Management of inflammatory bowel disease in pregnancy (original) (raw)
Related papers
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...
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...
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: :
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.
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
From conception to delivery: Managing the pregnant inflammatory bowel disease patient
World Journal of Gastroenterology, 2014
Inflammatory bowel disease (IBD) typically affects patients during their adolescent and young adult years. As these are the reproductive years, patients and physicians often have concerns regarding the interaction between IBD, medications and surgery used to treat IBD, and reproduction, pregnancy outcomes, and neonatal outcomes. Studies have shown a lack of knowledge among both patients and physicians regarding reproductive issues in IBD. As the literature is constantly expanding regarding these very issues, with this review, we provide a comprehensive, updated overview of the literature on the management of the IBD patient from conception to delivery, and provide action tips to help guide the clinician in the management of the IBD patient during pregnancy.
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.
United European Gastroenterology Journal, 2015
Patients with inflammatory bowel disease (IBD) tend to have smaller family sizes. Health care professionals (HCPs) may inadvertently provide inaccurate advice to patients resulting in voluntary childlessness or unfavourable pregnancy outcomes. The study aims to objectively measure IBD-specific pregnancy-related knowledge of general practitioners (GPs) and obstetricians/gynaecologists (OB/GYNs) in comparison with gastroenterologists (GEs) using the validated Crohn's and Colitis Pregnancy Knowledge (CCPKnow) questionnaire. GPs, OB/GYNs and GEs in two Australian states completed the CCPKnow (range 0-17) and demographic questionnaires. The CCPKnow addresses issues pertaining to conception, IBD inheritance, risk of congenital abnormalities, medication use in the peri-conceptual period, pregnancy and breastfeeding, and mode of delivery. In total, 337 HCPs responded. GPs (n = 188/2086) and OB/GYNs (n = 94/228) had significantly lower knowledge than GEs (n = 55/165) for the composite CCPKnow (medians 11, 13 and 17, respectively, p < 0.001), and almost all domains. GEs were the only group to attain a median CCPKnow score in the top category (14-17). More than 70% of GPs and OB/GYNs expressed discomfort with initiation of IBD medications around conception/pregnancy. GPs (43.6%) and OB/GYNs (45.7%) perceived thiopurine use to be unsafe during pregnancy and to cause serious harm to the baby. Our study demonstrates that GPs and OB/GYNs have inadequate and variable IBD-specific pregnancy-related knowledge including use of IBD medications. These results support the need for GEs' prime role in a team-based management for IBD patients who are pregnant or planning pregnancy.
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.
Treatment of inflammatory bowel disease and pregnancy: a review of the literature
Arquivos De Gastroenterologia, 2010
CONTEXT: The inflammatory bowel disease is diagnosed frequently among woman of childbearing capacity. The management must be carefully because there are potential risks for the mother and fetus. RESULTS AND CONCLUSIONS: We review literature about the management of inflammatory bowel disease in pregnancy. Some studies are needed to ensure the best approach to inflammatory bowel disease in pregnant women.