Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2015; 6(4): 156-171
Published online Nov 6, 2015. doi: 10.4292/wjgpt.v6.i4.156
Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management
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, Jonathan Steven Alexander
Pegah Hosseini-Carroll, Abhishek Seth, Moheb Boktor, Ankur Sheth, James Morris, Paul Jordan, Kenneth Manas, Department of Medicine, Section of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, United States
Monica Mutyala, Shaheen Nageeb, Demiana Soliman, Felix Becker, Jonathan Steven Alexander, Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, United States
Jonathon Chapman, Digestive Health Center of Louisiana, Baton Rouge, LA 70809, United States
Felix Becker, Department of General and Visceral Surgery, Muenster, 48149 Muenster, Germany
Author contributions: Hosseini-Carroll P and Alexander JS planned and supervised the study; Hosseini-Carroll P, Mutyala M, Nageeb S, Soliman D, Becker F and Alexander JS wrote the manuscript; Seth A, Boktor M, Sheth A, Chapman J, Morris J, Jordan P and 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.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jonathan Steven Alexander, PhD, Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, United States. jalexa@lsuhsc.edu
Telephone: +1-318-6754151 Fax: +1-318-6754156
Received: April 27, 2015
Peer-review started: April 29, 2015
First decision: June 19, 2015
Revised: June 30, 2015
Accepted: August 29, 2015
Article in press: September 7, 2015
Published online: November 6, 2015
Abstract

Inflammatory 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 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.

Keywords: Inflammatory bowel diseases, Pregnancy, Biologics, Breast-feeding, Immunomodulatorsi

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 physicians must often make challenging decisions on conception, pregnancy, and breastfeeding. This review discusses concerns and recommendations for pregnancy during IBD and is intended for gastroenterologists, general practitioners and IBD patients and their families.