Fertility and pregnancy in inflammatory bowel disease

Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding

“…29 Furthermore, there has never been any clear demonstration of teratogenicity of these agents in humans, but because of a paucity of clinical data, many patients have been advised to discontinue azathioprine before pregnancy. 5,6 However, azathioprine withdrawal is associated with a high risk of relapse, whatever the duration of remission under this treatment. 36,37 First, studies where the safety of azathioprine or mercaptopurine during pregnancy in women without IBD has been evaluated will be briefly commented on.…”

“…However, in view of the complications which may arise at the start of treatment with these agents (such as pancreatitis or leukopenia), it is perhaps not advisable to commence treatment for the first time during pregnancy. 5,6,8 Finally, although traditionally women receiving azathioprine or mercaptopurine have been discouraged from breast-feeding because of theoretical potential risks, it seems that these drugs may be safe during breast-feeding.…”

“…Therefore, in general, if a patient is established and well on azathioprine or mercaptopurine and it is felt to be essential to continue this drug to retain remission (which will be the case in most patients), after full discussion with the patient and her partner it is reasonable to decide to continue treatment during pregnancy. 5,6,8 It should be remembered that there are few alternatives to azathioprine/mercaptopurine in controlling steroid-dependent or -resistant IBD. What remains for the patient, the gastroenterologist, and the obstetrician is to balance the importance of remaining in remission with the probably small risk of these drugs.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14]21 They may have, perhaps, an increased risk of having a small or premature baby, but this is a small risk. 5,6,8,22 As a result, effective control of disease activity is vitally important during pregnancy. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In fact, it has been shown that the most important factor in the success of a pregnancy in patients with IBD is the state of disease activity.…”

“…Therefore, an informed pre-pregnancy discussion, with the patient (and her partner if appropriate), facilitates a decision made in partnership with clinicians and the formulation of a management plan. [5][6][7][8] Overall, the majority of medications used for the treatment of IBD are not associated with significant adverse effects. The United States Food and Drug Administration (FDA) classification of drugs offers a guide to the use of medications during pregnancy (Table 1).…”