Review article: reproduction in the patient with inflammatory bowel disease

Abstract

SUMMARY BackgroundInflammatory bowel disease (IBD) affects mainly the young population. The effect of IBD and its treatment on fertility and pregnancy is therefore an important clinical consideration.

Treatment of inflammatory bowel disease and pregnancy: a review of the literature

“…However, the DII does not increase the risk of maternal complications such as hypertension or proteinuria (11) . Regarding IUR, about 70%-80% of patients remain in remission during pregnancy and rates of relapse are similar to non pregnant (28) . Up to 7% present the first episode of colitis during pregnancy or puerperal period (58) .…”

“…Relapses occur most often during the first trimester and puerperium. Nor is there consensus on the route of delivery indicated, should be considered obstetric indications (28) . Women with IBD have a risk twice higher than the general population to have premature births or children considered of low birth weight and greater likelihood of surgical deliveries, which seems more related to activity of disease than the side effects of medications (18,44,51) .…”

“…Up to 7% present the first episode of colitis during pregnancy or puerperal period (58) . Carriers of ileum-anal anastomosis tolerate pregnancy better and exacerbations have more light and transient, resolving completely up in the post-partum period (28) . The rates of cesarean sections are higher in carriers of the disease, although IUR by itself represents no formal indication for this route of delivery (28) .…”

“…However, the risk of clinical exacerbations is no greater than any other period in life (1) . Furthermore, the adequate control of disease activity seems to be the main prognostic factor in pregnancy (1,4,24,28) . Disease activity is associated with increased number of spontaneous abortions, premature deliveries, babies born with low weight and/or small for gestational age and increased demand for surgical deliveries (11,18,28,35) .…”

Reproductive Health and Medication Concerns for Patients With Inflammatory Bowel Disease: Thematic and Quantitative Analysis Using Social Listening (Preprint)

“…Adverse outcomes such as preterm delivery, low birth weight and increased risk of miscarriage are all associated with the degree of disease activity at the time of conception [3,4]. Women who plan their pregnancies while in remission are less likely to experience disease flares during pregnancy and have similar fertility rates as the general population [5]. A growing body of literature now suggests that the majority of IBD medications are low risk for use during pregnancy and even lactation [6].…”