Treatment of pregnant women with a diagnosis of inflammatory bowel disease

Abstract

The frequency of diagnosis of inflammatory bowel disease (IBD) has increased in younger populations. For this reason, pregnancy in patients with IBD is a topic of interest, warranting additional focus on disease management during this period. The main objective of this article is to summarize the latest findings and guidelines on the management of potential problems from pregnancy to the breastfeeding stage. Fertility is decreased in patients with active IBD. Disease remission prior to conception will likely decrease the rate of pregnancy-related complications. Most of the drugs used for IBD treatment are safe during both pregnancy and breastfeeding. Two exceptions are methotrexate and thalidomide, which are contraindicated in pregnancy. Anti-tumor necrosis factor agents are not advised during the third trimester as they exhibit increased transplacental transmission and potentially cause immunosuppression in the fetus. Radiological and endoscopic examinations and surgical interventions should be performed only when absolutely necessary. Surgery increases the fetal mortality rate. The delivery method should be determined with consideration of the disease site and presence of progression or flare up. Treatment planning should be a collaborative effort among the gastroenterologist, obstetrician, colorectal surgeon and patient.

Keywords: Pregnancy; Inflammatory bowel disease; Immunomodulators; Biologics; Breastfeeding; Treatment

Core tip: Active disease prior to conception and during pregnancy increases the rate of pregnancy-related complications; thus, special attention should be given to pregnancy during the disease remission period. The safest drugs for use during pregnancy and breastfeeding are 5-aminosalicylic acid complexes, thiopurines and corticosteroids. Methotrexate and thalidomide are contraindicated. Anti-tumor necrosis factor treatment should be avoided during the third trimester. The risk of venous thromboembolism is increased in patients with moderate-to-severe disease. The delivery method should be selected according to the region of the body involved and disease activity. In this article, the problems encountered by patients with inflammatory bowel disease from pregnancy to breastfeeding are discussed, and appropriate management strategies are suggested.