Diagnosis & treatment guidelinesMy Treatment ApproachMy Treatment Approach to Management of the Pregnant Patient With Inflammatory Bowel Disease
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
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Cited by (15)
Primary Care Evaluation and Management of Gastroenterologic Issues in Women
2016, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :The biologic therapies are Food and Drug Administration category B and to date are not associated with a consistent pattern of adverse pregnancy outcome.66 Current evidence suggests that the risks of birth defects, infectious complications, or impairment in developmental milestones are not increased among children exposed to biologic therapies.66,72,73 Ultimately, an interdisciplinary approach with active engagement of the patient and appropriate communication through providers is needed to provide the expected favorable outcomes in pregnancy.
Risk of Postpartum Flare Hospitalizations in Patients with Inflammatory Bowel Disease Persists After Six Months
2022, Digestive Diseases and SciencesTherapeutic strategies for pulmonary sarcoidosis
2020, Expert Review of Respiratory MedicineInflammatory bowel diseases in pregnancy
2020, Ceska GynekologieGender features of the level of intestinal inflammatory markers in patients with ulcerative colitis
2019, Gastroenterology (Ukraine)
Potential Competing Interests: Dr Mahadevan serves as a consultant for AbbVie, Janssen, and UCB.