Inflammatory Bowel Disease During Pregnancy.

Area of Science:

• Gastroenterology and Reproductive Health
• Management of Inflammatory Bowel Disease (IBD) in Pregnancy

Background:

• Pregnancy management for inflammatory bowel disease (IBD) patients presents unique challenges for both men and women.
• Disease activity at conception significantly impacts pregnancy outcomes, with quiescent disease correlating to uncomplicated pregnancies and active disease linked to adverse events.

Purpose of the Study:

• To provide guidance on managing inflammatory bowel disease (IBD) in patients planning pregnancy.
• To outline the risks associated with active IBD during pregnancy and discuss medication safety.

Main Methods:

• Review of current literature on IBD management during pregnancy.
• Analysis of the impact of disease activity and specific medications on pregnancy outcomes.

Main Results:

• Quiescent IBD generally leads to successful pregnancy outcomes, comparable to the general population.
• Active IBD increases risks of miscarriage, stillbirth, and disease exacerbation during pregnancy.
• 5-Aminosalicylic acid (5-ASA) and corticosteroids are considered relatively safe; 6-mercaptopurine and azathioprine require caution; methotrexate is contraindicated; infliximab data is limited.
• Male fertility is generally unaffected by IBD, but caution with 6-mercaptopurine and azathioprine prior to conception is advised.

Conclusions:

• Achieving and maintaining IBD remission before and during pregnancy is paramount for optimal maternal and fetal health.
• Aggressive treatment of active IBD is essential, even in unexpected pregnancies, to ensure the best possible pregnancy outcome.
• Most IBD medications should be continued during pregnancy, with careful consideration of individual drug safety profiles and potential risks.