Safety of drug therapy for inflammatory bowel disease in pregnant and nursing women

Abstract

: Drug therapy is justified in pregnant patients with active inflammatory bowel disease. Selection of medical treatment depends on disease severity and the potential for fetal toxicity. Preferably, pregnancy should be planned to coincide with periods of disease quiescence, so that drug requirements can be minimized. Sulphasalazine and prednisolone are clearly safe in pregnancy and lactation. Preliminary studies suggest that lowto-moderate-dose mesalazine is well tolerated in pregnant and nursing mothers. Immunosuppressive therapy during pregnancy in transplant and nontransplant recipients may be associated with an increased risk of fetal growth retardation and prematurity. The risk of congenital malformations from azathioprine and cyclosporin is not markedly increased, although exposure to methotrexate during the first trimester may cause fetal loss and characteristic anomalies. Short-term therapy with metronidazole in the first trimester is not associated with an increased risk of teratogenicity, although the safety of this drug in pregnancy as primary therapy for Crohn's disease using higher doses for prolonged periods has not been confirmed.

Review article: the management of Crohn's disease and ulcerative colitis during pregnancy and lactation

“…The risk for pre‐term birth and small for gestational age neonates under this medication is increased. Neither the diagnosis of IBD nor the adequate medical therapy are medical indications for abortion …”

“…Methotrexate is considered teratogenic and mutagenic, consequently contraindicated in pregnancy . Patients on MTX have to be advised to use an effective method for contraception.…”

“…Neither the diagnosis of IBD nor the adequate medical therapy are medical indications for abortion. 33,[70][71][72][73][74] The basic principles of the medical IBD therapy before and during pregnancy are: (i) An acute flare has to be treated prompt and effectively. (ii) An effective therapy should not be discontinued, if not contraindicated.…”

Salvage therapy for acute severe ulcerative colitis during pregnancy

“…Disease activity improves in approximately 1/3 of patients; remains stable in 1/3 and worsens in 1/3 of cases during pregnancy. The biggest driver of adverse outcomes in pregnant women is active disease therefore, active medical management is considered to be justified 8. The management and treatment of ulcerative colitis during pregnancy must take into consideration the risks and benefits of treatment associated with each trimester 9–12…”

Exposure to mesalamine during pregnancy increased preterm deliveries (but not birth defects) and decreased birth weight

“…In this respect, mesalazine joins sulfasalazine, steroids, azathioprine, and 6-mercaptopurine as effective agents in IBD that are safe for use during pregnancy 1. Pregnant patients and their primary physicians, gastroenterologists, obstetricians, and paediatricians must all be educated to the fact that the greatest risk to pregnancy is active disease, not active treatment.…”