Diagnosis & treatment guidelines
My Treatment Approach
My Treatment Approach to Management of the Pregnant Patient With Inflammatory Bowel Disease

https://doi.org/10.1016/j.mayocp.2013.11.012Get rights and content

Abstract

Inflammatory bowel disease (IBD) is frequently diagnosed in women of childbearing age. Of paramount concern are questions about the effect of the disease on a woman's ability to conceive and carry the pregnancy safely to term, as well as the effect of the disease and its therapies on the health of the fetus. For health care providers, there is also the issue of medication dose adjustments and management of flares during pregnancy. Growing experience with IBD in pregnancy suggests that most women will have good outcomes; however, concerns and uncertainty remain for both the patient and the physician. This article outlines our approach to the treatment of these patients with respect to preconception counseling and management during pregnancy and the postpartum period.

Section snippets

Preparing for Pregnancy

Providers should ensure that a patient's vaccinations (hepatitis A and B, pneumonia, influenza, and tetanus/diphtheria/pertussis), colon cancer surveillance, and cervical dysplasia screening are up to date.1 Routine laboratory tests should include a complete blood cell count and vitamin B12, folic acid, and iron levels. In addition, physicians should consider checking vitamin D and tissue transglutaminase levels, particularly if a patient is having difficulty conceiving, because abnormal levels

Getting Pregnant

Active disease may reduce fertility,8 so disease quiescence should ideally be achieved before attempting conception. The rates of fertility in women with stable IBD are generally similar to those in age-matched controls.9 The one major exception is women who have undergone previous pelvic surgery, particularly an ileal pouch–anal anastomosis, which is associated with a 3-fold increase in infertility.10 If calculated attempts to conceive are unsuccessful after 6 months and disease remission is

Effect of IBD on Pregnancy

Most studies suggest that women with IBD have higher rates of pregnancy complications compared with age-matched controls. Complications include increased risk of preterm delivery, low birth weight, spontaneous abortion, and peripartum complications, including preeclampsia.11, 12 Disease activity at conception and during pregnancy is associated with higher rates of adverse pregnancy outcomes,13, 14 but even patients with quiescent disease are at elevated risk for complications throughout their

Medications

Most medications used for the treatment of IBD are considered compatible with pregnancy and breastfeeding. In general, the act of stopping medications and precipitating a possible disease flare poses a greater risk to the fetus than any potential adverse effects of most medications themselves. Therefore, we advise patients to have a thoughtful discussion with their gastroenterologist before making any changes to their treatment regimen. It has been our experience that patients who have a

Recommendations

There are several key points that providers should keep in mind when treating IBD in women who are interested in conceiving or are pregnant (Table). Women with IBD who have not had pelvic surgery have similar chances of conceiving as women without IBD. Once pregnant, women with IBD are at increased risk for adverse outcomes and should be observed as high-risk obstetric patients, even in remission. Ideally, women should strive to achieve quiescent or stable disease before conception and to

References (36)

  • S. Ben-Horin et al.

    Detection of infliximab in breast milk of nursing mothers with inflammatory bowel disease

    J Crohns Colitis

    (2011)
  • S. Ben-Horin et al.

    Adalimumab level in breast milk of a nursing mother

    Clin Gastroenterol Hepatol

    (2010)
  • M. Moscandrew et al.

    General health maintenance in IBD

    Inflamm Bowel Dis

    (2009)
  • H.M. Pappa et al.

    Report on the vitamin D status of adult and pediatric patients with inflammatory bowel disease and its significance for bone health and disease

    Inflamm Bowel Dis

    (2006)
  • J.M. Choi et al.

    Increased prevalence of celiac disease in patients with unexplained infertility in the United States

    J Reprod Med

    (2011)
  • H. Yang et al.

    Familial empirical risks of inflammatory bowel disease: differences between Jews and non-Jews

    Gut

    (1993)
  • A. Waljee et al.

    Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis

    Gut

    (2006)
  • O. Stephansson et al.

    Congenital abnormalities and other birth outcomes in children born to women with ulcerative colitis in Denmark and Sweden

    Inflamm Bowel Dis

    (2011)
  • Cited by (15)

    View all citing articles on Scopus

    Potential Competing Interests: Dr Mahadevan serves as a consultant for AbbVie, Janssen, and UCB.

    View full text