Treating Inflammatory Bowel Disease in Pregnancy: The Issues We Face Today

J Crohns Colitis. 2015 Oct;9(10):928-36. doi: 10.1093/ecco-jcc/jjv118. Epub 2015 Jun 30.

Abstract

Many women of childbearing age are living with inflammatory bowel disease [IBD], yet there are limited studies on the use of IBD medications in pregnancy. In this review, we provide a comprehensive update on the safety of these medications during pregnancy, particularly thiopurines and biologicals. Antibiotics, steroids, and aminosalicylates are relatively low risk for use in pregnancy, and growing evidence supports the safety of immunomodulators and anti-tumour necrosis factor agents as well. Available studies on infliximab, adalimumab, and certolizumab pegol show no increase in adverse events during pregnancy or perinatally. Similarly, studies on lactation demonstrate that concentrations of subcutaneous anti-tumour necrosis factor biologicals are undetectable, and levels of thiopurines and infliximab are negligible in breast milk. Less is known about anti-integrins in pregnancy [eg natalizumab and vedolizumab] but currently available data suggest they may be safe as well. Although more studies are needed to examine the long-term effects of these medications on offspring, the available data provide reassuring information for providers caring for women of childbearing age.

Keywords: Crohn’s disease; Inflammatory bowel disease; breastfeeding; pregnancy; ulcerative colitis.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Colitis, Ulcerative / drug therapy*
  • Crohn Disease / drug therapy*
  • Female
  • Humans
  • Immunologic Factors / therapeutic use
  • Maternal-Fetal Exchange
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors

Substances

  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Immunologic Factors
  • Tumor Necrosis Factor-alpha