Pregnancy in Crohn's Disease

Abstract

Over a 13-year period, the course of 109 pregnancies in 68 women with Crohn's disease was studied. A total of 76 children were delivered. There were no gemellary deliveries, and none of the children had congenital malformations. Pregnancy entailed no increased risk of an exacerbation of the bowel disease. As compared with the reference population and with women with ulcerative colitis, the total material showed an increased risk of premature delivery and spontaneous abortion, but a further analysis showed that this was due only to an increased risk in women with active disease at the time of conception and in women who had undergone bowel resection during pregnancy. Birth weight and birth length corresponded to those in the reference population. The frequency of neonatal hyperbilirubinaemia was not higher in children of mothers with Crohn's disease than in children of healthy mothers. Treatment with sulphasalazine, salazosulphadimidine, and corticosteroids did not influence the course of pregnancy or the frequency of neonatal jaundice or malformations. Consequently, in Crohn's disease a pregnant woman should be given the same medical treatment as when not pregnant. Generally, the women should be advised preferably to conceive at a time when their bowel disease is inactive. The risk groups should be followed up with frequent obstetrical examinations throughout pregnancy.

Management of inflammatory bowel disease in pregnancy

“…Specifically, Nielsen reported UC flare rates of 34 versus 32% in pregnant and nonpregnant women, respectively. A similar finding was seen among CD patients [28]. A large northern California population-based cohort study of 461 pregnant IBD patients showed the majority of patients with UC and CD had inactive or mild disease throughout pregnancy (65-80% based on the pregnancy stage) [29].…”

“…Earlier studies showed active disease at conception was associated with a higher rate of fetal loss [52] and preterm birth [9,28]. Disease activity during pregnancy has also previously been associated with preterm birth and low birthweight [37,46,53,54].…”

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

“…Complications associated with IBD activity at the time of conception include: Abortion, low birth weight (LBW), and premature births [50,[52][53][54][55] . These complications again, are usually seen more often in CD patients than UC patients.…”

Interação da gestação na atividade da doença inflamatória intestinal e sua influência sobre o prognóstico gestacional e na fecundidade

“…Quanto aos efeitos da RC e da DC sobre a gravidez, estudos demonstraram uma taxa de proles saudáveis, similar à taxa da população em geral [2,5,6]. Trabalhos demonstraram que se a doença estiver quiescente durante a gestação, não há aumento do risco de abortamento espontâneo, complicações relacionadas à gestação, anomalias congênitas ou outras intercorrências com o feto [7,8,9,10,11,12,13,14,15].…”

“…Nesta situação há maior incidência de abortamento espontâneo, prematuridade e outras alterações perinatais, parecendo ser maior na DC do que na RC. [5,7,13,15,18,19,20,21]. Há trabalhos que demonstraram maior incidência de recém-nascidos de baixo peso e pré-termos e risco de abortamento espontâneo em mães com doença inflamatória intestinal, principalmente na DC em atividade, no momento da concepção [5,18,22,23].…”