[Pre-conception counseling and pregnancy in chronic inflammatory bowel diseases--Crohn disease and ulcerative...

Since chronic inflammatory diseases start to develop during the fertile years, the possibility of a mutual influence of pregnancy and bowel disease obviously must be considered. The knowledge about the interference between disease and pregnancy influences the management of pregnancy and delivery as well as of the disease itself. Intensive care, including genetic counseling, dietary management, and drug therapy ought to start even before pregnancy. In the care of the pregnant patient with Crohn's disease or ulcerative colitis corticosteroids and sulphasalazine may be used just as in the nonpregnant patient. An increased activity of the disease in the beginning of pregnancy causes high rates of prematurity, spontaneous abortions, and stillbirths. Frequency of defects in embryonic development varies between 0 and 4% and is even higher in severe cases of Crohn's disease. Prophylactic drug administration in pregnancy is not suitable to decrease the risk of exacerbation. Several studies revealed that the risk of exacerbation is not increased during pregnancy. Low activity in the onset of pregnancy is continued in 61%. Higher rates of abdominal and vaginal operative deliveries (26% in Crohn's disease) seems to be associated with active intervention on the base of activity indices.