Pregnancy Week by Week : Week 18 (part 2) - How Your Actions Affect Your Baby’s Development

Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) describes two common problems—ulcerative colitis and Crohn’s disease. (Crohn’s disease is discussed in Week 24.) IBD affects about 2 million Americans. (IBD is not the same as IBS—irritable bowel syndrome. See Week 30 for a discussion of IBS.)

With ulcerative colitis, the inner lining of the intestine gets red and swollen, and develops ulcers. It may be most severe in the rectal area, which can cause frequent diarrhea. Mucus and blood often appear in the stool if the colon lining is damaged

IBD can be caused by many things, including environment and diet. Lifestyle choices may affect IBD. Not smoking and taking omega-3 fatty acids seem to help. A defective immune system may also be a cause.

The problem seems to run in families. This has led researchers to believe a gene variant may affect how the immune system works.

The most common symptoms of IBD are diarrhea and stomach pain. Diarrhea can range from mild to severe. At times, IBD may also cause constipation. People with the problem may lose fluid and nutrients from diarrhea, which can lead to fever, fatigue, weight loss and malnutrition. Stomach pain is caused by irritation of the nerves and muscles that control intestinal contractions.

Some people with IBD may experience inflammation in other parts of the body, including the joints, eyes, skin and liver. Skin tags may also develop around the anus.

Diagnosing and Treating IBD. Diagnosing the problem can be difficult because IBD symptoms often resemble those of other conditions. If you lose weight, have repeated bouts of diarrhea or abdominal cramping, IBD may be suspected.

Your healthcare provider may order blood tests to look for inflammation, to check for anemia and to look for other causes of symptoms. A stool test might also be done to check for blood, or a barium study of the intestines may be ordered.

Drug treatment is most often used to treat IBD symptoms. You may be prescribed anti-inflammatory drugs and/or immunosuppressive agents. If symptoms don’t respond to either medication, surgery may be necessary. If needed during pregnancy, it should be performed during the second trimester.

You may need more tests during pregnancy. Experts believe it’s safe to have a colonoscopy, sigmoidoscopy, upper endoscopy, rectal biopsy or abdominal ultrasound during pregnancy. Avoid X-rays and CT scans. Ask your OB/GYN about an MRI if one is recommended. It’s important to involve your gastroenterologist. Ask your pregnancy healthcare provider how to go about this.

IBD and Pregnancy. Most women who have IBD can have a normal pregnancy and give birth to a healthy baby. If you didn’t talk to your healthcare provider before you got pregnant, contact your healthcare provider before you stop taking any medication.

If your IBD is in remission when you get pregnant, it may stay in remission during pregnancy. This happens with about 65% of all pregnant women. If your disease is active, it will probably remain active throughout pregnancy.

A third of all women with ulcerative colitis relapse during pregnancy, usually during the first trimester. Flare-ups occur most often during the first trimester and immediately after birth.

Women who have severe IBD have a higher risk of problems. You may be seen more often during your pregnancy, and you may have more tests.

5. How Your Actions Affect Your Baby’s Development

Exercise in the Second Trimester

Everyone has heard stories of women who continued with strenuous exercise or arduous activities until the day of delivery without problems. Stories are told of Olympic athletes who were pregnant at the time they won medals. This kind of training and physical stress isn’t a good idea for most pregnant women.

As you grow, your sense of balance may be affected. You may feel clumsy. This isn’t the time for contact sports or sports where you might fall easily, injure yourself or be struck in the tummy.

Pregnant women can usually participate safely in many sports and exercise activities throughout pregnancy. This is a different attitude from 30 and 40 years ago; decreased activity was common then. Exercise and activity can benefit you and your growing baby.

Discuss your activities at a prenatal visit. If your pregnancy is high risk or if you have had several miscarriages, it’s particularly important to discuss exercise with your healthcare provider before starting any activity. Now is not the time to train to increase activity. In fact, this may be a good time to decrease the amount or intensity of exercise you do. Listen to your body. It will tell you when it’s time to slow down.

What about activities you’re already involved in or would like to begin? Below is a discussion of various activities and how they will affect you in your second and third trimesters.

Activities You May Enjoy. Swimming can be good for you. The support and buoyancy of the water can be relaxing. If you swim, swim throughout pregnancy. If you can’t swim and have done water exercises (exercising in the shallow end of a swimming pool), you can continue during your pregnancy. This is an exercise you can begin at any time during pregnancy, if you don’t overdo it.

Walking is great during pregnancy. It can be a good time for you and your partner to talk. Even when the weather is bad, you can walk in many places, such as an enclosed shopping mall, to get a good workout. Two miles of walking at a good pace is adequate. As pregnancy progresses, you may need to decrease your speed and distance. Walking is an exercise you can begin at any time during pregnancy, if you don’t overdo it.

If you’re comfortable riding and have safe places to ride, you can enjoy bicycling with your partner or family. But now is not the time to learn to ride a bike. Your balance changes as your body changes. This can make getting on and off a bicycle difficult. A fall from a bicycle could injure you or your baby.

A stationary bicycle is good for bad weather and for later in pregnancy. Many experts suggest you ride a stationary bike in the last 2 to 3 months of pregnancy to avoid the danger of a fall. Spinning—a high-intensity stationary cycling workout—may not be recommended during pregnancy because it may cause dehydration and a rapid heart rate.

Jogging may be permitted during pregnancy, but check with your healthcare provider first. Some women continue to jog during pregnancy. If your pregnancy is high risk, jogging may not be a good idea. Pregnancy is not the time to increase mileage or to train for a race. Wear comfortable clothing and supportive athletic shoes with good cushioning. Allow plenty of time to stretch and to cool down.

During your pregnancy, you’ll probably need to slow down and to decrease the number of miles you run. You may even change to walking. If you have pain, bleeding, contractions or other symptoms during or after jogging, call your healthcare provider immediately.

We are often asked about other sports activities. Below is a discussion of various sports you may want information about.

• Tennis and golf are safe to continue in the second and third trimesters but may provide little actual exercise.

• Horseback riding is not advisable during pregnancy.

• Avoid water skiing.

• Bowling is OK, although the amount of exercise you get varies. Be careful in late pregnancy; you could fall or strain your back. As balance changes, bowling could be more difficult for you.

• Talk to your healthcare provider about skiing before you hit the slopes or the trails. Both may be OK during pregnancy. Also discuss snowboarding, if this is a sport you enjoy. Your balance changes significantly during pregnancy; a fall could be harmful to you and your baby. Some healthcare providers may allow skiing or boarding in early pregnancy, but many agree these activities in the second half of pregnancy are not a good idea.

• Riding snowmobiles, jet skis or motorcycles is not advised. Some experts feel it’s OK to ride if it isn’t strenuous. However, most believe the risk is too great, especially if you have had problems during this or a previous pregnancy.