Inflammatory Bowel Disease and Reproductive Health: From Fertility to Pregnancy-A Narrative Review

Abstract

Despite the fact that knowledge on obstetrical management of Inflammatory Bowel Diseases (IBDs) has greatly improved over the years, many patients still actively avoid pregnancy for fear of adverse maternal or neonatal outcomes, of adverse effects of pregnancy on the disease activity, of eventual IBD inheritance, or of an increased risk of congenital malformations. Indeed, though data prove that fertility is hardly affected by the disease, a reduced birth rate is nevertheless observed in patients with IBD. Misconceptions on the safety of drugs during gestation and breastfeeding may influence patient choice and negatively affect their serenity during pregnancy or lactation. Moreover, physicians often showed concerns about starting IBD medications before and during pregnancy and did not feel adequately trained on the safety of IBD therapies. IBD-expert gastroenterologists and gynecologists should discuss pregnancy and breastfeeding issues with patients when starting or changing medications in order to provide appropriate information; therefore, pre-conception counselling on an individualized basis should be mandatory for all patients of reproductive age to reassure them that maintaining disease remission and balancing the eventual obstetrical risks is possible.

Keywords: Crohn’s disease; breastfeeding; diet; gut microbiota; infertility; inflammation; inflammatory bowel diseases; malabsorption; pregnancy; ulcerative colitis.

Figure 1

Management flowchart for young women affected by Inflammatory Bowel Disease at reproductive age (IBD: Inflammatory Bowel Disease; AFC: Antral follicular count; AMH: Anti-Mullerian Hormone; IUI: Intrauterine Insemination; IVF: In Vitro Fertilization; ICSI: Intracytoplasmic Sperm Injection).