IBD in Pregnancy

  • – Females fertility itself is not impaired by uncomplicated IBD
  • – Pregnancy is spuriously low because of poor self-image and sexual avoidance and voluntary childlessness
  • – Male fertility is impaired by sulfasalazine due to decreased sperm count that usually returns to normal within 6 months of discontinuing the drug
  • – IBD patients are at increased risk for poor pregnancy outcome even if they have mild/inactive disease
  • Major complications of pregnancy in IBD
  •                • Premature birth
  •               • Low birth weight
  •               • Small for gestational age
  •               • Increased Caesarian section rate
  • – Fulminant colitis is managed as same as in non-pregnant women
  • – Synchronous caesarian section and sub-total colectomy is advocated for patients presenting with fulminant colitis after 28 weeks of gestation
  • – Most experts agree, during gestation, affected patients should continue optimized pre-pregnancy therapy to avoid flare due to medication withdrawal
  • – Disease activity prior to conception seems to be the most important factor determining the course of the illness during gestation

Pregnancy category of IBD drugs:

Maternal complications of Glucocorticoid:

  • – Maternal glucose intolerance
  • – HTN
  • – Macrosomia
  • – Fetal adrenal suppression

Anti-TNF in Pregnancy:

  • – Anti-TNF-a should be discontinued early in the third trimester to avoid fetal exposure until better data on the safety of agents are available. when necessary, glucocorticoid may be substituted
  • – Infants exposed in utero by Anti-TNF-a should not receive live vaccine during the first 6 months of life

Delivery of IBD patients:

  • – Vaginal delivery is not contraindicated
  • – Caesarian section is recommended for active perianal disease
  • – IPAA patients are also advised to avoid vaginal delivery to avoid sphincter injury

 


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