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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2016; 7(4): 490-502
Published online Nov 6, 2016. doi: 10.4292/wjgpt.v7.i4.490
Treatment of pregnant women with a diagnosis of inflammatory bowel disease
Sule Poturoglu, Asli Ciftcibasi Ormeci, Ali Erkan Duman
Sule Poturoglu, Asli Ciftcibasi Ormeci, Ali Erkan Duman, Department of Gastroenterology, Haseki Training and Research Hospital, 34096 Istanbul, Turkey
Author contributions: Poturoglu S, Ormeci AC and Duman AE contributed equally to this work; Poturoglu S and Ormeci AC performed the literature search, designed and wrote the manuscript; Poturoglu S and Duman AE was responsible for critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: No conflicts of interest.
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: Sule Poturoglu, MD, Department of Gastroenterology, Haseki Training and Research Hospital, 34096 Istanbul, Turkey. sulepot@mynet.com
Telephone: +90-542-5257271 Fax: +90-212-5896229
Received: March 29, 2016
Peer-review started: April 4, 2016
First decision: May 23, 2016
Revised: August 20, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: November 6, 2016
Processing time: 216 Days and 2.4 Hours
Abstract

The frequency of diagnosis of inflammatory bowel disease (IBD) has increased in younger populations. For this reason, pregnancy in patients with IBD is a topic of interest, warranting additional focus on disease management during this period. The main objective of this article is to summarize the latest findings and guidelines on the management of potential problems from pregnancy to the breastfeeding stage. Fertility is decreased in patients with active IBD. Disease remission prior to conception will likely decrease the rate of pregnancy-related complications. Most of the drugs used for IBD treatment are safe during both pregnancy and breastfeeding. Two exceptions are methotrexate and thalidomide, which are contraindicated in pregnancy. Anti-tumor necrosis factor agents are not advised during the third trimester as they exhibit increased transplacental transmission and potentially cause immunosuppression in the fetus. Radiological and endoscopic examinations and surgical interventions should be performed only when absolutely necessary. Surgery increases the fetal mortality rate. The delivery method should be determined with consideration of the disease site and presence of progression or flare up. Treatment planning should be a collaborative effort among the gastroenterologist, obstetrician, colorectal surgeon and patient.

Keywords: Pregnancy; Inflammatory bowel disease; Immunomodulators; Biologics; Breastfeeding; Treatment

Core tip: Active disease prior to conception and during pregnancy increases the rate of pregnancy-related complications; thus, special attention should be given to pregnancy during the disease remission period. The safest drugs for use during pregnancy and breastfeeding are 5-aminosalicylic acid complexes, thiopurines and corticosteroids. Methotrexate and thalidomide are contraindicated. Anti-tumor necrosis factor treatment should be avoided during the third trimester. The risk of venous thromboembolism is increased in patients with moderate-to-severe disease. The delivery method should be selected according to the region of the body involved and disease activity. In this article, the problems encountered by patients with inflammatory bowel disease from pregnancy to breastfeeding are discussed, and appropriate management strategies are suggested.