Inflammatory bowel disease (IBD) includes ulcerative colitis and Crohn’s disease. IBD usually starts in women between ages 15 and 25, just through the peak childbearing years. In the past, women with IBD were advised that being pregnant was too risky and that a flare-up of IBD symptoms during pregnancy could increase the risk for miscarriage or preterm birth. [1,2]
They may also have been told that taking medications to prevent a flare-up during pregnancy could be dangerous for their developing baby. As such, they were between the proverbial “rock and a hard place.”
Fortunately, the US-based Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) study now brings good news to women with IBD who want to become pregnant. 
The Breakthrough of Biologics
To understand why PIANO is good news for IBD and pregnancy, you need to know about drugs called “biologics”. These drugs have changed the life of many people with IBD. They have changed the disease. For those who respond to them, biologics can eliminate inflammation, reduce the need for surgery, and minimize the need for other drugs with more toxicity and side effects. 
Biologics are manufactured antibodies that block proteins responsible for inflammation in IBD. The main biologics for IBD are called anti-tumor necrosis factor-alpha biologics (anti-TNF agents). Many women have a very good response to these agents. However, like for most other medications, there was no scientific evidence whether they are safe in pregnancy. So what was a pregnant mother to do if her response to the biologic medication is good (in other words, the medication is effective) and she wants to get pregnant? [3,4]
What the PIANO Study Found
The PIANO study has been going on for 9 years. There are about 1,500 pregnant women enrolled in the study, and there is finally enough data to make an assessment about the safety of anti-TNF agents during pregnancy. The conclusion is that they are safe.  Here is the good news for women with IBD who are pregnant or want to become pregnant:
- If your disease is under control, you should have no more problem than other women in getting pregnant. 
- If your disease is under control during pregnancy, you should be able to have a normal pregnancy. Pregnancy may actually block IBD flare-ups in some women. 
- Biologics have helped many people with IBD get their condition under control. 
- If you need a biologic during pregnancy, there is no evidence that your baby will have any increased risk of birth defects or birth problems. 
- If you want to breastfeed your baby, you can take your biologic and breastfeed as long as you want. 
In summary, if you want to become pregnant and have IBD, you are no longer “between a rock and hard place.” 
The PIANO study is also educating doctors who treat women with other autoimmune inflammatory diseases about the use of biologics during pregnancy. Biologics have done wonders for rheumatoid arthritis and psoriasis and they may soon be a major option for women with multiple sclerosis.  Fortunately, pregnancy is no longer an unattainable goal for many of them.
- Crohn’s & Colitis Foundation of America, Women and IBD.
- Crohn’s & Colitis Foundation of America.
- Rheumatology News, PIANO study provides insight on safety of biologics in pregnancy.
- Medscape, Inflammatory Bowel Disease Treatment & Management.