Update on Pregnancy in Patients with IBD
- PDF / 444,293 Bytes
- 19 Pages / 595.276 x 790.866 pts Page_size
- 84 Downloads / 186 Views
Inflammatory Bowel Disease (G Lichtenstein, Section Editor)
Update on Pregnancy in Patients with IBD Rachel W. Winter, MD, MPH1,3 Sonia Friedman, MD1,2,3,* Address 1 Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA 2 Department of Clinical Epidemiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark *,3 Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA Email: [email protected]
Published online: 13 August 2020 * Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Inflammatory Bowel Disease Keywords Inflammatory bowel disease I Crohn’s disease I Ulcerative colitis I Pregnancy I Fertility
Abstract Purpose of review This review summarizes the most current clinical research and latest clinical guidelines in managing inflammatory bowel disease (IBD) before, during, and after pregnancy. Recent findings Recent guidelines emphasize the safety of thiopurines and biologics during pregnancy and nursing. Patients should be in remission for 3–6 months prior to conceiving and remain in remission to decrease the risk of poor pregnancy outcomes. Fertility is decreased in women with active IBD and in women who have had anal or rectal resection. Women with IBD, especially those with Crohn’s disease (CD) who have had surgery, have an increased time to pregnancy. Women with CD and ulcerative colitis who need assisted reproduction have a decreased chance of a live birth compared with women in the general population. Indications for caesarian section include active perianal disease. Summary Most IBD medications are safe during pregnancy and should be continued to ensure remission. Preconception counseling and a multidisciplinary team approach are the best ways to support a healthy pregnancy and delivery.
Introduction One of the important clinical care and research areas, in the expanding population of young patients with IBD, is the concern related to reproduction. Patients often question their ability to conceive, plan a pregnancy, cope
with disease during pregnancy, and ensure safety of medications during pregnancy and while nursing. Additionally, patients worry about the impact of IBD and IBD medications on short- and long-term health
424
Inflammatory Bowel Disease (G Lichtenstein, Section Editor)
consequences in the offspring. There is a growing body of research and clinical experience in multiple reproductive issues concerning IBD including the factors that impact fertility, the safety of thiopurines and biologics during pregnancy, the safest method of delivery, and the
best antepartum care. Below is a summary of the most current clinical research as well as latest clinical guidelines in managing IBD before, during, and after pregnancy.
Preconception counseling The most important message regarding preconception counseling is that patients should be in remission for 3–6 months on stable medications prior to conceiving. De Lim
Data Loading...
