[Pregnancy and labor in ulcerative colitis and Crohn disease]

Abstract

Background: About one quarter of women with the diagnosis conceive after the diagnosis has been made, and patients and clinicians are concerned about the health of the foetus and the possible side effects of medical and surgical treatment.

Material, methods and results: A survey of the literature shows that the general outlook is positive. The lifetime risk of developing inflammatory bowel disease if one of the parents has ulcerative colitis or Crohn's disease is 5-10 per cent. The fertility seems to be more or less normal for ulcerative colitis and slightly lower for Crohn's. Women with active disease at the time of conception have a higher risk of early miscarriage, fetal death and still birth. It is therefore advisable that the disease is in a stable and inactive phase at the time of conception. The rule of thumb is that one in three gets worse and one in three improves during pregnancy. The indications for surgery are the same as for non-pregnant patients. Relapses during pregnancy should be treated in the same way as in non-pregnant patients. Apart from methotrexate, most drugs used regularly to treat ulcerative colitis and Crohn's disease can safely be used by pregnant women. The same guidelines as for non-pregnant patients apply in terms of indications and dosage.

Interpretation: In general there is no need to advise these patients against conceiving.