Management of Inflammatory Bowel Diseases during Pregnancy

Abstract

Inflammatory bowel diseases (IBD) have a high prevalence in younger patients with child-bearing potential. Usually, pregnancies in women with IBD will develop normally, if the patient is in remission or has minor disease activity at the time of conception. In contrast, the frequency of normal pregnancies is significantly reduced and the frequency of adverse outcomes like preterm birth or miscarriage is increased, when conception occurs in phases with active IBD. Therefore, it is generally recommended to women with IBD to conceive at a time with minor disease activity or in remission. IBD patients who plan to become pregnant or are pregnant should be treated adequately. Currently, it is widely accepted that the treatment of IBD with corticosteroids and 5-ASA derivatives does not increase the risk of malformations or adverse outcomes in pregnant IBD patients. However, a slight increase in the number of pre-term deliveries or reduced birth weight is observed. More recently, it has also been appreciated that azathioprine and 6-MP and presumably also infliximab and other TNF-α blockers can be safely used during pregnancy in IBD, as no significant increase of malformations, miscarriages or adverse pregnancy outcomes is observed. Information on cyclosporine and tacrolimus during pregnancy is scarcer, but it may be continued or started in some situations if clinically needed. Methotrexate is contraindicated, as this drug is known to significantly increase the risk of malformations and spontaneous abortion. Patients, who wish to nurse their babies, may be treated with steroids and 5-ASA derivatives without a significantly increased risk for the newborn.

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

“…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.…”

“…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 …”

Tacrolimus in the Treatment of Ocular Diseases

“…[83] It has been demonstrated that various patient factors can influence the pharmacokinetic parameters of systemic tacrolimus, which include demographic characteristics, [84][85][86][87] hepatic dysfunction, [84,85,88] hepatitis C, renal function, time after transplant, age, donor characteristics, sex, race, hematocrit and albumin concentrations, diurnal variations, administration of food, corticosteroid dosage, diarrhea, ascites, short or absent small bowel jejunostomy, and intestinal P-glycoprotein as well as cytochrome P450 expression. [53] Orally administered tacrolimus is also used for treatment of rheumatoid arthritis, [89][90][91] moderate to severe psoriasis, [92,93] and inflammatory bowel disease, [94][95][96][97] often in combination with other therapeutics. Lower daily doses (1.5-3 mg day) than for transplant patients are used for these conditions, resulting in lower trough tacrolimus concentrations in serum ranging from 2 to 10 ng mL.…”

Relevance of Patient-Reported Outcomes for the Management of Patients with Inflammatory Bowel Disease

“…Furthermore, the risk of spontaneous abortions and fetal abnormalities are not significantly increased with basic IBD medications. 17 However, there is an increased risk of preterm births and reduced weight at birth; 17 there is no indication for therapeutic abortion. 18 Active IBD can be treated with 5-ASA derivatives, budesonide, and corticosteroids as in non-pregnant patients.…”