European Crohn’s and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation

Abstract

Inflammatory bowel disease has a high incidence and prevalence especially in young individuals in their reproductive years. 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. Therefore, the management of patients with a wish to conceive and during pregnancy requires specialized counselling and appropriate management including a multidisciplinary approach and close involvement of the prospective parents under a shared decision-making model. This updated consensus paper addresses these issues and is aimed to optimize pre-conceptional, pregnancy and post pregnancy counselling, including the monitoring and therapeutic management of patients with IBD patients with a wish to conceive.

Live vaccinations for infants exposed to maternal infliximab in utero and via breast milk – the need for nuanced decision making

“… 2 As the infant will be exposed to anti-TNF by active placental transfer, live vaccinations for the infant should be delayed to avoid potentially fatal infant outcomes. 3 …”

“…4 As clearance of Infliximab from the infant’s blood stream occurs after a mean of 7 months and may take 12 months, this is logical and is reflected in the new European Crohns and Colitis Organisation (ECCO) guidelines. 3 5 The second recommendation is that live vaccinations should be avoided in infant exposed to Infliximab through breast milk. 4 While Infliximab has been detected in breast milk in small amounts, there is no credible evidence that this leads to clinically significant serum levels in infants.…”

“…This is now supported by the newest ECCO guidelines on reproduction and lactation. 3 The main vaccines affected by this are rotavirus (at 8 and 12 weeks) and BCG (4 weeks in high-risk groups) vaccines. However, the first dose of the Measle Mumps Rubella vaccine is given at 12 months.…”

“… 5 The new ECCO guidelines therefore have a simple unified message for all anti-TNF medications and recommend a delay of all live vaccinations for 1 year. 3 We caution against a “one size fits all” approach and suggest that, IBD and obstetric teams continue to provide well-considered and evidence based advice on effects of maternal IBD medication on suitability of childhood vaccinations. Clinicians need to weight the risk of vaccination against the risk of acquiring TB through community exposure without discouraging women from breast feeding.…”

“…2 As the infant will be exposed to anti-TNF by active placental transfer, live vaccinations for the infant should be delayed to avoid potentially fatal infant outcomes. 3 The Medicines and Healthcare products Regulatory Agency (MHRA) and European Medicines Agency (EMA) have recently issued guidance for infants exposed to Infliximab in utero and by breast feeding. 4 They recommend that infants exposed to Infliximab in utero should not receive live vaccinations until 12 months of age.…”