Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

Hosseini‐Carroll, Pegah; Mutyala, Monica; Seth, Abhishek; Nageeb, Shaheen; Soliman, Demiana; Boktor, Moheb; Sheth, Aakash; Chapman, Jonathon; Morris, James; Jordan, Paul; Manas, Kenneth; Becker, Felix; Alexander, J. Steven

doi:10.4292/wjgpt.v6.i4.156

Cited by 20 publications

(17 citation statements)

References 114 publications

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“…It is recommended that IBD remission should be achieved prior to conception. [18][19][20] Quiescent disease is believed to have minimal impact on the course and outcome of pregnancy, whereas patients with active disease at conception have increased rates of spontaneous abortion, pre-term birth, low birth weight and infants that are small for gestational age. 18,[21][22][23] Interpretation of the impact of IBD disease activity on pregnancy outcome in vedolizumab-treated females is confounded by incomplete availability of data and the small numbers of patients; however, generally more severe disease activity was recorded in individuals experiencing a pre-term live birth or spontaneous abortion than in those with a fullterm pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease

Vermeire

Lasch

et al. 2017

Aliment Pharmacol Ther

109

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Summary Background Vedolizumab is a gut‐selective immunoglobulin G1 monoclonal antibody to α4β7 integrin for the treatment of Crohn's disease (CD) and ulcerative colitis (UC). Prospective clinical studies of vedolizumab in pregnancy have not been conducted; therefore, existing safety data of vedolizumab in pregnancy were examined. Aim To assess pregnancy outcomes in females and partners of males who received vedolizumab. Methods All pregnancy data collected during the clinical programme (from 14 May 2007 to 27 June 2013) and in the post‐marketing setting (to 19 November 2015) were analysed. Results Across six studies, there were 27 pregnancies in female participants and 19 pregnancies in partners of male participants. Among 24 vedolizumab‐treated females (23 with CD/UC, one healthy volunteer), there were 11 live births, five elective terminations, four spontaneous abortions and four undocumented outcomes. A congenital corpus callosum agenesis anomaly was reported in one live birth from a healthy volunteer with extensive obstetric history exposed to single‐dose vedolizumab 79 days before estimated conception. Of 19 pregnancies in partners of male participants, there were 11 live births, two spontaneous abortions, three elective terminations and three undocumented outcomes. Post‐marketing reports recorded 81 pregnancies, resulting in four live births, 11 spontaneous abortions and 66 pregnancies that were on‐going or reported undocumented outcomes. Conclusions Initial analysis, limited by sample size and follow‐up, identified no new safety concerns for pregnancy outcomes in females directly or indirectly exposed to vedolizumab. However, vedolizumab should be used during pregnancy only if the benefits to the mother outweigh the risks to the mother/unborn child.

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Section: Discussionmentioning

confidence: 99%

“…To control disease optimally and maintain remission, many patients require therapy throughout pregnancy. 19,20,22,24 Consequently, it is vital to consider the effect of IBD medications on foetal health. Generally, the greatest risk to mother and foetus during pregnancy is active IBD, not the medication used to treat it.…”

Section: Discussionmentioning

confidence: 99%

Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease

Vermeire

Lasch

et al. 2017

Aliment Pharmacol Ther

109

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“…Crohn's disease activity at the time of conception could determine the clinical course the patients with CD will experience during pregnancy . Increased disease activity has been shown to effect female fertility and pregnancy outcomes .…”

Section: Case Descriptionmentioning

confidence: 99%

Ustekinumab therapy for Crohn's disease during pregnancy: a case report and review of the literature

et al. 2016

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“…IBD flare-ups are often due to medication discontinuation during pregnancy, lactation and smoking resumption following birth[10]. Approximately one-third of patients have active disease during conception[11]. Nielsen et al[12] reported that the yearly exacerbation rate is 34% during pregnancy and 32% in non-pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Treatment of pregnant women with a diagnosis of inflammatory bowel disease

Poturoğlu¹,

Örmeci²,

Duman³

2016

WJGPT

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The frequency of diagnosis of inflammatory bowel disease (IBD) has increased in younger populations. For this reason, pregnancy in patients with IBD is a topic of interest, warranting additional focus on disease management during this period. The main objective of this article is to summarize the latest findings and guidelines on the management of potential problems from pregnancy to the breastfeeding stage. Fertility is decreased in patients with active IBD. Disease remission prior to conception will likely decrease the rate of pregnancy-related complications. Most of the drugs used for IBD treatment are safe during both pregnancy and breastfeeding. Two exceptions are methotrexate and thalidomide, which are contraindicated in pregnancy. Anti-tumor necrosis factor agents are not advised during the third trimester as they exhibit increased transplacental transmission and potentially cause immunosuppression in the fetus. Radiological and endoscopic examinations and surgical interventions should be performed only when absolutely necessary. Surgery increases the fetal mortality rate. The delivery method should be determined with consideration of the disease site and presence of progression or flare up. Treatment planning should be a collaborative effort among the gastroenterologist, obstetrician, colorectal surgeon and patient.

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Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

Cited by 20 publications

References 114 publications

Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease

Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease

Ustekinumab therapy for Crohn's disease during pregnancy: a case report and review of the literature

Treatment of pregnant women with a diagnosis of inflammatory bowel disease

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