Pregnancy and the Patient with Inflammatory Bowel Disease: Fertility, Treatment, Delivery, and Complications

Ryan A McConnell; Uma Mahadevan

doi:10.1016/j.gtc.2016.02.006

Pregnancy and the Patient with Inflammatory Bowel Disease: Fertility, Treatment, Delivery, and Complications

Gastroenterol Clin North Am. 2016 Jun;45(2):285-301. doi: 10.1016/j.gtc.2016.02.006.

Authors

Ryan A McConnell¹, Uma Mahadevan²

Affiliations

¹ Division of Gastroenterology, University of California, San Francisco, 1701 Divisadero Street, #120, San Francisco, CA 94115, USA.
² Division of Gastroenterology, UCSF Center for Colitis and Crohn's Disease, 1701 Divisadero Street, #120, San Francisco, CA 94115, USA. Electronic address: [email protected].

PMID: 27261899
DOI: 10.1016/j.gtc.2016.02.006

Abstract

For many women with inflammatory bowel disease (IBD), the illness coincides with their childbearing years. IBD increases the risk of pregnancy complications and adverse pregnancy outcomes. The multidisciplinary care team should emphasize the importance of medication adherence to achieve preconception disease control and maintain corticosteroid-free remission throughout pregnancy. Medication adjustments to reduce fetal exposure may be considered on an individualized basis in quiescent disease; however, any benefits of such adjustments remain theoretic and there is risk of worsening disease activity. Mode of delivery is determined by obstetric indications, except for women with active perianal disease who should consider cesarean delivery.

Keywords: Breast feeding; Crohn disease; Drug-related side effects and adverse reactions; Fertility; Inflammatory bowel disease; Obstetric delivery; Pregnancy; Ulcerative colitis.

Publication types

Review

MeSH terms

Adalimumab / therapeutic use
Aminosalicylic Acids / therapeutic use*
Anti-Bacterial Agents / therapeutic use*
Antibodies, Monoclonal / therapeutic use
Biological Products
Breast Feeding
Budesonide / therapeutic use
Certolizumab Pegol / therapeutic use
Delivery, Obstetric / methods*
Female
Gastrointestinal Agents / therapeutic use
Glucocorticoids / therapeutic use*
Humans
Immunosuppressive Agents / therapeutic use*
Infertility, Female / diagnosis
Infertility, Female / epidemiology
Infertility, Female / therapy*
Infertility, Male / epidemiology
Inflammatory Bowel Diseases / drug therapy*
Inflammatory Bowel Diseases / epidemiology
Infliximab / therapeutic use
Male
Natalizumab / therapeutic use
Prednisone / therapeutic use
Pregnancy
Pregnancy Complications / drug therapy*
Pregnancy Outcome
Pregnancy Rate

Substances

Aminosalicylic Acids
Anti-Bacterial Agents
Antibodies, Monoclonal
Biological Products
Gastrointestinal Agents
Glucocorticoids
Immunosuppressive Agents
Natalizumab
Budesonide
golimumab
Infliximab
Adalimumab
Certolizumab Pegol
Prednisone