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Colorectal
Review
IBD in pregnancy: recent advances, practical management
  1. Christian P Selinger1,
  2. Catherine Nelson-Piercy2,
  3. Aileen Fraser3,
  4. Veronica Hall4,
  5. Jimmy Limdi5,6,
  6. Lyn Smith7,
  7. Marie Smith8,
  8. Reem Nasur8,
  9. Melanie Gunn9,
  10. Andrew King9,
  11. Aarthi Mohan10,
  12. Khasia Mulgabal11,
  13. Alexandra Kent12,
  14. Klaartje Bel Kok13,
  15. Tracey Glanville14
  1. 1 Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2 Obstetric Medicine, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
  3. 3 Gastroenterology, United Hospitals Bristol, Bristol, Avon, UK
  4. 4 Gastroenterology, Royal Bolton Foundation NHS Trust, Bolton, UK
  5. 5 Section of iBD- Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
  6. 6 Gastroenterology, Manchester Academic Health Science Centre, Manchester, UK
  7. 7 Gastroenterology, NHS Greater Glasgow and Clyde North Glasgow University Hospitals Division, Glasgow, UK
  8. 8 Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  9. 9 Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
  10. 10 Obstetrics, United Hospitals Bristol, Bristol, Avon, UK
  11. 11 Obstetrics, Royal Bolton Foundation NHS Trust, Bolton, UK
  12. 12 Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
  13. 13 Gastroenterology, Barts and The London NHS Trust, London, UK
  14. 14 Obstetrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Christian P Selinger, Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; christian.selinger{at}web.de

Abstract

Inflammatory bowel disease (IBD) poses complex issues in pregnancy, but with high-quality care excellent pregnancy outcomes are achievable. In this article, we review the current evidence and recommendations for pregnant women with IBD and aim to provide guidance for clinicians involved in their care. Many women with IBD have poor knowledge about pregnancy-related issues and a substantial minority remains voluntarily childless. Active IBD is associated with an increased risk of preterm birth, low for gestation weight and fetal loss. With the exception of methotrexate and tofacitinib the risk of a flare outweighs the risk of IBD medication and maintenance of remission from IBD should be the main of care. Most women with IBD will experience a normal pregnancy and can have a vaginal delivery. Active perianal Crohn’s disease is an absolute and ileal pouch surgery a relative indication for a caesarean section. Breast feeding is beneficial to the infant and the risk from most IBD medications is negligible.

  • ulcerative colitis
  • crohn's disease

https://doi.org/10.1136/flgastro-2019-101371

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    Footnotes

    • Contributors CPS, CN-P, AF, VH, JL, LS, MS, RN, MG, AK, AM, KM, AK, KBK and TG all wrote parts of the manuscript and critically reviewed the draft manuscript. CPS joined the parts together and wrote abstract and conclusion. CPS, CN-P, AF, VH, JL, LS, MS, RN, MG, AK, AM, KM, AK, KBK and TG all critically reviewed the draft and the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests CPS has received unrestricted research grants from Warner Chilcott, Janssen and AbbVie, has provided consultancy to Warner Chilcott, Falk, AbbVie, Takeda, Fresenius Kabi and Janssen, and had speaker arrangements with Warner Chilcott, Falk, AbbVie, MSD, Pfizer and Takeda. CN-P had speaker arrangements with Falk, UCB, Sanofi, Alliance and Alexion. KBK has provided consultancy to Amgen and PredictImmune, and had speaker arrangements with Janssen and Takeda. JL has received research grants from Takeda, consultancy and speaker fees from Abbvie, Janssen, MSD, Pfizer and Takeda. AK has provided consultancy to Abbvie, and had speaker arrangements with Pfizer, Janssen and Takeda.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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      Frontline Gastroenterology 2021; 12 167-168 Published Online First: 07 Apr 2021. doi: 10.1136/flgastro-2021-101849