The course of inflammatory bowel disease during pregnancy and postpartum.

To determine whether pregnancy influences the course of inflammatory bowel disease, a survey of 324 patients, 178 with ulcerative colitis and 146 with Crohn's disease was carried out. During pregnancy, 70% of the patients remained unchanged or improved, whereas 30% developed exacerbations. The course of the disease was significantly milder in patients who became pregnant while in remission, as compared to those with moderate to severe disease (P less than 0.001). Postpartum, only 13% of patients, with quiescent to mild disease at term, experienced moderate to severe disease in contrast to 53% of those with active disease (P less than 0.001). We conclude that: 1. The course of inflammatory bowel disease is not adversely affected by concurrent pregnancy or postpartum 2. Exacerbations during or after pregnancy are more frequent in patients with active or uncontrolled disease. 3. Since the risk of relapse during pregnancy and postpartum is significantly lower in patients with inactive disease, treatment designed to induce and maintain remission in the course of pregnancy should minimize such exacerbations.