Pregnancy in Inflammatory Bowel Disease

Mogadam, Michael; Dobbins, William O.; Korelitz, Burton I.; Ahmed, Susan W.

doi:10.1097/00006254-198107000-00017

Cited by 8 publications

(3 citation statements)

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“…They have no demonstrated effect on prematurity, spontaneous abortion or stillbirth [9] . Adrenal suppression in the fetus due to maternal use has hitherto been described infrequently [10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 96%

High-Dose Methylprednisolone in a Pregnant Woman with Crohn’s Disease and Adrenal Suppression in Her Newborn

2008

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Background: The synthetic corticosteroid methylprednisolone is used for the treatment of acute exacerbations of Crohn’s disease, also in pregnancy. Its use is considered to be less harmful than the effect of active disease on the fetus. Adrenal suppression in a fetus due to administration of methylprednisolone has hitherto been rarely published. Objective: To present a case of neonatal adrenal suppression due to the use of high-dose methylprednisolone in late pregnancy of a woman with Crohn’s disease. Methods and Results: Clinical signs of adrenal suppression were observed in the newborn 3 h after birth. After hydrocortisone supplementation and intensive therapy the baby recovered completely. Conclusions: Life-threatening adrenal suppression, requiring hydrocortisone supplementation and intensive therapy, was observed and successfully treated in a newborn, whose mother had received high-dose methylprednisolone in late pregnancy.

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Section: Introductionmentioning

confidence: 96%

High-Dose Methylprednisolone in a Pregnant Woman with Crohn’s Disease and Adrenal Suppression in Her Newborn

2008

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“…Sulphasalazine also crosses the placenta (89,90) and could theoretically displace conjugated bilirubin from binding sites on albumin and thus predispose to kernicterus. However, two large retrospective studies of pregnancy in colitis, which include altogether over 200 pregnancies in mothers receiving sulphasalazine and 190 in mothers receiving corticosteroids, have shown a reassuring and convincing lack of any complications resulting from drug therapy in pregnancy (91,92). Sulphasalazine therapy should therefore be continued throughout pregnancy unless previous attacks of colitis have been very mild and distal while any acute attack of colitis occurring during pregnancy should be treated promptly with corticosteroids in the same way as in a nonpregnant patient.…”

Section: Treatment In Pregnancymentioning

confidence: 99%

“…Corticosteroids and sulphasalazine seem to be very safe in pregnancy (91,92) so any attacks of Crohn's disease occurring in pregnancy should be treated conventionally using these drugs. It is, of course, very important that the obstetrician and neonatal paediatrician are aware of the mother's corticosteroid treatment.…”

Section: Treatment In Pregnancymentioning

confidence: 99%

Therapeutic Progress—reviewix.

Rhodes

1983

J Clin Pharm Ther

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Ulcerative colitis is a disease of unknown aetiology in which colonic mucosal inflammation and ulceration result in rectal bleeding and diarrhoea. Most patients have relapses separated by long periods of disease inactivity, but a minority of patients have more chronic symptoms. The great majority of a t t x k s of ulcerative colitis settle with prompt medical management but in the few cases where this fails, colectomy is curative although generally leaves the patient with a permanent ileostomy. With good medical and surgical management, mortality from the disease should therefore approach zero. Acute atracksCorticosteroids are the only drugs which have been shown to have an important and unequivocal therapeutic effect in acute attacks of ulcerative colitis (1, 2,3,4). If the disease is confined to the rectum or distal colon, local steroid therapy is often sufficient to obtain a remission (2, 3, 5). It may be given in the form of suppositories, enemas or rectal foam. Suppositories are the simplest to use but are only likely to give adequate drug concentrations in the lower rectum and should therefore only be used in cases of localized distal proctitis. One might imagine that a liquid enema would reach further up the colon than rectal foam but abdominal scanning following rectal instillation of isotopically labelled steroid foam has shown convincingly that it usually passes up to the proximal sigmoid colon and sometimes well into the descending colon (6). In practice, hydrocortisone foam seems at least as effective as hydrocortisone enemas, similar in cost, and generally preferred by the patient (7). It has been shown that approximately half the steroid in enemas containing hydrocortisone or prednisolone-21-phosphate is absorbed (8, 9, 10, l l ) , although it is generally thought that some at least of the therapeutic effect results from the high levels obtained locally in the rectum (10, 11 , 12, 13). Prednisolone metasulphobenzoate sodium is probably as effective as prednisolone-2 1-phosphate when given rectally, but produces much lower free prednisolone levels in the blood (13) and would therefore be expected to cause less adrenal suppression. However, this probably is of little importance clinically if topical steroids are used for a fairly short course of a few weeks or less.

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Approach to Gastrointestinal and Liver Diseases in Pregnancy

Saha

Reau

2015

Yamada' S Textbook of Gastroenterology

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Pregnancy in Inflammatory Bowel Disease

Cited by 8 publications

References 0 publications

High-Dose Methylprednisolone in a Pregnant Woman with Crohn’s Disease and Adrenal Suppression in Her Newborn

High-Dose Methylprednisolone in a Pregnant Woman with Crohn’s Disease and Adrenal Suppression in Her Newborn

Therapeutic Progress—reviewix.

Approach to Gastrointestinal and Liver Diseases in Pregnancy

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