Inflammatory Bowel Disease and Pregnancy: A Review

Abstract

Inflammatory bowel disease often occurs during peak reproductive years. Rates of conception, pregnancy outcome and disease course during pregnancy should be discussed prior to attempted conception. The majority of patients whose disease is well controlled prior to pregnancy should expect a fertility rate comparable to the general population, and an uncomplicated pregnancy with a favorable outcome. The disease should continue to be pharmacologically or surgically controlled as necesssary during pregnancy; the majority of drug options available to pregnant patients being without detriment to the fetus. No predictable inheritance pattern has been established and, at this time, there is no ability to screen prenatally.

Risk of Adverse Pregnancy Outcomes for Women with IBD in an Expert IBD Antenatal Clinic

“…We confirmed that disease activity prior to conception correlates with disease activity during pregnancy [ 2 , 3 , 12 , 13 ]. Antenatal disease activity did not increase the risk of emergency CS, suggesting that disease activity alone should not be classed as an indication for elective CS in IBD patients.…”

“…As disease activity at conception often predicts disease activity during pregnancy, patients with IBD should aim for remission prior to pregnancy [ 2 , 3 , 4 , 5 , 6 ]. In patients with active disease, the risk of adverse maternal and neonatal outcomes increases; thus, careful monitoring, medication optimisation, and input from gastroenterologists are essential for the obstetric care of patients with IBD [ 2 , 3 , 4 , 5 , 7 , 8 , 9 , 10 , 11 ].…”

“…We recently reported the perineal outcomes in our patient cohort [ 14 ]. Specific indications amongst the IBD population exist for elective CS delivery, such as active perianal disease and ileal pouch anal anastomosis (IPAA); however, these indications do not completely explain the higher rate of CS in this group [ 3 , 9 ].…”

“…Delivery of preterm and small infants is more commonly observed for mothers with IBD. However, the risk of outcomes such as stillbirth or neonatal intensive care unit (NICU) admission have not been consistently demonstrated in the infants of IBD patients [ 3 , 4 , 7 , 12 , 15 ].…”