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Review
. 2021 May 18:14:17562848211016242.
doi: 10.1177/17562848211016242. eCollection 2021.

Review of pregnancy in Crohn's disease and ulcerative colitis

Robyn Laube  1 , Sudarshan Paramsothy  1 , Rupert W Leong  2
Affiliations
Review

Review of pregnancy in Crohn's disease and ulcerative colitis

Robyn Laube et al. Therap Adv Gastroenterol. .

Abstract

Inflammatory bowel disease (IBD) frequently affects women of childbearing age and can have implications in pregnancy. Most women with IBD have comparable fertility with women in the general population. Fertility is reduced in women with active disease or previous ileal-pouch-anal anastomosis (IPAA) surgery and is temporarily reduced in men taking sulfasalazine. Women with IBD have an increased risk of preterm delivery, low birth weight, small-for-gestational-age infants and Cesarean section (CS) delivery, however, no increased risk of congenital abnormalities. These adverse outcomes are particularly prevalent for women with active IBD compared with those with quiescent disease. Conception should occur during disease remission to optimize maternal and fetal outcomes and reduce the risk of disease exacerbations during pregnancy. Pre-conception counseling is therefore pertinent to provide patient education, medication review for risk of teratogenicity and objective disease assessment. Most medications are safe during pregnancy and breastfeeding, with the exception of methotrexate, ciclosporin, allopurinol and tofacitinib. Delivery modality should be guided by obstetric factors in most cases; however, CS is recommended for women with active perianal disease and can be considered for women with inactive perianal disease or IPAA. In conclusion, most women with IBD have uncomplicated pregnancies. Active IBD is the predominant predictor of poor outcomes and disease exacerbations; therefore, maintenance of disease remission during and before pregnancy is crucial.

Keywords: complications; fertility; inflammatory bowel disease; management; pregnancy; vaccinations.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Fertility therapy referral pathway. IBD, inflammatory bowel disease.
Figure 2.
Figure 2.
Considerations for pregnancy management in women with inflammatory bowel disease. IBD, inflammatory bowel disease.
Figure 3.
Figure 3.
Care pathway for pregnant women with inflammatory bowel disease. CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; IBD, inflammatory bowel disease; MRI, magnetic resonance imaging.
See this image and copyright information in PMC

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