it was safer to go off meds. Now we know better. A 2023 global consensus from 42 experts across 15 countries says the same thing: aim for clinical and endoscopic remission for at least three months before conceiving. That means no symptoms, no inflammation on colonoscopy, and no steroids. Steroids themselves carry risks-like cleft palate if used in the first trimester. So the goal isn’t just to be symptom-free. It’s to be truly healed.
When to Talk to Your Doctor
Don’t wait until you’re pregnant to ask about meds. Start the conversation at least six months before you plan to conceive. This gives you time to switch medications, adjust doses, and get your disease under control. Many women don’t realize their gastroenterologist and OB-GYN should be working together. A coordinated plan reduces stress and improves outcomes.
Ask your doctor: “Is my current regimen safe for pregnancy?”, “Do I need a different brand of mesalamine?”, and “Should I get a colonoscopy before trying?” If your doctor isn’t familiar with the 2023 PIANO guidelines, ask for a referral to a specialist. Only 42% of community gastroenterologists knew all the safe IBD meds in a 2021 survey. You deserve better.
What About Breastfeeding?
Most IBD medications are safe while breastfeeding. Anti-TNFs, vedolizumab, and ustekinumab pass into breast milk in tiny amounts-far less than what the baby gets in the womb. There’s no need to pump and dump. Sulfasalazine might cause fussiness or diarrhea in some babies, but serious side effects are rare. Mesalamine is considered safe. The key is to keep taking your meds. A flare during breastfeeding is harder to manage and puts both you and your baby at risk.
What’s New in 2025?
The science is moving fast. In 2024, the FDA approved mirikizumab, a new biologic, with mandatory pregnancy registries to track outcomes. A major trial comparing vedolizumab to anti-TNFs in pregnant women is expected to publish results in late 2024. Researchers are also building tools to predict how much of a drug crosses the placenta-so we can tailor doses even better.
One big change: the FDA no longer uses letter categories (like Category B or C) for drug safety. Instead, labels now give detailed summaries of risks, benefits, and data. That means more clarity-but also more reading. Talk to your doctor to interpret the new labels.
Real Talk: Anxiety Is Normal. But Don’t Let It Stop You.
A 2022 survey found that 68% of pregnant women with IBD were terrified of their meds harming their baby. That fear is real. But the data tells a different story. The risk of birth defects from mesalamine or infliximab is about 2.5-3%, the same as the general population. The risk from an active flare? 10-15%.
You’re not alone. Thousands of women with IBD have had healthy babies while staying on their meds. The key is planning, not panic. Work with your team. Get your disease quiet. Take your folic acid. Choose the right drugs. Then, enjoy your pregnancy.
Can I get pregnant if I have IBD?
Yes, absolutely. Most women with IBD can conceive and have healthy pregnancies. The key is being in remission before you try. If your disease is active, your chances of complications go up. Work with your doctor to get your IBD under control before conception.
Are biologics safe during pregnancy?
Yes, the most studied biologics-infliximab, adalimumab, vedolizumab, and ustekinumab-are considered safe. Data from over 2,000 pregnancies shows no increase in birth defects. These drugs help keep you in remission, which is far more important than avoiding them.
Should I stop my IBD meds when I get pregnant?
No, unless your doctor tells you to. Stopping meds often leads to flares, which are more dangerous to your baby than the drugs. The only exceptions are methotrexate, thalidomide, and sometimes JAK inhibitors-these must be stopped before conception.
Is it safe to breastfeed while on IBD medication?
Yes. Most IBD medications, including biologics and 5-ASAs, pass into breast milk in very small amounts. There’s no need to stop breastfeeding. In fact, staying on your meds helps prevent a flare, which benefits both you and your baby.
What’s the best time to plan pregnancy with IBD?
At least 3-6 months before trying. This gives you time to switch to safer meds if needed, get your disease into remission, and start high-dose folic acid. Planning ahead cuts your risk of complications by half.
Do I need to stop my meds before a C-section?
No. There’s no reason to stop IBD medications before delivery, even for a C-section. Continuing them helps prevent postpartum flares. Your surgical team and GI doctor can coordinate care safely.
Can my baby get vaccinated if I took biologics during pregnancy?
Yes. Babies exposed to anti-TNFs or other biologics in the womb can receive all routine vaccines, including live ones like MMR and varicella. The 2024 ECCO guidelines confirm this. There’s no increased risk of infection from vaccine exposure.
What if I get pregnant while on methotrexate?
Stop methotrexate immediately and contact your doctor. It’s a known teratogen and can cause serious birth defects. You’ll need a detailed ultrasound and possibly genetic counseling. Never restart it during pregnancy or while breastfeeding.
Usha Sundar
December 24, 2025 AT 03:26Just stop all meds and pray. I did and had a perfectly healthy baby.
claire davies
December 24, 2025 AT 16:42Oh honey, I’m so glad you wrote this. As a nurse who’s seen three IBD mamas through pregnancy, I’ve watched the fear paralyze women into stopping their meds-and then the flares hit like a freight train. Mesalamine? Safe as toast. Infliximab? Been used in over 2,000 pregnancies with zero red flags. The real villain isn’t the drug-it’s the untreated inflammation creeping through your gut and into your placenta. Folic acid? 4 mg daily, no exceptions. And please, for the love of all that’s holy, ditch Asacol HD. Switch to Lialda. DBP isn’t just a chemical-it’s a silent saboteur. You’re not being reckless by staying on treatment. You’re being a warrior.
Payson Mattes
December 26, 2025 AT 07:01Wait… so you’re telling me the FDA and Big Pharma are pushing these drugs because they make billions? I read on a forum that the coatings in mesalamine are laced with phthalates to keep you dependent. And what about that 2024 mirikizumab trial? The FDA didn’t approve it-they just greenlit it because they’re scared of lawsuits. I know a guy whose cousin’s neighbor’s dog got sick after a vet gave it a biologic. Coincidence? I think not. Also, why don’t they test the babies’ poop for drug residues? Nobody talks about that. I’ve been taking turmeric and bentonite clay for 8 months now. My IBD’s gone. No meds. No flares. Just pure Earth energy.
Rosemary O'Shea
December 27, 2025 AT 00:03How utterly pedestrian. You’ve distilled a complex, nuanced medical landscape into a bullet-pointed pamphlet fit for a Pinterest board. The PIANO registry? Darling, it’s observational. It doesn’t prove safety-it proves correlation, and even that’s muddied by selection bias. And please, spare me the ‘folic acid is a must’ sermon. Of course it is. But you’ve omitted the elephant in the room: the epigenetic ripple effects of long-term biologic exposure. We simply don’t have data beyond five years. Are we really comfortable turning pregnant women into unwitting participants in a pharmacological experiment? And why is no one talking about the microbiome collapse these drugs induce? I’m not anti-medication-I’m pro-thoughtfulness. And right now, your tone is alarmingly reductive.
Lu Jelonek
December 28, 2025 AT 14:01Thank you for this. As an immigrant from India who struggled for years to find a doctor who understood IBD in pregnancy, this feels like a lifeline. I was told by a local GP to stop everything when I got pregnant. My flare was brutal. I ended up in the hospital at 28 weeks. Now I’m 34 weeks along, on Lialda and folic acid, and my baby is thriving. The key is coordination-GI + OB-GYN + a nutritionist who doesn’t push keto. I wish I’d known about the DBP issue earlier. My old brand was Asacol. I switched last year and slept better for the first time in five years. You’re right: it’s not about avoiding drugs. It’s about choosing the right ones. And you? You’re doing the work. Keep going.
siddharth tiwari
December 28, 2025 AT 20:45u guys are all wrong. jaks are fine. i read on reddit that a guy in delhi got pregnant while on tofacitinib and his kid is 2 now and plays soccer. no defects. also, why are you all scared of phthalates? its just plastic. my cousin drank from a plastic bottle while pregnant and her kid is a genius. also, i think you should take ashwagandha. its from ayurveda. its better than mesalamine. and why do you need colonoscopy? its painful. just take turmeric and chill. also, folic acid is for rich people. i took 1 mg and my baby is fine. you overthink too much. its all stress anyway.
Adarsh Dubey
December 29, 2025 AT 20:09There’s a lot here, and honestly, most of it makes sense. I’ve got Crohn’s and my wife is pregnant right now. We switched from sulfasalazine to mesalamine (Lialda) and started the 4mg folic acid like clockwork. We’re 20 weeks in, no flares, no drama. The biologics part was the scariest, but reading the PIANO data made me feel way better. I get that people are scared-pregnancy makes you hyper-aware of every chemical in your environment. But the data here is solid. The real takeaway? Don’t panic. Plan. And if your doctor doesn’t know this stuff, find one who does. It’s not about being perfect. It’s about being informed.
Jeffrey Frye
December 31, 2025 AT 15:42Let’s be real-this article is basically a pharma-funded ad disguised as medical advice. You mention ‘2,000 pregnancies’ like that’s a mountain of evidence. It’s not. It’s a drop in the ocean compared to the millions of unmonitored cases. And you gloss over the fact that biologics suppress immunity. What happens when the baby gets RSV at 3 months? What if they develop autoimmune issues at 12? We’re talking about a developing immune system being exposed to drugs that literally shut down cytokine signaling. And yet, you say ‘no increased risk’? That’s not the same as ‘zero risk.’ Also, why is there no mention of the rising rates of childhood asthma and allergies in kids born to moms on biologics? You’re cherry-picking data. And that’s not medicine-that’s marketing.
Chris Buchanan
January 1, 2026 AT 21:16So let me get this straight-you’re telling me the best way to have a healthy baby is to… take your meds? Shocking. Who knew? I mean, I guess if you’re a rational human being who reads peer-reviewed studies instead of TikTok moms, this makes sense. But hey, congrats on not being a disaster. You didn’t stop your meds because you were scared of a 0.5% theoretical risk. You listened to science. You planned. You didn’t let fear turn you into a DIY herbalist on a 30-day juice cleanse. Kudos. Now go hug your GI doc. They’re probably tired of being the only adult in the room.
Raja P
January 2, 2026 AT 06:58Man, this is exactly what I needed. I was gonna quit my meds when I found out I was pregnant. Scared out of my mind. But after reading this, I talked to my GI and we kept me on adalimumab. I’m 22 weeks now. No flares. Baby’s kicking like crazy. I even switched to Lialda after you mentioned the DBP thing-never knew that. Also, my OB didn’t even know about the folic acid dose. Had to teach her. So yeah-thank you. This isn’t just info. It’s peace of mind.
Joseph Manuel
January 3, 2026 AT 04:47While the intent of this article is commendable, its methodological rigor is suspect. The reliance on registry data without control for confounding variables-such as socioeconomic status, prenatal care access, and baseline disease severity-renders the conclusions potentially misleading. Furthermore, the dismissal of JAK inhibitors as merely ‘precautionary’ ignores the pharmacokinetic principle that embryonic exposure during organogenesis is non-linear and potentially threshold-dependent. The assertion that ‘risk is no greater than background’ lacks statistical power to support such a definitive claim. A more cautious, evidence-limited interpretation would have been more scientifically defensible.
Bret Freeman
January 3, 2026 AT 15:46You people are so naive. I’ve been reading about this for years. The FDA doesn’t care about your baby. They care about lawsuits. That’s why they say ‘safe’-because if something goes wrong, they can say ‘it’s not proven to be harmful.’ But the truth? Every drug has a price. And your baby pays it in silence. I know a woman who took mesalamine and her son had a cleft palate. She didn’t know until after birth. Now she’s suing the drug company. And guess what? They settled. Because they knew they were hiding something. Don’t trust the ‘experts.’ They’re paid to lie. Your gut is your gut. Let it heal naturally. No drugs. No fear. Just truth.