TBA (20W102)

Inflammatory Bowel Disease and Pregnancy – Clinical Care Guidelines

Author(s)

Foley C., Lardner C., O’Toole A.

Department(s)/Institutions

Department of Gastroenterology, Beaumont Hospital, Beaumont, Dublin 9.

Introduction

Inflammatory bowel disease (IBD) are chronic inflammatory intestinal disorders commonly affecting women during their reproductive years. IBD affects young people, with more than 50% diagnosed before 32 years of age and 25% of women conceive subsequent to their diagnosis. Of relevance to pregnancy and fecundity is that IBD often necessitates the use of potent immunomodulator and biologic therapy as well as abdominal and pelvic surgery. Issues concerning fertility, antepartum pregnancy management, mode of delivery and lactation are influenced by disease activity, medications, perianal disease and previous ileoanal pouch surgery.

Aims/Background

Given the complexity of managing both a chronic inflammatory disease and pregnancy we felt a clinical care guideline would benefit both clinicians and patients.

Method

We performed a review of recent studies and recommendations regarding the management of inflammatory bowel disease and pregnancy in an attempt to produce a succint clinical care guideline relevant to both gastroenterology and obstetric health care providers

Results

Recommendations in relation to preconception counseling, fertility, fecundity and assisted reproduction, the medical management of IBD during pregnancy, mode of delivery, management of ostomies during pregnancy and postpartum management were made following a review of recent literature.

Conclusions

Multidisciplinary management with input from high-risk obstetricians, fertility specialists, gastroenterologists and colorectal surgeons is recommended following the review. Clinicians should strive to maintain remission, avoid surgery, minimize interventions and prevent exposure to teratogenic medications. Care should incorporate pre-conception advise/therapy to ensure disease remission, regular review during pregnancy with gastroenterology and obstetrics, maintenance monotherapy if achievable, vaginal delivery if appropriate and post-partum review soon after delivery.