Remicade and Pregnancy decision

I am on Remicade (every 8 weeks) and am almost 26 weeks pregnant. From what I heard from my GI, I can do Remicade infusions until 32 weeks, then again at 40 weeks right after the baby comes. I am in the middle of a move from Utah to Houston and have new doctors there. I plan on talking to them about this, but I also wanted to get others' opinions.

I got pregnant in the middle of an infusion, so by stretching out the infusions to 8 1/2 weeks each time, I was able to make it so that I will have an infusion at 29 weeks instead of 27 weeks. This means, though, that I will be due for the next infusion at 37 weeks. I have to have a c-section because I have a rectovaginal fistula and they're afraid that vaginal birth will cause it to tear more and I won't be able to really heal.

So....do I have the c-section at 37 weeks so I can have the infusion on time or should I postpone the infusion for a couple of weeks, hoping that I don't flare or get an allergy in that time? Again, I plan on discussing this with my new doctors but I wanted to see if anyone has had to make a similar decision in the past.

I've been on Remicade for about a year now, but at each infusion I've either had c. diff., had no BMs because of pancreatitis/feeding tube, and/or been on prednisone (the Remicade is working, but each time c. diff. came up we did pred as a precaution, and then I've already flared twice with the pregnancy because of severe dehydration from morning sickness). So I haven't been "normal" enough to know if I start to have symptoms a couple of days before an infusion or not.

Anyway, does anyone have any thoughts? Thanks so much!

I had my son 10/2011. Around my 20th week I had formed a perianal fistula, so we decided to do c section. The idea was already being tossed around due to previous fistula repair surgeries. I had my last infusion at the start of my 32nd week, we played with the infusion times to target the last infusion date. I had my son at the end of my 38th week. We delayed live vaccinations for the first year. I was a bit of a germaphobe because I was afraid of him getting sick, but he never did. I personally felt that the last couple weeks of my pregnancy were important to the development of my son and decided that as long as I wasn't terribly ill I would try to keep him in there cooking as long as I could.

I also moved across the country, from WA state to AL, early in my 2nd trimester. We're a military family and our previous post had a military GI where this one didn't so it took forever between paperwork & waiting for an appointment and I started to flare. My OBGYN actually set up my infusion because she was concerned. I was scheduled to have an infusion every 10 weeks and it had been 18 by the time I finally got one. It was really scary, but it all worked out in the end. Best of luck.

I've had 2 remicade babies and 1 humira baby- all born via c-sec. #3 came 11 days early and she was so tiny! The extra days would have really benefited her. What does your gut tell you to do?

Can you get your infusion early? Can you get it at 6 or 7 weeks so that you are able to get it at the 32 week mark? That is what I would do. I know a baby born at 37 weeks can be just fine, but I would try to arrange your infusion schedule to allow the baby to stay put until 39 weeks. Is that something you could work out?

When I had my first baby the info about remicade crossing the placenta was not known. I had infusions every 5 weeks during the entire pregnancy all the up to 35 weeks. My child has not suffered any negative complications. She is healthy and super intelligent.

So, I don't know what a doctor would tell you. Most would probably want to act conservatively and not give you the infusion past 32 weeks, but they wouldn't want you to flare either, so there has to be some good common ground.

Hope your move isn't too stressful and I hope you like Texas. I just moved to Utah from a warm state and would love to trade you! The snow is NOT my thing! :) good luck and if you have more questions feel free to email me.

P.s. just read your blog and I see that you are LDS. I am too. Pray about this and get a blessing. You will know what to do. I'll pray for you too.

Stef

Post Edited (Stef17) : 5/5/2013 10:02:11 PM (GMT-6)

Just an update: after talking with the OB, the GI, and the colo-rectal surgeon, we've scheduled the c-section for 37 weeks 1 day, which is the 8 week mark for the Remicade. Since I start to get symptoms the couple of days before the Remicade, they decided this would be the best decision. They absolutely don't want to give me the Remicade after 32 weeks while she's still in there, because it would severely weaken her immune system they said.

We feel good about this decision. I got into Texas Children's, which is one of the top in the country, along with my GI being from Baylor. So even if there are complications, she'll have excellent care. They're having me drink slim-fast in addition to the little bit that I'm able to eat and keep down. Some days I'm lucky to eat one meal, so I haven't been getting the nutrients that I need. I try, but I just throw up so much.

As a sidenote, flares are no fun at all when you have a baby kicking your sore intestines. (Not that they're fun at all, but this just took it to a whole new level!)

She's growing ok. She's measuring about 2 weeks small, but I'm pretty petite (only 5 feet tall). My mom said that all 6 of her biological kids were measuring a month small or more by the time we were born, but we were all just fine.

I've been trying to take supplements - pills just make me sick. But I discovered chewy prenatal vitamins, which is great. I also think the slim-fast drinks will help.

Hey! Congratulations!! My little girl is now 5 months old and she is doing absolutely fantastic. She's had an ear infection once, but that's about it. We had the c-section at 37 weeks. She was tiny at only 4 lbs 8 oz, but that was because she was slightly early, I'm only 5 feet tall, and I threw up every day the entire pregnancy.

I had the Remicade infusion the day after the c-section and did fine with it. It meant an extra day in the hospital, but I was ok with that.

If you start getting morning sickness at all and get dehydrated, get IV fluids immediately or you'll spin into a flare fast.