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IBD in pregnancy: recent advances, practical management
Christian P Selinger1, Catherine Nelson-Piercy2, Aileen Fraser3
1Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
High-quality care ensures excellent pregnancy outcomes for women with inflammatory bowel disease (IBD). Maintaining IBD remission is crucial, as medication risks are generally low, outweighing flare risks.
Area of Science:
- Gastroenterology
- Obstetrics
- Pharmacology
Background:
- Inflammatory bowel disease (IBD) presents unique challenges during pregnancy.
- Many IBD patients lack knowledge regarding pregnancy and reproductive health, leading to voluntary childlessness.
- Active IBD correlates with adverse pregnancy outcomes like preterm birth and fetal loss.
Purpose of the Study:
- To review current evidence and recommendations for managing pregnant women with IBD.
- To offer clinical guidance for healthcare providers caring for IBD patients during pregnancy.
- To address patient knowledge gaps and concerns about IBD and pregnancy.
Main Methods:
- Comprehensive review of existing literature and clinical guidelines.
- Analysis of risks associated with IBD activity versus medication use during pregnancy.
- Evaluation of delivery modes and breastfeeding in the context of IBD management.
Main Results:
- Excellent pregnancy outcomes are achievable with high-quality care.
- Maintaining IBD remission is paramount; risks of medication are generally low, except for methotrexate and tofacitinib.
- Most women with IBD can have normal pregnancies and vaginal deliveries.
Conclusions:
- Proactive management and maintenance of IBD remission are key for successful pregnancies.
- Active perianal Crohn's disease and ileal pouch surgery are specific indications for cesarean section.
- Breastfeeding is encouraged, with minimal risk from most IBD medications.
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