The following text is intended for women with inflammatory bowel disease (Crohn's, colitis) who are planning to become pregnant, are already pregnant, or are planning to undergo or are undergoing fertility treatments.

A few weeks ago, I sat down with Dr. Yulia Ron, a senior gastroenterologist at Ichilov, a specialist in inflammatory bowel diseases, and asked her a number of questions that interested me. Dr. Ron's answers are here for you.

Are there any symptoms that worry you as a gastroenterologist in a pregnant woman?

Dr. Ron: "When there is bleeding from the anus - not when wiping (because bleeding when wiping is more characteristic of hemorrhoids) but heavy bleeding, bloody diarrhea, a fever lasting several days, new anemia that appears in tests, nighttime abdominal pain, mucous stools - in all of these the woman should be examined."

Is there a connection between hormonal changes and Crohn's or ulcerative colitis?

"Inflammatory bowel disease is like other autoimmune diseases - one-third improve during pregnancy, one-third worsen, and one-third remain unchanged."

We don't know how the disease will behave.

The more balanced a woman is before the illness, the more likely it is that the illness will be quieter.

The more balanced a woman is before the illness, the more likely it is that the illness will be quieter.

What should a woman with Crohn's or ulcerative colitis be careful about when she wants to get pregnant?

Dr. Ron: Stay in remission, verify with the treating gastroenterologist that she is in clinical remission. The remission should be at least 3-6 months before getting pregnant.

Sometimes the patient feels great but there is active inflammation in the background, so it is important to perform a colonoscopy or a calprotectin test (as directed by the attending physician) to verify that there is indeed remission.

It is important not to stop medication without consulting your doctor, and it is important to know that most medications are permitted during pregnancy.

Basic vitamin and folic acid levels should also be checked before becoming pregnant.

What do you think about using herbs or nutritional supplements during pregnancy in women with inflammatory bowel disease?

Dr. Ron: There is not enough information on this. Curcumin has not been tested in pregnancy. Supplements and herbs have not been validated (a systematic process of testing) in pregnancy. I do recommend acupuncture and reflexology during pregnancy for pain relief.

Additional things that Dr. Ron mentioned in the interview: It is important to continue with medication even during the breastfeeding phase (most medications are allowed during breastfeeding) because six months after birth, there may be a more significant flare-up compared to pregnancy due to major hormonal changes. Therefore, it is important to make an appointment with a gastroenterologist about 3-5 months after birth, to be sure to maintain the treatment, to continue consuming multivitamins + iron while breastfeeding, and sometimes even increase the supplements. "In addition, when there is inflammatory bowel disease, it is recommended to avoid pills such as Atofen, Arcoksiya, Nurofen (from the NSAIDS group) because these medications increase flare-ups in Crohn's and colitis patients. For pain, it is recommended to take paracetamol or receive treatment with complementary medicine - acupuncture or reflexology."

Dr. Yulia Ron is a leader in the field of multi-professional clinics at the Gastroenterology Institute in Ichilov: responsible for the combined clinic for inflammatory bowel diseases in high-risk pregnancies, the adolescent clinic, and day care.

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