Remicade: treatment before or after delivery?

So as most of you know from previous posts, I am expecting my second daughter in a few weeks. I have continued on remicade throughout the pregnancy and I am currently 37 weeks. My next scheduled treatment would be Sept 9 (8 weeks) and my official due date is Sept 15. I scheduled the next treatment for Sept 11 (didn't think pushing it back 2 days would be that big of a deal) so that I could give myself and baby a few more days. At this point I'm not really sure where I got confused but I did because I thought my GI said he didn't want me to have a treatment until AFTER she is born and my OB/GYN agreed. We had tentatively set an induction date for Sept 9 so that I could be out of the hospital to get my treatment (I take treatments at a different location and can't switch it because of insurance reasons) on the 11th. BUT last Thursday I saw my GI for first time in a few months and he said he wants me to have a treatment RIGHT BEFORE delivery so that the med is as heavy in my system as possible in case of a flare up. I put in a call to my OB/GYN yesterday to see what his thoughts are...I go back to see him for my weekly check up on Thursday so we'll see what he says. Somewhere I got confused (possibly from Crohn's and pregnancy HAZE..HA HA!!) but I know that ONE of them said they didn't want me to have a treatment that close before delivery.

I know there are lots of varying opinions out there about remicade and pregnancy, it's affect on the baby and if/when it crosses the placenta. Both my OB and GI have said in the past that if it was going to affect the baby it would have done it in the first 12 weeks and she shows no signs of issues thus far. I'm curious what others experiences are and any advice anyone might have at this point.

I trust my GI and he has been wonderful over the past 4 years, but I also trust my OB who has been great as well. In the end I know I will do what I feel is best for the baby after hearing what both have to say this week, but I am nervous to say the least. This is the first time during my pregnancy that I have been this worried that I might get really sick after delivery if I don't get the treatment before. Will a few days make that big of a difference? Will not having the med in my system AT delivery make that much a difference? Does a flare come on immediately or take awhile to set in after the hormone shift for most women?

Thanks in advance for all your help and advice!

Remicade starts to cross the placenta somewhere between 30 and 32 weeks in a pregnancy. SO, if you decide to get the remicade, your baby will be exposed to it. However, I don't know that it's really that big of a deal, especially if it's a one-time thing. When I was pregnant with my first child I got infusions every 5 weeks - this was before they knew when it crossed. So, I had infusions at 30 and 35 weeks. Then I had one as soon after delivery as I could. My daughter is FINE and healthy and has had no ill effects from the remicade. about 3 months after her birth I started a SEVERE flare and it took well over a year to get under control.

My opinion is this: Your GI has a point that it would be good to have it in your system. Labor and delivery are stressful events to the body and this would help preclude any instinct to flare that your body might have. HOWEVER, I don't think it's going to make any significant difference. I personally would want to get it before the birth just so I didn't have to leave the baby for a few hours. Things are so much more complicated after the baby comes. :) I don't think either option is going to help you or hurt you significantly. Go with your gut (no pun intended) and I'm sure everything will be fine! Sorry if that doesn't help very much.

Stef17..I haven't found any articles or medical info that actually shows when remicade passes thru the placenta. Can you tell me where you read/heard it from? I would be interested to read anything I can find on it... Thanks!!

Thanks Stef..I'll take your word on it, I was just curious if there was something out there I didn't find about it. My OB called back today and said that really there is nothing "written" out there other than that it does cross the placenta in late stages of pregnancy. Pretty much what I already knew that there have been no acutal studies, etc. He said he would prefer I waited until after delivery, but if I NEEDED NEEDED it then to go ahead and get it. I then called my GI (who was out of the main office today at another location) and talked with a NP and phone nurse. They took the name/# of my OB and are going to have my GI call him tomorrow and discuss everything...then get back to me when I see my OB on Thursday for 37wk weekly visit.

I feel like I am being paranoid to be honest! I cried while explaining everything to my husband on the phone..then again to my mom on the phone. My husband tried to rationalize that if they really thought it was going to do something serious to the baby they would not be suggesting (GI) that I get it right before delivery and my OB wouldn't say if needed to go ahead. Not that it would be easier to treat a possible flare, but alot less risk of me being sick than a new born with low immune system anyways. I kinda agreed but still have this thought that IF something was wrong with her when she is born I will guilt myself to death and second guess why I got the treatment for the rest of my life. I'm trying to stay focused and trust in my dr(s), but right now it's a struggle!! Hopefully on Thursday they will have come to a solution together that they both feel good about and I will be good with it too.

Thanks to all who replied!!

Just thought I would let you guys know that after going back and forth with both my GI and my OB, I have decided not to get another treatment until after I deliver. The plan for now is to be induced on the 9th and have my treatment on the 11th. If for whatever reason something changes and I go naturally I'm not sure what we'll do since my insurance isn't cooperating with moving one treatment to the hospital I am delivering at. My GI is worried that I will flare and wanted me to get a treatment 3 days before induction/delivery. My OB thinks that because there is SO much unknown with how the remicade will affect the baby if given that close that he doesn't feel like it's a MUST!

I have cried for days, going back and forth on what is the right thing to do. Do I risk flaring and being sick/possibly being unable to care for my daughters the way I would like to OR risk something (who knows the possibilities at this point) being wrong with my daughter. In my heart I have to take the chance on getting sick myself because I couldn't live with knowing I MIGHT have done something to harm her. My husband has been great about supporting the decision I made and will do everything he can to make things easier for me if I do get sick. Plus I have a great support of family and friends. In the end, I know we'll get through whatever happens so I'm trying not to worry toooo much.

Thanks to everyone that replied and gave advice/experience! I GREATLY appreciate it!!!!!!

Thanks for the reassurance!!! I feel alot better since I made the decision. I have been great during the pregnancy. No pain, no bathroom issues, even my hemrroids have been better than normal. My OB also stated that since I have been fine throughout the pregnancy, I should have less risk of flaring afterwards. In the end, I'm at peace with my choice and I know I'll make it whatever may happen. Thanks again!

Aww, i don't think it is a big deal for the baby's vaccines to be a little delayed. You had to take care of you first and foremost because you being sick is a far greater danger to your baby.

I guess I forgot to put in the post that the nurse said for the baby to not have the live vaccines for 6 months. I know that when my daughter was having her immunizations, I don't remember her getting anything orally. I also checked her shot records and there was nothing listed for roto-virus. She will be 3 on the 23rd of this month..so maybe it's newer or maybe they don't list it because it's not a shot? I looked online to try to find some sort of listing as to what is considered a "live vaccine" and each website was a little different. MMR, Polio and Chicken Pox were listed on almost all of them, but I didn't see roto-virus listed. Again this could be because it's not in a shot form? According to my daughters shot records for Indiana (we live in Ohio but dr in Indiana) the only one she would get within the first 6 months is the Polio (1 shot at 2 months and another at 4 months).

Honestly I panicked when the nurse called this morning. I have really been struggling with this information the last week or so since the drs decided that they didn't agree. It would have been an easy choice for me if they would have agreed, but who do I trust more in their opinion is what I feel like I am being asked. I feel comfortable in the choice that we made not to have another treatment, but now am questioning whether I should have gotten the treatments throughout the pregnancy. I know it's something all mothers do, worry worry worry!!! I am going to ask my OB and my family dr tomorrow to double check on everything and we'll go from there.

Thanks for all your support..it means SOOO much to me! It's comforting to know someone has knowledge or experience of this disease when I am in doubt!!

My OB was sick this week and left early today, but I saw a midwife in his office. I asked her about the vaccinations and she said they don't give any that are live...actually they don't give any at birth. She said the ones that they give are live attenuated (I think this is the word she used) which are created from dead vaccines. I am still going to make sure my family dr is aware for the babies first shots at 2 months as I obviously don't want to put her at risk, but I think it will be fine. She said they don't give the roto-virus to everyone either, not sure what the stipulations are but I was right that my almost 3 year old never had it. I feel much better about the situation now :)

Oh yeah... I'm 2cm dialated and will hopefully go on my own tonight or tomorrow cause I am contracting like crazy right now. BUT if not, I'll be induced on Tuesday at 6am! YAY!! There is an end in sight!!!  

Oh wow! The ball is definitely rolling now. Can't wait to hear that you've delivered! Sending good vibes your way ((((((((((((((easy labor & delivery & noooooooo flaring))))))))))))))

Hoping everything goes smoothly, I felt good up to about three months after my daughter was born, so like everything else with this disease you just never know. Prayers for a short delivery and long remission. hugs Dawn☼

Sending good wishes for a safe and happy delivery. Please let us know the details when your little one arrives.

Tough one. I delivered unexpectedly at 29 weeks and 2 days and then had my scheduled infusion exactly 1 week later. I was fine, but my delivery was emergency c-section AND I lost one of my twin girls, so I was high on adrenaline and likely my Crohn's was on the "back burner" But, my pregnancy hormones were also friendly to my Crohn's, so that may have something to do with it too.

If I had a choice, I'd get the Remicade BEFORE delivery. This way you can combat any POTENTIAL flares. That's just me.

As for the safety of Remicade while pg? I've seen some top notch GIs and SEVERAL very experienced Maternal Fetal Medicine specialists and their genetics counselors.... Remicade is safe according to current studies. I hate the unknown, but I find faith in the fact that my daughter is alive and healthy and despite being born nearly 3 months early she's on track developmentally and doing well. So, that gives me hope that everything is fine. A while back there were several gals on here who BF while on Remicade. I was actually recommended to NOT BF, but that was because the fluctuation in hormones on my body causes me to flare, so we opted to go straight to birth control pills to control my hormones after delivery and to not BF. Besides that, I had a LOT of my plate after my delivery. It was the best option for me.

GL! I know it's a tough decision.... and I just realized....this message may already be late! GL with whatever happens