Nearly 1 in 100 Canadians has inflammatory bowel disease. Too many believe it rules out having children

The best time to prepare for a healthy pregnancy is before it starts. If you have inflammatory bowel disease, speak with your gastroenterologist before conception if you can. (Unsplash+/Getty Images) Nearly 1 in 100 Canadians has inflammatory bowel disease. Too many believe it rules out having children Published: August 6, 2026 12.17pm EDT Share article Print article I often reflect on the advice of an outdated article on inflammatory bowel disease (IBD) and pregnancy from 1956. It stated: “There should be no doubt that a woman with ulcerative colitis who wishes to have a child should be advised to postpone until the colitis is inactive — sometimes this may mean waiting forever.” As a gastroenterologist specializing in IBD, I sit across from women weekly seeking updated advice on how their disease affects pregnancy. Crohn’s disease and ulcerative colitis, the two main forms of IBD, affect nearly one per cent of Canadians and are usually diagnosed in adolescence and early adulthood. An increasing number of young women are navigating life’s stages while managing a chronic condition. Historical caution Historically, women with IBD were cautioned against having children, or advised to choose between treating their bowel disease and having a healthy infant. While this caution was founded in real concerns about higher disease activity and complications, it was not a necessary ultimatum then and certainly isn’t now with modern treatments. However, I still meet patients who have internalized that message built on fear and outmoded concerns. Many expectant parents wonder whether IBD could be inherited by their children, and most overestimate it. If one parent has Crohn’s, a child’s risk is roughly one in 10; for ulcerative colitis it’s lower. Since the early 2000s, biologics (medications targeting the immune signals that drive IBD) have revolutionized disease management. They allow lasting remission, healing of damaged intestines and restore normalcy and quality of life. With these medications came new questions, and the initial approach to pregnancy was one of reasonable caution: ceasing medication in late pregnancy when placental transfer starts to occur and fetal exposure becomes possible. Unfortunately, this approach led to many women with well-controlled disease not only experiencing flares but also developing the very complications we had been attempting to avoid, such as pre-term birth and low birth weight. It rarely occurs to patients to call…