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

Schulze, H; Esters, Philip; Dignaß, Axel

doi:10.1111/apt.12949

Cited by 52 publications

(64 citation statements)

References 210 publications

(348 reference statements)

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“…The indications in 11 (14.9%) pregnancies were unknown. In general, patients with UC or CD tend to be affected at a relatively young age [22], whereas patients with RA are typically older [23]. These disease-specific factors are likely responsible, at least in part, for the higher number of patients with UC and CD in our dataset.…”

Section: Discussionmentioning

confidence: 95%

Pregnancy Outcomes of Patients Exposed to Adalimumab in Japan

Kawai

Tsuchiya

Aoki

2018

Dig Dis

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Background: This is the first retrospective report of pregnancy outcomes after exposure to adalimumab treatment in Japan. Methods: Using the AbbVie safety database, we analyzed pregnancy outcome data from patients who received adalimumab treatment from April 16, 2008, to May 15, 2017. Results: Data were extracted retrospectively for 74 pregnancies in 73 patients. More than half of the patients included in the study received adalimumab for the treatment of Crohn’s disease (37.8%) or ulcerative colitis (20.3%), while 9.5% received adalimumab for rheumatoid arthritis. Of the 53 pregnancies with available outcome data, 45 newborns (45/53 [84.9%]) were delivered. Of these births, 30 were full-term, 2 were preterm, and 13 were unknown. Apgar scores were available for 11 of the 16 newborns whose mothers were exposed to adalimumab in the third trimester; all scores were within the normal range. Low birth weight was observed in 5 infants out of the 30 full-term deliveries. There were also 5 miscarriages (5/53 [9.4%]), 2 induced abortions (2/53 [3.8%]), and 1 stillbirth (1/53 [1.9%]). Eight maternal adverse events were observed in 5 pregnancies; no serious adverse events occurred. Conclusion: Although safety concerns were inconclusive, these data do not report additional risk to pregnancy outcomes with adalimumab exposure.

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Section: Discussionmentioning

confidence: 95%

Pregnancy Outcomes of Patients Exposed to Adalimumab in Japan

Kawai

Tsuchiya

Aoki

2018

Dig Dis

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“…A number of review articles and guidelines summarising the treatment recommendations for IBD in pregnancy and lactation have recently been published, and recommend that women plan pregnancy when in remission. 6,7,40 Education of women with IBD of childbearing age may include the provision of information about medications and nutrition (including prepregnancy folic acid), potentially changing medication to avoid teratogenicity, and possibly effective contraception to plan pregnancies when IBD is in remission. 41 The standard indications for a caesarean section for women with IBD, aside from obstetric indications, are active perianal disease and previous pouch surgery; however, there may be significant variation between clinicians in recommendations of care for women of reproductive age with UC and an ileo-pouch anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory bowel disease in pregnancy: a population‐based study of prevalence and pregnancy outcomes

Shand

Chen

Selby

et al. 2016

BJOG

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Objective To determine the prevalence of the inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD), in pregnant women and determine pregnancy and fetal/neonatal outcomes.Design Population-based cohort study.Setting New South Wales, Australia, 2001-11.Population A total of 630 742 women who delivered at ≥20 weeks of gestation.Methods Descriptive and multivariate regression analyses of perinatal data linked to hospital admission data. We compared birth outcomes of women with and without a documented diagnosis of IBD.Main outcome measures Caesarean section, severe maternal morbidity, preterm birth <37 weeks of gestation, planned preterm birth, small-for-gestational-age (birthweight <10th centile), perinatal mortality (stillbirth/neonatal death ≤28 days).Results In all, 1960 women (0.31%) with IBD, who had 2781 births (1183 UC, 1287 CD and 311 IBD-indeterminate). Women with IBD were more likely than women without IBD to have a caesarean section [41.5 versus 28.2%, adjusted risk ratio (aRR) 1.38, 95% CI 1.31-1.45], severe maternal morbidity (2.6 versus 1.6%, aRR 1.54, 95% CI 1.17-2.03), preterm birth (9.7 versus 6.6%, aRR 1.47, 95% CI 1.30-1.66), planned preterm birth (5.3 versus 2.9%, aRR 1.74, 95% CI 1.47-2.07), and their infants to be small-for-gestational-age (9.7 versus 9.5%, aRR 1.19, 95% CI 1.04-1.36). There was no evidence of a difference in perinatal mortality.Conclusion Pregnancy-associated IBD is more common than previously reported. Pregnancies complicated by IBD at or near the time of birth have significantly higher rates of adverse pregnancy outcomes than pregnancies of women without IBD.Keywords Crohn's disease, inflammatory bowel disease, population-based, pregnancy, ulcerative colitis.Tweetable abstract Increased rates preterm birth and caesarean section in women with inflammatory bowel disease.Please cite this paper as: Shand AW, Chen JS, Selby W, Solomon M, Roberts CL. Inflammatory bowel disease in pregnancy: a population-based study of prevalence and pregnancy outcomes.

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“…Levels of inflammatory markers are commonly modified in pregnancy; however, FC and CRP may be useful indicators of relapse in IBD during pregnancy. Mechanisms such as anabolic metabolism and changes in hepatic and renal clearance result in physiological changes of laboratory parameters (6). Hemodilution can explain changes in hemoglobin and albumin levels, and these parameters may decreases with progression of pregnancy (7).…”

Section: Discussionmentioning

confidence: 99%

“…Iron deficiency is also common and should not be used as a marker of blood loss (7). Erythrocyte sedimentation rate (ESR) is commonly accelerated, and physiological leukocytosis is up to 15000 cells/μL (6). On the other hand, noninvasive techniques have great use in defining disease activity in IBD during pregnancy due to the limited use of endoscopic procedures in this population.…”

Section: Discussionmentioning

confidence: 99%