Inflammatory Bowel Disease

Abstract

The incidence and prevalence of inflammatory bowel disease (IBD) continues to rise with time, signifying its emergence as a global disease. Clinical onset of IBD, comprising Crohn’s disease and ulcerative colitis, typically occurs prior to or at peak reproductive age. Although active disease in female patients is associated with reduced fertility and adverse obstetric outcomes in pregnancy, the molecular mechanisms underlying this altered reproductive course, as well as its impact on IBD transmission to offspring, remain poorly understood. Clinical and experimental studies have now begun to elucidate the hormonal, environmental and microbial factors that modulate immune-reproductive crosstalk in IBD, and define their impact on maternal health, fetal development and heritability of disease risk. Evolving insight into maternal-fetal imprinting in IBD has important implications for patient counseling and disease management during pregnancy, and may help predict clinical outcomes for both mother and child.

The Impact of Inflammatory Bowel Disease on Pregnancy and the Fetus: A Literature Review

“…A condition highlighted in this article is that of IBD which is a spectrum of chronic idiopathic inflammatory conditions with episodes of relapsing and remitting intestinal inflammation and extra-intestinal manifestations affecting several different regions [1]. Ulcerative Colitis (UC) involves the colonic and rectal mucosa and submucosa while Crohn’s Disease (CD) is characterized by transmural inflammation involving any region but sparing the rectum [1]. Hallmark GI symptoms of IBD include diarrhea, constipation, bloody stools, increased bowel movements, abdominal cramping, nausea, and vomiting.…”

“…Nonetheless, drugs and their impact on the growing fetus can also be quite challenging. Although the number of prospective clinical studies focused on the impact of IBD medications during pregnancy is increasing, there is still a marked deficit in our understanding of how active disease elicits immediate pregnancy risks and how maternal disease throughout gestation may impact fetal immune development and lifelong IBD susceptibility [1]. In a Swedish cohort, women with IBD had high rates of postpartum admissions for GI indications leading to stillbirths.…”

“…Live attenuated vaccines like rota, oral polio, and BCG are not indicated postponing them for six months or more in children exposed to TNF agents during gestation [43]. Owing to the large molecular weight if these drugs, negligible levels are found in the breast milk and are therefore considered safe during lactation [1]. A study conducted in the Czech Republic illustrated an exposure to anti-TNF-α antibodies seemed to be safe for the growth and psychomotor development of children [44].…”