Inflammatory Bowel Disease (IBD) in pregnancy. PROGRESS IN NUTRITION 2015.pdf (original) (raw)
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.
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.
Care of Women with Chronic Inflammatory Bowel Disease (Chronic IBD) During Pregnancy
Geburtshilfe und Frauenheilkunde
The incidence of chronic inflammatory bowel disease (chronic IBD) in persons of reproductive age is high. Chronic IBD does not typically lead to impaired fertility. Nevertheless, the percentage of women suffering from chronic IBD who have children is lower than that of the general population, due to self-imposed childlessness. Providing women with open, unbiased information and, if necessary, helping them to overcome baseless fears should therefore be an essential part of preconception counseling. With the exception of methotrexate, most standard drugs can and should be continued during pregnancy. If the pregnancy occurs during an inactive phase of disease, the rate of complications in pregnancy should, in principle, not be higher than normal. Nevertheless, pregnant women with chronic IBD are classed as high-risk pregnancies. Organ screening in accordance with DEGUM II criteria should be carried out in every case, and women must be monitored for the potential development of placenta...
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...
Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management
World journal of gastrointestinal pharmacology and therapeutics, 2015
Inflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by relapsing and remitting episodes of inflammation which can affect several different regions of the gastrointestinal tract, but also shows extra-intestinal manifestations. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While IBD therapy has improved dramatically with enhanced surveillance and more abundant and powerful treatment options, IBD disease can have important effects on pregnancy and presents several challenges for maintaining optimal outcomes for mothers with IBD and the developing fetus/neonate. Women with IBD, the medical team treating them (both gastroenterologists and obstetricians/gynecologists) must often make highly complicated choices regarding conception, pregnancy, and post-natal care (particularly breastfeeding) related to their choice of treatment options at different phases of pre...
Journal of Crohn's & colitis, 2014
Trying to conceive and being pregnant is an emotional period for those involved. In the majority of patients suffering from inflammatory bowel disease, maintenance therapy is required during pregnancy to control the disease, and disease control might necessitate introduction of new drugs during a vulnerable period. In this updated consensus on the reproduction and pregnancy in inflammatory bowel disease reproductive issues including fertility, the safety of drugs during pregnancy and lactation are discussed.
Inflammatory bowel disease in pregnancy
BMJ, 2008
Active maternal inflammatory bowel disease during pregnancy carries a greater risk to the fetus than appropriate treatment. Careful management is essential to achieve good obstetric outcome This is one of a series of occasional articles about how to manage a pre-existing medical condition during pregnancy METHODS We searched the PubMed database using the terms "inflammatory bowel disease", "Crohn's disease", "ulcerative colitis", "pregnancy", and "congenital malformations". We assessed the results for relevance and all relevant articles were reviewed where possible. Papers that were referenced in these articles were also reviewed if thought to be relevant.
Pregnancy related issues in inflammatory bowel disease: Evidence base and patients' perspective
World Journal of Gastroenterology, 2012
been addressed in several studies, there are minimal studies evaluating patients' perspective on these issues. Women's attitudes may influence their decision to have children and can positively or negatively influence the chance of conceiving, and their beliefs regarding therapies may impact on the course of their disease during pregnancy and/or breastfeeding. This review article outlines the impact of IBD and its treatment on pregnancy, and examines the available data on patients' views on this subject.
A meta-analysis on the influence of inflammatory bowel disease on pregnancy
Gut, 2007
Background: Inflammatory bowel disease (IBD) has a typical onset during the peak reproductive years. Evidence of the risk of adverse pregnancy outcomes in IBD is important for the management of pregnancy to assist in its management. Aim: To provide a clear assessment of risk of adverse outcomes during pregnancy in women with IBD. Design: The Medline literature was searched to identify studies reporting outcomes of pregnancy in patients with IBD. Random-effect meta-analysis was used to compare outcomes between women with IBD and normal controls. Patients and setting: A total of 3907 patients with IBD (Crohn's disease 1952 (63%), ulcerative colitis 1113 (36%)) and 320 531 controls were reported in 12 studies that satisfied the inclusion criteria. Results: For women with IBD, there was a 1.87-fold increase in incidence of prematurity (,37 weeks gestation; 95% CI 1.52 to 2.31; p,0.001) compared with controls. The incidence of low birth weight (,2500 g) was over twice that of normal controls (95% CI 1.38 to 3.19; p,0.001). Women with IBD were 1.5 times more likely to undergo caesarean section (95% CI 1.26 to 1.79; p,0.001), and the risk of congenital abnormalities was found to be 2.37-fold increased (95% CI 1.47 to 3.82; p,0.001). Conclusion: The study has shown a higher incidence of adverse pregnancy outcomes in patients with IBD. Further studies are required to clarify which women are at higher risk, as this was not determined in the present study. This has an effect on the management of patients with IBD during pregnancy, who should be treated as a potentially high-risk group.
Pregnancy and IBD treatment: This challenging interplay from a patients' perspective
Journal of Crohn's and Colitis, 2010
Introduction: Current data suggest that exacerbations of Inflammatory Bowel Disease (IBD) during pregnancy worsen perinatal outcomes. However, patients' perceptions regarding the interaction between pregnancy and IBD management are unexplored. Aims: To (1) obtain pregnancy outcome data from local female IBD patients, and (2) to gain insight into patients' understanding of the interaction between IBD and pregnancy, and how this affects medication-taking behaviour. Methods: Female IBD subjects aged 18-50 years were surveyed by questionnaire. This large retrospective study sought patient who reported pregnancy outcomes and examined the relationship between major adverse outcomes, IBD activity and treatment. Subjective data regarding patients' perceptions about IBD management and pregnancy were sought. Results: 219 females were surveyed, 143 completing a questionnaire (68.1%). 342 pregnancies occurred, 298 of which outcome data were available. Overall IBD women reported adverse pregnancy outcome rates comparable to the local population. Major adverse outcomes were more frequent in the subgroup with severe disease during pregnancy (5/ 14 (35.7%)) than those with inactive disease (14 / 284 (4.9%)), (OR 6.8 (95% CI 1.7-26.3), p = 0.006). Adjusting for disease severity, neither corticosteroid, azathioprine nor 5ASA affected pregnancy outcome. Most female patients (84%) reported (unwarranted) concerns about the effect of IBD medications on pregnancy, free text responses indicating that this was of greater concern than any effect of IBD exacerbation. Conclusions: Unwarranted fear of adverse medication effect on pregnancy is highly prevalent in women with IBD, yet awareness of the harmful effect of IBD exacerbation during pregnancy is poor. This information gap between patients and their gastroenterologists warrants attention.
Management of inflammatory bowel disease during pregnancy and nursing
Seminars in gastrointestinal disease, 2001
The peak age of onset for inflammatory bowel disease (IBD) coincides with the peak age for conception and pregnancy, and gastroenterologists will frequently be called on to treat pregnant IBD patients. The greatest threat to a normal conception and pregnancy is active disease, not active medicine. The majority of IBD medications are safe in pregnancy and nursing and should be used as needed. When in remission, ulcerative colitis and Crohn's disease usually do not affect fertility. Fertility may be impaired, however, by pelvic adhesions and scarring from old operations or disease. Pregnant IBD patients should be followed in a facility where diagnostic tests, such as sigmoidoscopy and ultrasound, and surgery can be performed if necessary.
Safety of TNF-α inhibitors during IBD pregnancy: a systematic review
BMC Medicine, 2013
Background: Tumor necrosis factor (TNF)-α inhibitors are increasingly being used in inflammatory bowel disease (IBD). Because this chronic intestinal disorder often affects women of fertile age, it is essential to assess the effect of biologics on pregnancy outcome.