Editorial: Are Thiopurines and Anti-TNFα Agents Safe to Use in Pregnant Patients With Inflammatory Bowel Disease?

Abstract

Inflammatory bowel disease affects women in their peak reproductive years. Increased disease activity during pregnancy has been associated with adverse outcomes. Thus, it is recommended that immunosuppressant medications be continued during pregnancy. However, data regarding the safety of these medications during pregnancy are sparse and often conflicting. The study by Casanova et al. (1) adds to the growing evidence that the use of thiopurines and anti-TNFα agents during pregnancy does not increase the risk of birth defects. Results from prospective studies with longer follow-up are needed to fully understand the impact of thiopurines and anti-TNFα agents on child development and maturation of the immune system.

Meta-analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease

“…Such non-adherence has been associated with a higher risk of disease exacerbation in the peri-partum period (32). Gastroenterologists have historically encouraged the use of maintenance therapy when pregnancy is considered, as prior studies have emphasized the risk of persistent disease activity in patients who become pregnant when their IBD is active (1,11,33). …”

“…32 Gastroenterologists have historically encouraged the use of maintenance therapy when pregnancy is considered, as prior studies have emphasised the risk of persistent disease activity in patients who become pregnant when their IBD is active. 1,11,33 This is the first meta-analysis to determine the effect estimate of disease activity at conception on the course of IBD during pregnancy. In patients with IBD, there is a twofold risk of colitis remaining persistently active during pregnancy if patients become pregnant with active colitis.…”