Women with IBD: Recommendations for Treatment During Pregnancy
the MPR take:
Women with active inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn's disease, may be at an increased risk of pregnancy complications compared to women with quiescent disease. A review article published in the journal Alimentary Pharmacology & Therapeutics discusses recommendations for IBD management in pregnant women based on a review of existing literature. In about 80% of patients with IBD, pregnancies will develop normally. While ultrasound of the abdomen is considered the safest choice, gastroscopy, sigmoidoscopy, and colonoscopy with propofol sedation are considered safe in pregnant women, especially in the second trimester. With regards to drug therapy, aminosalicylates including sulfasalazine are considered safe; however, additional folic acid supplementation (2mg/day) is recommended. Steroids can be used for acute flare in pregnant patients, but they have been associated with a low risk of lip-jaw-palate clefts, especially if used in the first trimester. Thiopurines, metronidazole, probiotics, simethicone, and short-term loperamide are generally considered safe, while limited data exists for calcineurin inhibitors and biological agents. Metoclopramide should be used with caution, while methotrexate should be discontinued even before pregnancy because of its teratogenic and mutagenic effects. Overall pregnancy outcomes for women with IBD are not much different from women without IBD; these disorders should not discourage women from becoming pregnant.
Inflammatory bowel diseases (IBD) commonly affect young patients in the reproductive phase of their lives. The chronic and relapsing nature of IBD and the potential need for medical or surgical interventions raise concerns about family planning issues.