Pregnancy and medications in inflammatory bowel disease

Abstract

IBD affects patients at a significant time in their lives, often coinciding with family planning or pregnancy. While advances in IBD therapies have afforded women greater opportunities for successful conception and pregnancy outcomes, there still remains considerable maternal fear surrounding continuation of treatment throughout pregnancy. With the exception of methotrexate, most IBD drugs are safe and well-tolerated during pregnancy and are not associated with significant risk of adverse fetal or pregnancy outcomes. Furthermore, the current evidence overwhelmingly suggests that good control of disease activity and clinical remission at time of conception are the greatest prognostic factors for an uncomplicated pregnancy and maintenance of quiescent disease during gestation. Management of pregnant IBD patients should involve frank discussions with the mother and family about fears or concerns surrounding the impact of IBD on pregnancy. Mothers should be supported and counselled carefully on the safety and importance of adherence to therapy in maintaining remission. Optimal management of these women requires an inter-disciplinary team effort, involving the general practitioner, in close consultation and discussion with both gastroenterologists and obstetricians.

The Retroperitoneal Space

“…Given her ethnicity, her parents' main concern was the possible negative effects of the treatment on her prospects of pregnancy. This led to the adjustment of therapy using the lowest possible dose of methotrexate (risk of teratogenicity) 12 and avoidance of cyclophosphamide as it could induce infertility. 13 Castleman disease is a rare cause of benign lymph node enlargement and has a poorly understood pathophysiology.…”

Crohn's disease and clinical management today: How it does?

“…Beyond the considerable physical impact of CD, the disease process can affect various aspects of mental well-being and interpersonal relationships[ 139 ]. This disease directly interferes with family planning for couples because, while the pathogenesis of CD is not related to infertility, studies have shown that women with this disease often choose not to become mothers due to conditions such as excessive pain, dyspareunia, anemia, depression, low libido, and malnutrition[ 140 ]. Additionally, concerns about the use of medications during pregnancy and their potential side effects, as well as the possibility of active disease during labor, which increases the risk of complications, contribute to reducing discussions about family planning[ 141 ].…”

“…Other complications such as miscarriages, placental abruption, eclampsia, and pre-eclampsia can be associated with pregnancy and CD[ 142 ]. Finally, men using medications or experiencing clinical conditions associated with pain have also been related to voluntary avoidance of having children[ 140 , 141 ].…”

Rectal bleeding in pregnant women

“…Якщо користь перевищує ризик, азатіоприн і меркаптопурин можна безпечно призначати вагітним. Інгібітори фактора некрозу пухлини альфа (TNF-α) інфліксимаб чи адалімумаб також безпечні під час вагітності й не підвищують ризик збільшення кількості випадків вад розвитку у новонароджених [44][45][46].…”