New Here, Crohn's Meds and Breastfeeding

[LaurenGinger]

Hey Everyone!

I am new here, my friend actually directed me over to you all. I am almost 7 weeks pregnant and I have crohn's disease. I went off of my meds at first and then I started to flare and my doc and I agreed the risk of losing the baby (or the baby not getting enough nutrients) from a flare was to much so I am back on my meds. One is category B the other category C. I tried being just on the category B one with no luck.

So anyway, I am upset about that, but I can't let it get me down. I need to stay healthy for the baby. My new issue is breastfeeding. I will have to stay on the meds after giving birth. Most women with crohn's have a flare right after giving birth, so most likely I will still be on my medication. One is said to be found in breast milk when taken. My question is, do you think the benefits out way the risks? I realllllly want to breastfeed. I am a high-raw vegan and no formula would be good enough for me. I want the best for my baby and hope to raise he or she vegan as well. Some say breast milk over the canned stuff is better with meds and all, others disagree. Any advice, tips, experience would be great. I am only 26 and this is my first baby! YAY!

Thanks, great to be here!

Edited to Add: My meds are Enotocort and Lialda

[PatioGardener]

Welcome! And congratulations on your pregnancy.

I suggest you get a copy of Dr Thomas Hale's Medications and Mother's Milk (or post your meds here and hopefully a Mama will look them up for you.) Hale gives really really good info about medications, contraindications, precautions and alternatives. Much better than any other expert or resource I have ever seen.

With 'the facts' about the meds you need to be on, you can make an informed decision. And remember if you decide not to feed your baby your own milk, donor milk may be an option.

Best wishes for your pregnancy!

[LaurenGinger]

Thank you! My meds are Lialda and Enocort. I would love if anyone had any solid info. The info online is all over the place! I really want to breastfeed, this is so discouraging.

[PatioGardener]

I don't have the latest Hale's, so hopefully someone else will post too.

budesonide (Entocort) is rated as L2 in his 2006 edition. He warns against using some other medications at the same time because they can boost the levels in the blood, but says using normal doses it is unlikely that budesonide will reach the milk.

mesalamine (Lialda) is an L3. There were a couple of case reports about nursing moms taking it in 2006, but I bet his 2010 book has more info.

[LaurenGinger]

Thank you!!! I also found some info on a site:

Entocort: http://toxnet.nlm.nih.gov/cgi-bin/si...temp/~AlDdgg:1

Lialda: http://toxnet.nlm.nih.gov/cgi-bin/si...temp/~pyDg1l:1

Not sure if what they are stating is good or bad..lol.. any info would be great!

[Llyra]

But Lialda is just mesalamine. I took mesalamine while nursing my twins, from when they were 4 months until we weaned. The GI doc strongly recommended weaning, but he was just covering his butt. My pediatrician and I went over the literature carefully, and concluded that the only known risk was the possibility of digestive upset in the babies. So we monitored carefully for that. The kids were fine, and still are.


Entocort is a corticosteroid. I know that prednisone is AAP approved for use in breastfeeding, and I took it for six weeks while nursing (the twins were about a year old at that point.) I don't know how Entocort differs from other corticosteroids. If you post a new thread, and in the subject line ask for it to be looked up in Hale's, somebody here should be able to help you. I don't have a copy myself, but when I was making meds decisions while nursing, people here were very helpful.

I have ulcerative colitis, which is a bit less complicated to treat, but I can say from experience that feeling well makes you a better mother. I flared when my twins were 4 days old, and tried living with it for two months before I finally had to admit it wasn't working. My pediatrician told me that in her opinion during the first year the benefits outweigh the risks for all but a very few categories of meds-- like anticancer drugs, and those that suppress the immune system, and a few other very strong drugs. So I say that it's good that you're thinking ahead and doing the research and are prepared.

[LaurenGinger]

Thank you! I will start a new discussion!

So nice to see another IBD-er around here!!! Did u give birth naturally or c-section. My doc gave me the option because of tearing my back end, but I've never had fissures so hopefully I can go naturally. C-sections scare me.

Yes, Entocort is a steroid that is only absorbed in the stomach (no side effects). Did you have any issues with flaring during your pregnancy? I have a little anxiety because I went off my meds and had to go back on them yesterday due to seeing some blood in my stool. I don't want to flare, but I've heard MANY due right after giving birth. I am like u, I always wait to long to get help (I always end up in the hospital). But I am going to try to be good this time! Thanks again!!!

[Llyra]

Originally Posted by LaurenGinger

Thank you! I will start a new discussion!

So nice to see another IBD-er around here!!! Did u give birth naturally or c-section. My doc gave me the option because of tearing my back end, but I've never had fissures so hopefully I can go naturally. C-sections scare me.

I had a c-section. But I would have been a VBAC candidate, plus with twins, one of them transverse, and I have a congenital heart condition. Plus I developed cholestasis in the third trimester. (That's a liver dysfunction that's more common in multiple births, which at that time the research was showing warranted delivery by 36 to 37 weeks to prevent stillbirth.) So there were a lot of reasons for the section.

[LaurenGinger]

Geez, yes there were. You are one strong chica for all that! Blessings to you and your little ones!

[Llyra]

Originally Posted by LaurenGinger

Did you have any issues with flaring during your pregnancy?

I stopped having any symptoms at all, and was off meds, from the time I was in the first trimester with DD1. She was born, and still no symptoms. I was well for 2 1/2 years, actually, and then the twins were born, and I was given a broad-spectrum antibiotic after the birth, and WHAM I was sick again. Badly.

If you do wind up with a section (hoping you won't, of course) talk to the docs carefully about the risks of "routine" broad-spectrum antibiotics in people with IBD. For me, they bring on CHAOS in my gut.

[LaurenGinger]

Thanks! I'll have to remember that! Eek! I hope you are well now~