Navigating Reproductive Care in Patients With Inflammatory Bowel Disease: A Comprehensive Review

Abstract

Inflammatory bowel disease [IBD] is often diagnosed in patients during their reproductive years. It is crucial that both healthcare providers and patients are adequately informed to avoid misguided decisions regarding family planning. One of the most important aspects during conception and pregnancy is to maintain disease remission, as disease activity is associated with adverse pregnancy outcomes. Apart from methotrexate, most conventional drugs used in IBD are considered low risk during conception and pregnancy. For newer agents, evidence is still limited. If needed, surgery must not be postponed and should ideally be performed in specialized centres. In most patients, delivery should be vaginal except for patients with complex perianal disease, with an ileoanal pouch anastomosis, or if there is an obstetric contraindication. In children exposed to biological treatments during pregnancy, the risk of infections appears to be low, and psychomotor development is probably not affected. Regarding immunizations, the standard vaccination schedule for inactivated vaccines should be followed for children exposed to biologics in utero. In the case of live vaccines, such as rotavirus, decisions should be individualized and take into consideration the risk-benefit ratio, particularly in developing countries. In this review, we provide a comprehensive and updated overview of aspects related to fertility, pregnancy, breastfeeding, and the impact on the care of children born to mothers with IBD. Both the available evidence and areas of uncertainty are discussed, with the goal of assisting healthcare professionals caring for IBD patients during this important stage of their lives.

Keywords: Crohn’s disease; Fertility; breastfeeding; gestation; inflammatory bowel disease; lactation; offspring; pregnancy; ulcerative colitis.

Figure 1.

Reasons for childlessness in inflammatory bowel disease [IBD]. It is important to establish if childlessness in IBD patients is voluntary or not. In the former, healthcare professionals should ascertain if the decision was based on correct information, and not misguided by inadequate understanding. In the case of involuntary childlessness, reasons for infertility should be sought and managed as appropriate, and referral for assisted reproductive technologies should be considered. Image credits: Flaticon.com.

Figure 2.

Pregnancy care pathway in inflammatory bowel disease [IBD], from preconception to post-partum. Image credits: Flaticon.com.