Inflammatory bowel disease in women of reproductive age

Abstract

Management of inflammatory bowel disease in women of reproductive age requires special attention. Even though fertility in women without previous pelvis surgery is similar to the general population, active disease at conception and during pregnancy can lead to unfavorable pregnancy and fetal outcomes. In general, most medications needed to treat inflammatory bowel disease are low risk during pregnancy and breastfeeding. Achieving and maintaining disease remission, patient education, and a multidisciplinary team approach is the key to a successful pregnancy.

Keywords::

• aminosalicylates
• antibiotics
• biologic
• breastfeeding
• Crohn’s disease
• fertility
• immunomodulators
• inflammatory bowel disease
• pregnancy
• ulcerative colitis

Financial & competing interests disclosure

SV Kane serves as a consultant to AbbVie, Amgen, UCB and Takeda and has received research funding from UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Fertility in inflammatory bowel disease (IBD) women without previous pelvic surgery is similar to the general population.

• Patients should achieve and maintain remission at conception and during pregnancy to have favorable pregnancy outcomes.

• Active disease during pregnancy, smoking and discontinuation of medications during pregnancy are risk factors for IBD flares.

• Most IBD medications are safe during lactation with the exception of methotrexate, metronidazole and cyclosporine.

• Most medications used to treat IBD are low risk during pregnancy except for US FDA pregnancy category X drugs (methotrexate and thalidomide).

• The risk–benefit ratio between maintaining disease remission and possible mediation side effects should be discussed on a case-by-case situation.