Ulcerative Colitis and Pregnancy: What to Know, What to Ask, What to Trust

Navigating Pregnancy with Ulcerative Colitis (UC)

Pregnancy is full of unknowns, even more so when you’re also living with ulcerative colitis. Over the years, I’ve spoken to women navigating this particular crossroads, and the same themes come up again and again: fear, conflicting advice, and a deep longing to do what’s best for both body and baby. If you’re here, you’re probably holding all of that and more. Maybe you’re trying to conceive, already pregnant, or simply wondering what the future might look like. Wherever you are, I hope this guide helps you feel more grounded. I’ve gathered the most trusted information, questions to ask your care team, and the kinds of honest insights I wish were easier to find. 

What to Know: Understanding UC and Pregnancy

Can You Have a Healthy Pregnancy with UC?

The short answer? Yes, you absolutely can. I’ve spoken to many women living with UC who have gone on to have healthy, full-term pregnancies and gorgeous, thriving babies. But I know how hard it can be to trust that, especially when your body has already carried you through so much.

One of the most helpful things to know is this: research shows that being in remission at the time of conception is one of the biggest predictors of a smoother pregnancy. UC often follows the pattern it’s in when you fall pregnant, so if you’re in remission, there’s a good chance you’ll stay in remission. If you’re flaring, that inflammation may carry through or even worsen.

That’s why many doctors recommend planning for pregnancy during a period of remission, if you’re able. But if things don’t go exactly according to plan, it doesn’t mean you can’t still have a beautiful outcome. You just might need a bit more support, and that’s okay.

It also helps to know that ulcerative colitis, on its own, doesn’t increase your risk of miscarriage or birth defects when the condition is in remission. That’s a powerful fact to hold onto when your brain tries to spiral into the “what ifs.” You deserve to step into this chapter with hope.

Does Pregnancy Make UC Worse or Better?

Here’s something you might not expect: for some women, pregnancy actually brings a period of relief. Hormonal changes during pregnancy, especially the rise in progesterone and certain immune-modulating shifts, can have a calming effect on the immune system. And since UC is an inflammatory condition rooted in immune dysfunction, that shift can sometimes mean fewer flares and more stability.

But (and it’s an important but), that’s not the case for everyone. Around a third of women with UC find that their symptoms improve during pregnancy, another third stay about the same, and the final third may experience a flare. It’s one of those deeply individual things, something you can’t control, but can plan and prepare for.

Pregnancy also brings its own physical and emotional changes: constipation or looser stools, shifting appetites, food aversions, heightened emotions, and sleep disruption. For anyone with UC, these can overlap with flare symptoms, making it tricky to tell what’s pregnancy and what’s your IBD acting up.

This is where it becomes essential to stay in touch with your care team. You don’t need to ‘wait and see’ alone or downplay symptoms out of fear. Your body is doing something huge, and you’re allowed to ask for help every step of the way.

How UC Can Affect Fertility and Conception

One of the hardest things about living with UC is the way it quietly plants seeds of doubt, especially when it comes to fertility. So let’s clear a few things up.

For most women with ulcerative colitis, fertility is not significantly affected, especially if the condition is in remission. If you’re well, your chances of conceiving naturally are generally the same as someone without IBD. But when UC is active, that can sometimes change. Ongoing inflammation, nutritional deficiencies, and the emotional toll of chronic illness can all play a role in temporarily reducing fertility.

Then there’s the question of surgery. If you’ve had a colectomy with J-pouch reconstruction (also called ileal pouch-anal anastomosis, or IPAA), studies do show a reduced fertility rate, mainly due to the way the surgery can affect the fallopian tubes. That said, many women still go on to have successful pregnancies after this kind of surgery. It just might take a little more planning and support.

If you’re considering pregnancy, now is a good time to have a frank conversation with your gastroenterologist or IBD specialist. Ask them about how your current health status and treatment plan may impact your fertility, and whether any adjustments might be helpful before trying to conceive.

The takeaway? UC doesn’t automatically mean infertility. It might mean a few extra steps, a bit more preparation, and a team that understands the full picture. But that’s something you deserve anyway.

What to Ask: Questions for Your Medical Team

When you’re thinking about pregnancy with UC in the mix, you shouldn’t have to figure it all out alone. The right team, one that includes your gastroenterologist, GP, and ideally a supportive OB-GYN, can help you navigate the unknowns with clarity and confidence. But let’s be honest: it can be hard to know what to even ask at those appointments.

Here are some key questions to bring to the table, broken down by stage. Feel free to save this list or take a screenshot for your next visit to ensure that you’re having the right conversations.

Pre-Pregnancy Planning

• Is my UC in remission right now? Understanding your current disease activity helps guide when it’s safest to try.

• Are the medications I’m on safe for pregnancy? Many UC meds are considered low-risk, but some need to be stopped or swapped in advance.

• Should I take any supplements or adjust my diet? Folate, iron, and B12 are commonly flagged. Your care team can help tailor this to your needs.

• How do we handle a potential flare during pregnancy? It's empowering to know what the plan would be before you’re in the thick of it.

• Do I need to see a high-risk OB? Not everyone with UC will need one, but in some cases, it’s worth having that extra support.

During Pregnancy

• What symptoms should I report right away? Clear guidelines can help you avoid unnecessary anxiety (or underplaying something important).

• How often will I need check-ins with my GI during pregnancy? Some women go months without issues, others need closer monitoring.

• Will we adjust my medication dose or frequency? Pregnancy can change how your body absorbs or processes medication.

• Can I keep taking my probiotics, supplements, or anti-inflammatories? Just because it’s “natural” doesn’t always mean it’s safe during pregnancy.

• If I have a flare, what are the safest treatment options while pregnant? Knowing your emergency toolkit ahead of time = less panic, more preparedness.

Birth Plans and Postpartum Considerations

• Are there any reasons I might need a C-section? Vaginal delivery is possible for most, but J-pouch or rectal involvement may change that.

• Will UC impact my ability to breastfeed? Most UC meds are safe during breastfeeding, but it’s worth discussing specifics.

• What can I expect in terms of symptom changes after birth? Some flare postpartum, especially as hormones shift and sleep disappears.

• Should I have a postpartum flare plan in place? Yes. Postnatal care should include your gut too, not just your uterus.

This is your body, your journey, and your right to ask questions, no matter how big, small, or “silly” they might feel. A supportive team won’t just tolerate your questions, they’ll welcome them.

What to Trust: Separating Fact from Fear

When you're pregnant or thinking about getting pregnant with UC, it can feel like every Google search opens a new tab of worry. One page says you should go off your meds. Another says that’s dangerous. Reddit tells you about someone’s flare that landed them in the hospital, and Instagram shows a smiling mum-to-be who had a "perfect pregnancy." So, how do you know who - or what - to trust?

Let’s break it down.

Reliable Sources vs. Google Spirals

Online groups like Reddit, for example, can be spaces for connection and shared experience. But they are not medical advice. One person’s story might reflect a rare complication, or it might be coloured by poor medical support. It might even be outdated.

Instead of relying on search engines alone, look for guidance from trusted sources like:

• Mayo Clinic

• Crohn’s & Colitis Foundation

• ECCO Guidelines on IBD and Pregnancy

• WebMD

• Your own medical team (who knows your UC history)

If you do find yourself going down a Google rabbit hole, pause and ask: Is this evidence-based? Is it recent? Does it apply to my situation?

Personal Stories Are Support, Not Scripture

There’s real comfort in hearing that someone else has walked the path you’re on. But their experience doesn’t have to be your prediction. Whether it’s a YouTube vlog, a social media post, or a blog, remember that these are stories, not scripts.

If someone else had a textbook pregnancy with UC, that’s beautiful, but it doesn’t mean you’re failing if yours looks different. And if someone else had a hard time, it doesn’t mean you will too.

You’re not doing it wrong. You’re doing it your way.

Gut Feelings Are Valid, Too

If something doesn’t sit right, whether it’s advice, a suggested medication change, or the way a doctor speaks to you, you’re allowed to get a second opinion. Trusting yourself is part of the journey. You’re not being difficult. You’re being discerning.

In fact, one of the best things you can do right now is build a filter that helps you sort fear from fact, noise from knowledge. You don’t need to know everything. You just need a few good sources, a doctor who listens, and the inner permission to trust your own instincts.

FAQs About Ulcerative Colitis and Pregnancy

Can UC medication harm my baby?

This is one of the most common (and understandable) fears. The reassuring news? Many UC medications are considered safe during pregnancy, including mesalamine, biologics, and certain immunosuppressants. Some older medications, like methotrexate, should be avoided. The key is to speak openly with your gastroenterologist and OB about what you’re taking, and never stop meds suddenly without guidance.

Should I only try to conceive when I’m in remission?

Ideally, yes. Being in remission gives you the best chance at a healthy pregnancy and lowers the risk of complications. But life doesn’t always line up perfectly. If you do fall pregnant during a flare, don’t panic, your care team can adjust your treatment to help keep you and baby safe.

Will my baby be born with IBD?

IBD isn’t directly inherited, but there is a slightly increased genetic risk. That said, most babies born to parents with UC do not develop it. Lifestyle, gut health, and environmental factors play a role too. There’s so much you can do to support your baby’s wellbeing, starting with how you care for yourself now.

Can I breastfeed while on UC meds?

In most cases, yes. Many medications used to treat UC are considered safe for breastfeeding, but it depends on the specific drug and dosage. If you're unsure, double-check with a doctor or pharmacist who understands IBD. The InfantRisk Center is also a great resource for this.

What if I have a flare while pregnant?

It’s possible, but treatable. Many flares can be managed safely during pregnancy, often with the same medications you've already been using. The goal is always to reduce inflammation quickly, because staying in remission supports both you and your baby. Keep your care team in the loop the moment symptoms shift.

Can I have a natural birth with UC?

Yes, natural birth is usually possible, even with UC. If you’ve had certain surgeries like a J-pouch, or if you have active rectal disease, a C-section might be recommended to avoid damage to the pouch or pelvic floor. Again, it comes down to your specific circumstances; this is where your OB and GI should work together.

Final Thoughts: Trusting Yourself Through It All

There’s something incredibly brave about exploring pregnancy while living with a condition like ulcerative colitis. You’re already carrying so much, physically, emotionally, and mentally, and yet here you are, seeking out information, asking thoughtful questions, and doing everything you can to give yourself and your future child the best possible start.

So if you’re feeling unsure, overwhelmed, or even afraid, you’re not alone. These feelings are valid. But they don’t get to run the show. You’ve got knowledge on your side. You’ve got options. And you’ve got a community that understands what it means to live with IBD and still hold space for hope, healing, and joy.

Trust your body. Trust your care team. Most importantly, trust yourself.

Whether you’re preparing for pregnancy, newly pregnant, or just starting to ask “what if”, this journey is still yours. And you deserve support that’s clear, calm, and compassionate every step of the way.