Relapses of Inflammatory Bowel Disease During Pregnancy: In-Hospital Management and Birth Outcomes

Reddy, Deepa; Murphy, Seamus; Kane, Sunanda V.; Present, Daniel H.; Kornbluth, Asher

doi:10.1111/j.1572-0241.2007.01756.x

Cited by 153 publications

(101 citation statements)

References 19 publications

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“…The onset of IBD in a pregnant woman is uncommon and is usually associated with a poor prognosis [1,10] because of an increased overall risk of an adverse neonatal outcome; the most frequently described are preterm delivery and low birth weight [5,[11][12][13] . An accurate patient history is crucial, as are clinical and pertinent investigations to assess colitis activity.…”

Section: Discussionmentioning

confidence: 99%

“…A first disease attack of UC during pregnancy is uncommon, and is usually associated with an adverse outcome [1] . Antenatal disease progression correlates with activity at the onset of pregnancy: if UC is in remission at the time of conception, it will remain quiescent throughout pregnancy, while if it is active, it will progressively worsen, leading to an increased incidence of stillbirth, preterm delivery, or postpartum complications for both mother and neonate [2][3][4][5][6] . The management of UC during pregnancy is quite different from that in nonpregnant women because medical therapy, radiology, endoscopy, and surgery imply potential risks for the fetus [2,7] .…”

Section: Introductionmentioning

confidence: 99%

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Fulminant ulcerative colitis in a healthy pregnant woman

Orabona

Valcamonico

Salemme

et al. 2015

WJG

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This case report concerns a 25-year-old patient with 6-7 bloody stools/d, abdominal pain, tachycardia, and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at 28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fulminant ulcerative colitis in a healthy pregnant woman

Orabona

Valcamonico

Salemme

et al. 2015

WJG

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“…Moser et al [57] demonstrated ileal disease was a particularly reliable index predicting LBW. Relapse of UC in pregnant women was also associated with LBW and preterm births [58] . Fortunately, increased risks for congenital abnormalities have not been demonstrated in neonates whose mothers had IBD compared to the general population [57] .…”

Section: Pregnancymentioning

confidence: 99%

Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

Hosseini‐Carroll¹,

Mutyala²,

Seth³

et al. 2015

WJGPT

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Manas K made critical revisions of the manuscript; Becker F and Alexander JS contributed equally as senior authors. Conflict-of-interest statement:There are no known conflicts of interest. The authors (Pegah Hosseini-Carroll, Monica Mutyala, Abhishek Seth, Shaheen Nageeb, Demiana Soliman, Moheb Boktor, Ankur Sheth, Jonathon Chapman, James Morris, Paul Jordan, Kenneth Manas, Felix Becker, and J Steven Alexander) have no relevant financial considerations related to this proposal, and the study was not supported by any corporate entity. There is no known intellectual property associated with this report. AbstractInflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by relapsing and remitting episodes of inflammation which can affect several different regions of the gastrointestinal tract, but also shows extra-intestinal manifestations. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While IBD therapy has improved dramatically with enhanced surveillance and more abundant and powerful treatment options, IBD disease can have important effects on pregnancy and presents several challenges for maintaining optimal outcomes for mothers with IBD and the developing fetus/neonate. Women with IBD, the medical team treating them (both gastroenterologists and obstetricians/gynecologists) must often make highly complicated choices regarding conception, pregnancy, and post-natal care (particularly breastfeeding) related to their choice of treatment options at different phases of pregnancy as well as post-partum. This current review discusses current concerns and recommendations for pregnancy during 157November 6, 2015|Volume 6|Issue 4| WJGPT|www.wjgnet.com Hosseini-Carroll P et al . Pregnancy and inflammatory bowel diseases IBD and is intended for gastroenterologists, general practitioners and IBD patients intending to become, (or already) pregnant, and their families. We have addressed patterns of IBD inheritance, effects of IBD on fertility and conception (in both men and women), the effects of IBD disease activity on maintenance of pregnancy and outcomes, risks of diagnostic procedures during pregnancy and potential risks and complications associated with different classes of IBD therapeutics. We also have evaluated the clinical experience using "top-down" care with biologics, which is currently the standard care at our institution. Post-partum care and breastfeeding recommendations are also addressed. Core tip: Inflammatory bowel diseases (IBD) are chronic inflammatory conditions characterized by relapsing and remitting episodes of intestinal inflammation. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While therapies have improved dramatically, IBDs have important effects on pregnancy and present challenges for maintaining optimal outcomes for mothers and their developing fetus/ neonate. Women with IBD and physician...

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“…Earlier studies showed active disease at conception was associated with a higher rate of fetal loss [52] and preterm birth [9,28]. Disease activity during pregnancy has also previously been associated with preterm birth and low birthweight [37,46,53,54]. Secondary analysis conducted by Stephansson et al attempted to correlate pregnancy outcomes with disease activity, specifically looking at women who had ever been hospitalized for UC compared with those with outpatient management only [40].…”

Section: Effect Of Ibd On Pregnancy Course and Pregnancy Outcomesmentioning

confidence: 99%

“…Cyclosporine can be used successfully in pregnancy, although it can cause premature labor and small-for-gestational-age (SGA) infants. In general, studies suggest that use of currently available medications to treat flares during pregnancy will lead to successful remission in greater than 80% of cases [37].…”

Section: Management Of Ibd Flares During Pregnancymentioning

confidence: 99%

Management of inflammatory bowel disease in pregnancy

Ng¹,

2013

Expert Review of Clinical Immunology

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Relapses of Inflammatory Bowel Disease During Pregnancy: In-Hospital Management and Birth Outcomes

Cited by 153 publications

References 19 publications

Fulminant ulcerative colitis in a healthy pregnant woman

Fulminant ulcerative colitis in a healthy pregnant woman

Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

Management of inflammatory bowel disease in pregnancy

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