Review article: Reproduction in the patient with inflammatory bowel disease

Area of Science:

• Gastroenterology
• Reproductive Medicine
• Clinical Pharmacology

Background:

• Inflammatory bowel disease (IBD) predominantly affects young individuals, necessitating careful consideration of its impact on fertility and pregnancy.
• Understanding the effects of IBD and its treatments on reproductive health is crucial for clinical management.

Purpose of the Study:

• To provide a comprehensive review of the optimal management strategies for inflammatory bowel disease (IBD) in women of reproductive age and during pregnancy.
• To synthesize current evidence on fertility, pregnancy outcomes, and medication safety in IBD patients.

Main Methods:

• Conducted a systematic literature search of MEDLINE and EMBASE databases.
• Utilized search terms including 'pregnancy AND IBD,' 'sulphasalazine AND male fertility,' 'AZA AND placenta,' and 'infliximab AND pregnancy.'
• Examined references from relevant review articles to ensure comprehensive data inclusion.

Main Results:

• Inflammatory bowel disease (IBD) itself does not significantly affect overall male or female fertility.
• Sulfasalazine use is associated with reduced male fertility; other IBD medications generally show no significant impact on human fertility.
• Disease activity at conception is the primary determinant of pregnancy complications and disease course during gestation.
• Proactive treatment to maintain remission during pregnancy is recommended, with most IBD drugs appearing safe, excluding methotrexate.
• Breastfeeding is encouraged for mothers with IBD.

Conclusions:

• Management of IBD in young and pregnant populations presents challenges due to reliance on retrospective data.
• Further large-scale prospective trials are essential to provide robust evidence for clinical decision-making in IBD management during pregnancy.