Pregnancy and breastfeeding with bowel and liver disease
Content date: 10 November 2026
Many people with bowel or liver disease can have a safe pregnancy and breastfeed with planning and follow-up. Controlling the disease helps protect mother and baby; do not change treatment yourself.
Your next step
Book a pre-pregnancy review and take a list of your medicines and doses to your gastroenterologist or liver specialist and obstetrician.
Get urgent help: Heavy bleeding, persistent severe pain, vomiting that prevents drinking, fainting, breathlessness, or marked jaundice with feeling very unwell; also any emergency warning sign identified by your maternity team.
Before pregnancy
- Ideally, plan pregnancy during stable remission, with a review of tests, nutrition, iron, folic acid and vaccinations. You may need to delay trying until your condition is stable or a medicine unsuitable for pregnancy has been changed.
- Tell the team about all medicines, supplements and herbs, and any history of blood clots or bowel surgery. The specialist will determine suitable contraception, the plan for changing medicines and when you can start trying; there is no single waiting period for every medicine.
Crohn’s disease and ulcerative colitis (IBD)
- Active inflammation during pregnancy may increase the risk of premature birth and poor fetal growth. Stopping effective treatment out of concern about pregnancy can trigger a flare; your doctor weighs the risks of both the disease and the medicine.
- Mesalazine, azathioprine and suitable biologics can often be continued during pregnancy and breastfeeding, depending on the medicine and your circumstances. Steroids may be used when needed with monitoring. Methotrexate and some newer oral medicines are unsuitable for pregnancy or breastfeeding and need an advance specialist plan.
- The delivery plan is agreed with your obstetrician; IBD does not automatically mean a cesarean section. Active fistulas or inflammation around the anus, or previous pouch surgery, may affect the decision.
Autoimmune hepatitis (AIH)
- Stable inflammation before pregnancy is important. Azathioprine and certain steroids can be used during pregnancy and breastfeeding with monitoring. Mycophenolate needs a planned switch before pregnancy and is not used during pregnancy or breastfeeding.
- The disease may flare after delivery even if it was stable during pregnancy. Keep your post-delivery liver tests and appointments, and do not reduce treatment because you feel better.
After liver transplantation
- Pregnancy needs early coordination with the transplant team. Usually, waiting at least one year after transplantation with stable graft function is preferred; the decision is individualized.
- Do not stop anti-rejection medicines yourself. Tacrolimus, ciclosporin or azathioprine may continue according to the plan, with monitoring of drug levels, kidney function and blood pressure. Mycophenolate and certain other medicines need changing before pregnancy; the transplant team determines the alternative and its timing.
Hepatitis B (HBV)
- Your doctor needs viral load testing (HBV DNA by PCR) and liver tests. If the viral load is high, tenofovir may be prescribed during pregnancy to reduce transmission to the baby. The specialist decides the formulation, when to start it and whether to continue after delivery.
- Arrange hepatitis B vaccine and hepatitis B immune globulin (HBIG) for the baby within the first 12 hours after birth, followed by completion of vaccinations and follow-up tests. Inform the maternity hospital early and bring your results.
- Hepatitis B does not usually prevent breastfeeding, and breastfeeding with tenofovir is possible under the agreed plan. Do not stop treatment after delivery without review; liver inflammation may increase after stopping.
Breastfeeding and your baby’s vaccinations
- Many IBD, AIH and transplant medicines can be used while breastfeeding, but this does not apply to every medicine. Review the exact drug with the team before delivery; do not rely only on the drug class name.
- If you used a biologic during pregnancy, tell the pediatrician the drug name and date of the last dose before any live vaccine, especially the BCG tuberculosis vaccine. Do not automatically delay all vaccines; rotavirus recommendations differ from BCG, and the pediatrician will make the appropriate plan.
Maternal medicine and last dose: ................
Infant vaccine plan, including any live-vaccine decisions: ................
If hepatitis B is present: newborn vaccine / immunoglobulin plan: ................
Specialist contact and review date: ................
When to get help
Heavy bleeding, persistent severe pain, vomiting that prevents drinking, fainting, breathlessness, or marked jaundice with feeling very unwell; also any emergency warning sign identified by your maternity team.
Contact the team the same day if your pregnancy test is positive while taking mycophenolate, methotrexate or a medicine you have been told is unsuitable for pregnancy. Do not wait for a routine visit to arrange an urgent plan. Report returning diarrhea or bleeding, fever or repeated vomiting early. During pregnancy, report new intense itching without a rash to your maternity and treating teams the same day, even without jaundice; you may need liver and bile-acid tests and a treatment review.
Related guides
Care after liver transplantation
Herbs, mixtures and supplements: benefits and risks
Benign liver lesions and cysts
Mycophenolate: CellCept and Myfortic
Anti-rejection medicines after liver transplantation: a practical guide