Inflammatory Bowel Disease (IBD) in pregnancy. PROGRESS IN NUTRITION 2015.pdf (original) (raw)
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Pregnancy and Delivery of Women with IBD
New Concepts in Inflammatory Bowel Disease
We provide a basic overview of inheritance, fertility and influence of IBD and pregnancy, therapy in pregnancy and childbirth options. A crucial factor for good results is the degree of inflammation at the time of conception and during pregnancy. If the disease is inactive, there is no decrease in fertility and no greater risk of deterioration of disease in pregnancy and pregnancy does not differ from the normal population. The opposite situation occurs if there is a pregnancy at the time of disease activity. Then, in up to 75% of pregnancy courses with big problems, fertility declines, inflammation also worsens and the risk of exacerbations increases during pregnancy. This aggravates the course of pregnancy and childbirth and has a negative effect on the fetus. Therefore, it is necessary to plan for a longer period of disease stabilization and continue chronic medication and not discontinue drugs for the fear of negative impact of medications on fetal development. Commonly used drugs such as aminosalicylates, corticosteroids, immunosuppressants and biological therapy appear to be safe and well tolerated during pregnancy. The method of delivery is different for each individual and depends on the form and location of the inflammation and the preceding operations.
Pregnancy and Inflammatory Bowel Disease: A Special Combination
Middle East journal of digestive diseases./Middle East journal of digestive diseases, 2023
doi 100 000 inhabitants, most frequently in women (58% of cases), with a female/male ratio of 1.39:1. The prevalence of CD was 17 per 100 000 inhabitants, and of UC was 113 per 100 000 inhabitants. 4 However, it is a population in which information about clinical and therapeutic phenotypes is still not well known, and data about women are even scarcer. 5 Women are affected by IBD during different stages of their lives, including reproductive life, pregnancy, and menopause, so the way the disease is managed in women of reproductive age can affect its course. 6 At least 50% of patients with IBD are diagnosed at age 35, and the disease most often affects women during their peak reproductive years. 7 Treatment and health maintenance strategies are very relevant. IBD poses a particular challenge during pregnancy because the health of the mother and fetus must be considered. For this reason, it is of utmost importance that the gastroenterologist and patients with IBD are aware of the effect of IBD on pregnancy, the effect of pregnancy on IBD, and the effect of IBD medications on the fetus and on pregnancy outcomes. 8 Taking into account the importance of the subject in daily clinical practice, it was decided to conduct the following review http://mejdd.org
Progress in Nutrition, 2015
The Inflammatory Bowel Diseases are a group of inflammatory diseases characterized by the presence of chronic inflammation, in the absence of infectious etiology. The two most well-known diseases in this group are: Crohn’s disease (CD) and Ulcerative Colitis (UC). In cases where it is not possible to distinguish between CD and UC, it is called Indeterminate Colitis. Inflammatory Bowel Diseases (IBD) can affect women pregnant. The causes of IBD are unknown, and the clinical course of the disease is characterized by phases of activity and remission. UC is a chronic inflammation of the mucosa of the colon and involving predominantly the left colon and rectum. It is associated with presence of blood and mucus in the stool, diarrhea and anemia. Characteristically, CD involves entire gastrointestinal tract, from the mouth to the anus. In CD, the inflammatory infiltrate involves the entire intestinal wall. Clinically manifested by abdominal pain, diarrhea, loss of appetite and weight loss....
The Impact of Inflammatory Bowel Disease on Pregnancy and the Fetus: A Literature Review
Cureus
Inflammatory bowel disease (IBD) is a constellation of devastating chronic inflammatory changes in the bowel, either involving the large or small bowel or part of both. As it is widely diagnosed in the fertile age group, this disorder can present itself, very commonly, during pregnancy and thus a better understanding of the disease can be an important factor to influence the maternal and fetal well-being. Medications are what is considered the first line in the management of this disease to control the symptoms or keep the disease in remission. In addition to this, the drugs used to keep the disease in remission can also cause significant adverse effects on the patient and the new nurturing life preparing itself for the outside world. What the fetus gets from the mother will stay for life with the child. We conducted an electronic literature review search which highlights the significance and impact of sustained remission of IBD and the cautious use of various drugs during pregnancy for that purpose. In addition to the influences already mentioned, It is evident that nutritional deficiencies can also prevail with the advancing disease, something to manage as a side note as well. These deficiencies can have a definite effect on the fetus and may cause developmental malformations. In order to avoid this process, a systemic and joint approach should be curtailed. This can reduce the adverse outcomes associated with this ailment during pregnancy.
Inflammatory bowel disease and pregnancy: fertility, complications and treatment
Annals of Gastroenterology
Inflammatory bowel disease (IBD) is commonly diagnosed and treated in the young population. Therefore, it is common that women anticipating or undergoing pregnancy will have to cope with the additional burden of their IBD. Pregnancy in an IBD patient also presents challenges for the practitioner, in that the usual diagnostic and therapeutic armamentarium of potential tests and therapies is disrupted. This review covers the implications of IBD for fertility, pregnancy and offspring, and discusses the management of IBD in pregnancy.
Editorial Current opinion on treatment of inflammatory bowel disease in pregnant women
Archives of Medical Science, 2012
Inflammatory bowel disease (IBD) refers to a relapsing and remitting disease representing as forms of ulcerative colitis (UC) and Crohn's disease (CD) [1]. The peak age of onset is between 20 and 40 years of age, and thus overlaps with child-bearing years [2]. Fear of the adverse effect of medication on pregnancy is highly established in women with IBD, yet awareness of the harmful effect of IBD relapse during pregnancy is poor [3]. Generally both the active disease and its treatment may affect pregnancy; however, the belief is that the risk of the active disease is always greater than its medications [4]. Active CD and UC during conception and pregnancy increase the risk of adverse prenatal outcomes such as low birth weight and preterm delivery. Therefore active treatment of the disease and establishing remission before conception is the main goal in young women. In a very recent study, Bortoli et al. evaluated pregnancy outcome in IBD patients in a prospective European multicenter case-control study. They demonstrated no significant difference in frequency of fetal abnormalities in IBD patients compared with non-IBD controls [5]. Van der Eoude et al. found that the risk of relapse after conception is the same as non-pregnant IBD patients but if pregnancy occurs during disease flare-up, the disease will remain persistently active during pregnancy [6]. Inflammatory bowel disease itself, especially CD, may increase the risk of adverse neonatal outcome [6]. The risk is not only related to the medications but also related to the disease severity. One of the most important improvements in the management of IBD over the past decade has been the finding that normal pregnancy outcomes can be accomplished when a woman enters pregnancy in remission [7]. New insights into the safety of a wider spectrum of drugs in these patients have a great role in increasing success in IBD management. Various classes of drugs are used in disease management including aminosalicylates, corticosteroids, immunosuppressive drugs, antibiotics, and biologic agents. Also in recent years, the effectiveness of probiotics in maintaining remission and their efficacy in preventing relapse in IBD have been supported by concrete evidence [8, 9]. C Co or rr re es sp po on nd di in ng g a au ut th ho or r: :
Review of pregnancy in Crohn’s disease and ulcerative colitis
Therapeutic Advances in Gastroenterology, 2021
Inflammatory bowel disease (IBD) frequently affects women of childbearing age and can have implications in pregnancy. Most women with IBD have comparable fertility with women in the general population. Fertility is reduced in women with active disease or previous ileal-pouch–anal anastomosis (IPAA) surgery and is temporarily reduced in men taking sulfasalazine. Women with IBD have an increased risk of preterm delivery, low birth weight, small-for-gestational-age infants and Cesarean section (CS) delivery, however, no increased risk of congenital abnormalities. These adverse outcomes are particularly prevalent for women with active IBD compared with those with quiescent disease. Conception should occur during disease remission to optimize maternal and fetal outcomes and reduce the risk of disease exacerbations during pregnancy. Pre-conception counseling is therefore pertinent to provide patient education, medication review for risk of teratogenicity and objective disease assessment. ...
Inflammatory bowel disease during pregnancy
Current Treatment Options in Gastroenterology, 2003
Purpose of review Roughly half of the nearly 1.6 million people with inflammatory bowel disease (IBD) are women of reproductive age. Caring for women with IBD who are also pregnant can be challenging, particularly if with a disease flare or in remission, as there are special considerations needed. Recent findings Despite older studies concluding potential risks associated with IBD medical therapies, more recent literature reports healthier maternal and birth outcomes associated with disease control and reduction in the inflammatory burden. Most IBD therapies should generally be continued throughout all three trimesters without interruption as this is associated with better outcomes. Summary Active IBD increases risk of pregnancy complications and adverse pregnancy outcomes. Most medications have a favorable safety profile for use during pregnancy, regardless if in disease flare or remission. Short course corticosteroids for induction and management of flare is permitted. Thiopurines should not be started during pregnancy for a disease flare, but may be continued during pregnancy if previously on monotherapy. Biologics should be continued throughout pregnancy without interruption and timing of third trimester dosing made based on drug levels and estimated date of delivery. Risks/benefit assessment of therapies and disease control is important and should be individualized.
Current aspects with regard to the link between pregnancy and inflammatory bowel disease
Archives of Biological Sciences, 2014
Inflammatory bowel disease (IBD) has a high incidence predominantly in young individuals, it also affects family planning and pregnancy. In this review we will summarize a number of issues and challenges that arise from this, such as the chances of having a successful pregnancy, how IBD affects pregnancy, what investigations are needed during pregnancy, as well as what is the correct management of IBD (dietary, medical or surgical) in pregnant women with this disorder. IBD in pregnancy requires a multidisciplinary approach involving close collaboration between patient, gynecologist and gastroenterologist in order to increase treatment compliance and facilitate a successful pregnancy.
The Toronto Consensus Statements for the Management of IBD in Pregnancy
Gastroenterology, 2015
The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy since the health of both the mother and the fetus must be considered. A systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Consensus was reached on 29 of the 30 recommendations considered. Preconception counseling and access to specialist care are paramount in optimizing disease management. In general, women on 5-ASA, thiopurine, or anti-TNF monotherapy for maintenance should continue therapy throughout pregnancy. Discontinuation of anti-TNF therapy or switching from combination therapy to monotherapy may be considered in very select low-risk individuals. Women who have a mild-to-moderate disease flare while on optimized 5-ASA or thiopurine should be managed with systemic corticosteroids or...