Akiyama S, Steinberg JM, Kobayashi M, Suzuki H, Tsuchiya K. Pregnancy and medications for inflammatory bowel disease: An updated narrative review. World J Clin Cases 2023; 11(8): 1730-1740 [PMID: 36969991 DOI: 10.12998/wjcc.v11.i8.1730]
Corresponding Author of This Article
Shintaro Akiyama, MD, MSc, PhD, Lecturer, Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan. akiyama@md.tsukuba.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shintaro Akiyama, Mariko Kobayashi, Hideo Suzuki, Kiichiro Tsuchiya, Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
Joshua M Steinberg, Department of Inflammatory Bowel Disease, Gastroenterology of the Rockies, Denver, CO 80027, United States
Author contributions: Akiyama S designed the research; Akiyama S and Kobayashi M performed the research and analyzed the data; Akiyama S, Steinberg JM, Kobayashi M, Suzuki H, and Tsuchiya K wrote the paper.
Conflict-of-interest statement: Akiyama S, Kobayashi M, and Suzuki H have no relevant disclosures; Steinberg JM has done consulting and/or Advisory Board for Pfizer, Janssen, BMS, GistMD and is on the Speakers Bureau for Takeda, Eli Lilly, BMS, Abbvie; Tsuchiya K has received grants from Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharmaceutical Corp., and Hitachi Ltd.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shintaro Akiyama, MD, MSc, PhD, Lecturer, Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan. akiyama@md.tsukuba.ac.jp
Received: January 4, 2023 Peer-review started: January 4, 2023 First decision: January 14, 2023 Revised: January 14, 2023 Accepted: February 21, 2023 Article in press: February 21, 2023 Published online: March 16, 2023 Processing time: 62 Days and 2.3 Hours
Abstract
Inflammatory bowel disease (IBD) is often diagnosed during the peak reproductive years of young women. Women with active IBD around conception are at a significantly increased risk of disease relapse during pregnancy, which is associated with poor pregnancy and neonatal outcomes. Given these substantial risks, it is prudent that disease remission should ideally be achieved before conception. Unfortunately, some patients may experience a disease flare-up even if they are in a state of remission before pregnancy. Patients must continue their IBD medications to reduce the risk of disease flare and subsequent poor outcomes during the gestational and postpartum periods. When treating IBD flare-ups during pregnancy, the management is quite similar to the therapeutic approach for non-pregnant patients with IBD, including 5-aminosalicylate, steroids, calcineurin inhibitors (CNIs), and biologic therapies. While the data regarding the safety of CNIs in pregnant women with IBD is limited, the findings in our recent meta-analysis suggest that CNIs may be safer to use in those with IBD than in solid organ transplant recipients. There are several types of biologics and small-molecule therapies currently approved for IBD, and physicians should thoroughly understand their clinical benefits and safety profiles when utilizing these treatments in the context of pregnancy. This review highlights recent studies, including our systematic review and meta-analysis, and discusses the clinical advantages and safety considerations of biologics and small molecules for pregnant women with IBD.
Core Tip: Anti-tumor necrosis factor monotherapy is safe during pregnancy in women with Inflammatory bowel disease (IBD). However, their use in combination with thiopurines may be associated increased risk of neonatal prematurity and infection, although these data are conflicting. According to meta-analyses, vedolizumab and ustekinumab may be associated with early pregnancy loss; however, these data might be biased by IBD activity or small sample sizes. Recent prospective studies have demonstrated these biologics are generally safe during pregnancy. Janus kinase inhibitors are contraindicated during pregnancy as animal studies have demonstrated harmful effects. Calcineurin inhibitors may be considered for pregnant women with IBD who develop clinical relapse.
