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World J Gastroenterol. Jun 7, 2012; 18(21): 2600-2608
Published online Jun 7, 2012. doi: 10.3748/wjg.v18.i21.2600
Pregnancy related issues in inflammatory bowel disease: Evidence base and patients' perspective
Christian P Selinger, Rupert WL Leong, Simon Lal
Christian P Selinger, Simon Lal, Department of Gastroenterology, Salford Royal Hospital, Salford M6 8HD, United Kingdom
Christian P Selinger, Rupert WL Leong, Gastroenterology and Liver Services, Sydney Local Health Network, Concord Hospital, NSW 2139 Sydney, Australia
Rupert WL Leong, Faculty of Medicine, The University of New South Wales, NSW 2052 Sydney, Australia
Author contributions: All authors made substantial contributions to conception and design, drafting the article and revising it critically for important intellectual content.
Correspondence to: Dr. Christian P Selinger, Department of Gastroenterology, Salford Royal Hospital, Stott Lane, Salford M6 8HD, United Kingdom. christian.selinger@web.de
Telephone: +44-161-7897373 Fax: +44-161-2061048
Received: July 8, 2011
Revised: September 9, 2011
Accepted: September 16, 2011
Published online: June 7, 2012
Abstract

Inflammatory bowel disease (IBD) affects women of childbearing age and can influence fertility, pregnancy and decisions regarding breastfeeding. Women with IBD need to consider the possible course of disease during pregnancy, the benefits and risks associated with medications required for disease management during pregnancy and breastfeeding and the effects of mode of delivery on their disease. When indicated, aminosalicylates and thiopurines can be safely used during pregnancy. Infliximab and Adalimumab are considered probably safe during the first two trimesters. During the third trimester the placenta can be crossed and caution should be applied. Methotrexate is associated with severe teratogenicity due to its folate antagonism and is strictly contraindicated. Women with IBD tend to deliver earlier than healthy women, but can have a vaginal delivery in most cases. Caesarean sections are generally recommended for women with active perianal disease or after ileo-anal pouch surgery.While the impact of disease activity and medication has been addressed in several studies, there are minimal studies evaluating patients’ perspective on these issues. Women’s attitudes may influence their decision to have children and can positively or negatively influence the chance of conceiving, and their beliefs regarding therapies may impact on the course of their disease during pregnancy and/or breastfeeding. This review article outlines the impact of IBD and its treatment on pregnancy, and examines the available data on patients’ views on this subject.

Keywords: Pregnancy; Breast-feeding; Nursing; Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis