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Pregnancy and inflammatory bowel disease.

J B Zeldis

    The Western Journal of Medicine
    |August 1, 1989
    PubMed
    Summary

    Managing inflammatory bowel disease during pregnancy requires judicious medical therapy. Active disease poses risks, but controlled inactive disease and appropriate treatment generally lead to good outcomes for both mother and fetus.

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    Area of Science:

    • Gastroenterology
    • Obstetrics
    • Immunology

    Background:

    • Inflammatory bowel disease (IBD) management during pregnancy presents unique challenges.
    • Understanding the interplay between IBD pathophysiology and pregnancy physiology is crucial for optimal patient care.

    Purpose of the Study:

    • To evaluate the impact of pregnancy on inflammatory bowel disease course.
    • To assess the safety and efficacy of various medical therapies for IBD during pregnancy.
    • To provide guidance on managing IBD patients requiring surgical intervention during gestation.

    Main Methods:

    • Analysis of physician surveys.
    • Retrospective chart reviews of patients with inflammatory bowel disease during pregnancy.

    Main Results:

    • Active IBD negatively impacts pregnancy outcomes compared to inactive disease.
    • Pregnancy generally does not alter the course of IBD, nor does inactive IBD affect pregnancy.
    • Sulfasalazine and steroid therapies are safe and effective for maintaining IBD quiescence during pregnancy.
    • Immunosuppressive therapies should be avoided.
    • Aggressive medical management, including total parenteral nutrition and a multidisciplinary team approach, can often prevent surgical intervention and ensure good fetal outcomes in active IBD cases.

    Conclusions:

    • Judicious medical therapy is effective for controlling inflammatory bowel disease throughout pregnancy.
    • Maintaining quiescent inflammatory bowel disease with necessary medications like sulfasalazine or steroids is recommended.
    • Surgical intervention during pregnancy can usually be avoided with aggressive, team-based medical management.
    • Contraception is only advised for patients with severe IBD at high risk of imminent surgery.

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