Vol 88, No 7 (2017)
Review paper
Published online: 2017-07-31
Inflammatory bowel disease and pregnancy
Abstract
Inflammatory bowel disease (IBD) comprising Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) may appear at any age. As such, IBD commonly affects young patients in their reproductive age. Rate of voluntary childlessness among women with IBD far exceed that of the general population, as patients with IBD fear not only the effect of pregnancy on the course of inflammatory bowel disease, but also the increased risk of the offspring developing the disease, adverse pregnancy outcomes, the effect IBD treatment may have on the health and development of the infant or the risk of relapse during pregnancy and the influence of lactation on child development and disease course. This article aims at improving pre-conception counseling of patients with inflammatory bowel disease.
Keywords: inflammatory bowel diseasepregnancylactation
References
- Shivananda S, Lennard-Jones J, Logan R, et al. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut. 1996; 39(5): 690–697.
- van der Woude CJ, Ardizzone S, Bengtson MB, et al. European Crohn’s and Colitis Organization. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis. 2015; 9(2): 107–124.
- Magro F, Gionchetti P, Eliakim R, et al. European Crohn’s and Colitis Organisation [ECCO]. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis. 2017; 11(6): 649–670.
- Hashash JG, Kane S. Pregnancy and Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2015; 11(2): 96–102.
- Mountifield R, Bampton P, Prosser R, et al. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis. 2009; 15(5): 720–725.
- Ban L, Tata LJ, Humes DJ, et al. Decreased fertility rates in 9639 women diagnosed with inflammatory bowel disease: a United Kingdom population-based cohort study. Aliment Pharmacol Ther. 2015; 42(7): 855–866.
- Şenateş E, Çolak Y, Erdem ED, et al. Serum anti-Müllerian hormone levels are lower in reproductive-age women with Crohn's disease compared to healthy control women. J Crohns Colitis. 2013; 7(2): e29–e34.
- de Lima-Karagiannis A, Zelinkova-Detkova Z, van der Woude CJ. The Effects of Active IBD During Pregnancy in the Era of Novel IBD Therapies. Am J Gastroenterol. 2016; 111(9): 1305–1312.
- Pedersen N, Bortoli A, Duricova D, et al. European Crohn-Colitis Organisation-ECCO-Study Group of Epidemiology Committee-EpiCom. The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom Study of 209 pregnant women. Aliment Pharmacol Ther. 2013; 38(5): 501–512.
- Castiglione F, Pignata S, Morace F, et al. Effect of pregnancy on the clinical course of a cohort of women with inflammatory bowel disease. Ital J Gastroenterol. 1996; 28(4): 199–204.
- Riis L, Vind I, Politi P, et al. European Collaborative study group on Inflammatory Bowel Disease. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease. Am J Gastroenterol. 2006; 101(7): 1539–1545.
- Raatikainen K, Mustonen J, Pajala MO, et al. The effects of pre- and post-pregnancy inflammatory bowel disease diagnosis on birth outcomes. Aliment Pharmacol Ther. 2011; 33(3): 333–339.
- Molnár T, Farkas K, Nagy F, et al. Pregnancy outcome in patients with inflammatory bowel disease according to the activity of the disease and the medical treatment: a case-control study. Scand J Gastroenterol. 2010; 45(11): 1302–1306.
- Oron G, Yogev Y, Shcolnick S, et al. Inflammatory bowel disease: risk factors for adverse pregnancy outcome and the impact of maternal weight gain. J Matern Fetal Neonatal Med. 2012; 25(11): 2256–2260.
- Naganuma M, Kunisaki R, Yoshimura N, et al. Conception and pregnancy outcome in women with inflammatory bowel disease: A multicentre study from Japan. J Crohns Colitis. 2011; 5(4): 317–323.
- Mahadevan U, Sandborn WJ, Li DK, et al. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology. 2007; 133(4): 1106–1112.
- Lin HC, Chiu CCJ, Chen SF, et al. Ulcerative colitis and pregnancy outcomes in an Asian population. Am J Gastroenterol. 2010; 105(2): 387–394.
- Stephansson O, Larsson H, Pedersen L, et al. Congenital abnormalities and other birth outcomes in children born to women with ulcerative colitis in Denmark and Sweden. Inflamm Bowel Dis. 2011; 17(3): 795–801.
- Morales M, Berney T, Jenny A, et al. Crohn's disease as a risk factor for the outcome of pregnancy. Hepatogastroenterology. 2000; 47(36): 1595–1598.
- Stephansson O, Larsson H, Pedersen L, et al. Crohn's disease is a risk factor for preterm birth. Clin Gastroenterol Hepatol. 2010; 8(6): 509–515.
- Brandt LJ, Estabrook SG, Reinus JF. Results of a survey to evaluate whether vaginal delivery and episiotomy lead to perineal involvement in women with Crohn's disease. Am J Gastroenterol. 1995; 90(11): 1918–1922.
- Smink M, Lotgering FK, Albers L, et al. Effect of childbirth on the course of Crohn's disease; results from a retrospective cohort study in the Netherlands. BMC Gastroenterol. 2011; 11: 6.
- Norton C, Dibley LB, Bassett P. Faecal incontinence in inflammatory bowel disease: associations and effect on quality of life. J Crohns Colitis. 2013; 7(8): e302–e311.
- Hahnloser D, Pemberton JH, Wolff BG, et al. Pregnancy and delivery before and after ileal pouch-anal anastomosis for inflammatory bowel disease: immediate and long-term consequences and outcomes. Dis Colon Rectum. 2004; 47(7): 1127–1135.
- Zelinkova Z, Stokkers PC, van der Linde K, et al. Maternal imprinting and female predominance in familial Crohn's disease. J Crohns Colitis. 2012; 6(7): 771–776.
- Ban Lu, Tata LJ, Fiaschi L, et al. Limited risks of major congenital anomalies in children of mothers with IBD and effects of medications. Gastroenterology. 2014; 146(1): 76–84.
- Wozniak P, Brucka-Kaczor A, Litwinska E, et al. Perinatal outcome in women with inflammatory bowel disease. Ginekol Pol. 2015 ; 86(5): 376–382.
- Moffatt DC, Ilnyckyj A, Bernstein CN. A population-based study of breastfeeding in inflammatory bowel disease: initiation, duration, and effect on disease in the postpartum period. Am J Gastroenterol. 2009; 104(10): 2517–2523.
- Kane S, Lemieux N. The role of breastfeeding in postpartum disease activity in women with inflammatory bowel disease. Am J Gastroenterol. 2005; 100(1): 102–105.
- Nguyen GC, Seow CH, Maxwell C, et al. IBD in Pregnancy Consensus Group, Canadian Association of Gastroenterology. The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy. Gastroenterology. 2016; 150(3): 734–757.e1.
- Damas OM, Deshpande AR, Avalos DJ, et al. Treating Inflammatory Bowel Disease in Pregnancy: The Issues We Face Today. J Crohns Colitis. 2015; 9(10): 928–936.
- Gaidos JKJ, Kane SV. Managing IBD Therapies in Pregnancy. Curr Treat Options Gastroenterol. 2017; 15(1): 71–83.
- Niebyl JR. Antibiotics and other anti-infective agents in pregnancy and lactation. Am J Perinatol. 2003; 20(8): 405–414.
- Lin K, Martin C, Dassopoulos T, et al. 2 Pregnancy Outcomes Amongst Mothers With Inflammatory Bowel Disease Exposed to Systemic Corticosteroids: Results of the PIANO Registry. Gastroenterology. 2014; 146(5): S-1.
- Cleary BJ, Källén B. Early pregnancy azathioprine use and pregnancy outcomes. Birth Defects Res A Clin Mol Teratol. 2009; 85(7): 647–654.
- Mahadevan U, Martin C, Dubinsky M, et al. 960 Exposure to Anti-TNFα Therapy in the Third Trimester of Pregnancy Is Not Associated With Increased Adverse Outcomes: Results From the PIANO Registry. Gastroenterology. 2014; 146(5): S-170.
