Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group

M, Uma; Robinson, Christopher; Bernasko, Nana; Boland, Brigid S.; Chambers, Christina D.; Dubinsky, Marla; Friedman, Sonia; Kane, Sunanda V.; Manthey, Jacob; Sauberan, Jason; Stone, Joanne; Jain, Rajeev

doi:10.1053/j.gastro.2018.12.022

Cited by 239 publications

(127 citation statements)

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“…Inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis (UC), are often diagnosed during the fertile period of life. This special situation must be taken into account when selecting an appropriate medical treatment . Previous studies have shown that disease remission prior to conception and throughout pregnancy is crucial for favourable pregnancy outcomes .…”

Section: Introductionmentioning

confidence: 99%

“…This special situation must be taken into account when selecting an appropriate medical treatment. 1 Previous studies have shown that disease remission prior to conception and throughout pregnancy is crucial for favourable pregnancy outcomes. 2 In order to achieve disease remission, patients with IBD are frequently treated with biological therapies such as vedolizumab (VDZ), a monoclonal antibody directed against the α4β7 integrin-mucosal vascular addressin cell adhesion molecule 1 (MAdCAM-1) interaction in the gut.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti‐TNF or conventional therapy: results of the European CONCEIVE study

Moens¹,

Woude²,

Julsgaard³

et al. 2019

Aliment Pharmacol Ther

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Summary Background Women with inflammatory bowel diseases (IBD) often receive biologicals during pregnancy to maintain disease remission. Data on outcome of vedolizumab‐exposed pregnancies (VDZE) are sparse. Aims To assess pregnancy and child outcomes of VDZE pregnancies and to compare these results to anti‐TNF exposed (TNFE) or both immunomodulatory and biologic unexposed (CON IBD) pregnancies. Methods A retrospective multicentre case‐control observational study was performed. Results VDZE group included 79 pregnancies in 73 IBD women. The TNFE and CON IBD group included 186 pregnancies (162 live births) in 164 IBD women and 184 pregnancies (163 live births) in 155 IBD women, respectively. At conception, cases more often had active disease ([VDZE: 36% vs TNFE: 17%, P = .002] and [VDZE: 36% vs CON IBD: 24%, P = .063]). No significant difference in miscarriage rates were found between groups (VDZE and TNFE: 16% vs 13%, P = .567; VDZE and CON IBD: 16% vs 10%, P = .216). In live‐born infants, median gestational age and birthweight were similar between groups. Median Apgar score at birth was numerically equal. Prematurity was similar in the VDZE group compared to the control groups, even when correcting for disease activity during pregnancy. The frequency of congenital anomalies was comparable between groups as were the percentages of breastfed babies. During the first year of life, no malignancies were reported and infants' infection risk did not significantly differ between groups. Conclusion No new safety signal was detected in VDZE pregnancies although larger, prospective studies are required for confirmation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti‐TNF or conventional therapy: results of the European CONCEIVE study

Moens¹,

Woude²,

Julsgaard³

et al. 2019

Aliment Pharmacol Ther

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“…Although aminosalicylates can be continued, women taking sulfasalazine should increase their folate supplementation to 2 mg daily. Thiopurines should be continued during pregnancy if they are needed for the maintenance of remission but should not be started during pregnancy due to the long onset of action and potential for adverse side effects in the mother, such as cytopenia and drug-induced pancreatitis [3]. Tumor necrosis factor (TNF) antibodies are safe for the induction and maintenance of active disease throughout pregnancy with studies supporting a decrease in disease flares when they are continued throughout pregnancy [4].…”

mentioning

confidence: 99%

“…For the newer, non-TNF-directed IBD biologics, vedolizumab and ustekinumab, though there are less safety data, they can safely be continued throughout pregnancy based on the currently available evidence. Tofacitinib, a small molecule agent, should be discontinued at least 1 week prior to conception if other treatment options are available to maintain disease remission [3].…”

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confidence: 99%

Medication Adherence During Pregnancy in IBD: Compliance Avoids Complications

Gaidos

Kane

2020

Dig Dis Sci

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“…A higher rate of spontaneous abortion was reported in one study; however, the women receiving VDZ had already failed on at least one biologic, and likely represent a population with more severe IBD . A pregnancy clinical care pathway was published with recommendations to continue VDZ throughout pregnancy, planning for the last dose to be given 6‐10 weeks before estimated date of confinement …”

mentioning

confidence: 99%