Care of the Pregnant Patient With Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease affects women in their peak reproductive years. Patients and physicians often have questions regarding the effect of inflammatory bowel disease on a woman's ability to conceive and to carry a pregnancy safely to term as well as the effect of inflammatory bowel disease and the medications used to treat it on pregnancy outcomes. Women with inflammatory bowel disease have the same rates of fertility as women without inflammatory bowel disease unless they have had prior surgery in the pelvis or active disease. However, women with inflammatory bowel disease do have higher rates of adverse pregnancy outcomes. A multidisciplinary approach involving gastroenterologists, obstetricians, and maternal-fetal medicine physicians should focus on preconception planning and disease optimization before pregnancy. Women with inflammatory bowel disease should be followed as high-risk obstetric patients. Most medications used to treat inflammatory bowel disease can be continued safely during pregnancy and lactation. The greatest risk to the pregnancy is active disease, which can be precipitated by discontinuation of effective maintenance medications. Preconception counseling should include education regarding the low risk of most inflammatory bowel disease medications during pregnancy and lactation and the high risk of a significant disease flare during pregnancy. This review outlines important considerations for obstetricians caring for women with inflammatory bowel disease before and during pregnancy and in the postpartum period.

Optimizing Inflammatory Bowel Disease for Successful In Vitro Fertilization

“…This case also corroborates expert considerations that conception may be best attempted after 6 months of remission, primarily advised to minimize the risk of active disease during pregnancy 12,16. Our patient’s unsuccessful fifth cycle of IVF was administered 2 months after starting topical and oral therapy for UC, but the increased bHCG response could be suggestive of an improved response, as increased bHCG levels are typically associated with increased likelihood of a viable gestation 17.…”

“…Our patient’s unsuccessful fifth cycle of IVF was administered 2 months after starting topical and oral therapy for UC, but the increased bHCG response could be suggestive of an improved response, as increased bHCG levels are typically associated with increased likelihood of a viable gestation 17. Vitamin B12, vitamin D, and iron labs should be checked and corrected to help ensure a healthy pregnancy and fetal development, especially as women with IBD often have low levels 12. Therefore, in addition to the standard infertility work-up, an infertile IBD patient should be optimized prior to IVF by having her active disease addressed and any vitamin deficiencies corrected, with an appropriate period of remission.…”

“…Limited data also suggest that active disease, particularly Crohn’s disease, can contribute to infertility 1,3,10. Active disease may cause inflammation in the fallopian tubes or ovaries, dyspareunia, decreased libido, depression, or decreased ovarian reserve 10-12…”

Optimizing Inflammatory Bowel Disease for Successful In Vitro Fertilization

“…This case also corroborates expert considerations that conception may be best attempted after 6 months of remission, primarily advised to minimize the risk of active disease during pregnancy. 12,16 Our patient's unsuccessful fifth cycle of IVF was administered 2 months after starting topical and oral therapy for UC, but the increased bHCG response could be suggestive of an improved response, as increased bHCG levels are A C B A B Figure 1. Initial colonoscopy of (A) rectum and (B) sigmoid revealed moderate colitis with circumferential continuous erythema, friability, and punctate erosions.…”

“…1,3,10 Active disease may cause inflammation in the fallopian tubes or ovaries, dyspareunia, decreased libido, depression, or decreased ovarian reserve. [10][11][12] For IBD patients with infertility, in vitro fertilization (IVF) is a common, safe, albeit expensive solution. IVF is as successful for women with IBD as the general IVF population in terms of cumulative live birth rate, pregnancy rate after one IVF cycle, and incidence of live birth after first cycle.…”