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Inflammatory bowel disease during pregnancy

management of a disease flare or remission

Afzali, Anitaa,b

Current Opinion in Gastroenterology: July 2019 - Volume 35 - Issue 4 - p 281–287
doi: 10.1097/MOG.0000000000000541

Purpose of review Roughly half of the nearly 1.6 million people with inflammatory bowel disease (IBD) are women of reproductive age. Caring for women with IBD who are also pregnant can be challenging, particularly if with a disease flare or in remission, as there are special considerations needed.

Recent findings Despite older studies concluding potential risks associated with IBD medical therapies, more recent literature reports healthier maternal and birth outcomes associated with disease control and reduction in the inflammatory burden. Most IBD therapies should generally be continued throughout all three trimesters without interruption as this is associated with better outcomes.

Summary Active IBD increases risk of pregnancy complications and adverse pregnancy outcomes. Most medications have a favorable safety profile for use during pregnancy, regardless if in disease flare or remission. Short course corticosteroids for induction and management of flare is permitted. Thiopurines should not be started during pregnancy for a disease flare, but may be continued during pregnancy if previously on monotherapy. Biologics should be continued throughout pregnancy without interruption and timing of third trimester dosing made based on drug levels and estimated date of delivery. Risks/benefit assessment of therapies and disease control is important and should be individualized.

aThe Ohio State University Inflammatory Bowel Disease Center

bDivision of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA

Correspondence to Anita Afzali, MD, MPH, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Avenue Room 280, Columbus, OH 43210, USA. Tel: +1 614 688 6710; e-mail:

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