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Care of the Pregnant Patient With Inflammatory Bowel Disease

Mahadevan, Uma MD; Matro, Rebecca MD

doi: 10.1097/AOG.0000000000000978
Contents: Clinical Expert Series
Expert Discussion
Spanish Translation

Inflammatory bowel disease affects women in their peak reproductive years. Patients and physicians often have questions regarding the effect of inflammatory bowel disease on a woman's ability to conceive and to carry a pregnancy safely to term as well as the effect of inflammatory bowel disease and the medications used to treat it on pregnancy outcomes. Women with inflammatory bowel disease have the same rates of fertility as women without inflammatory bowel disease unless they have had prior surgery in the pelvis or active disease. However, women with inflammatory bowel disease do have higher rates of adverse pregnancy outcomes. A multidisciplinary approach involving gastroenterologists, obstetricians, and maternal–fetal medicine physicians should focus on preconception planning and disease optimization before pregnancy. Women with inflammatory bowel disease should be followed as high-risk obstetric patients. Most medications used to treat inflammatory bowel disease can be continued safely during pregnancy and lactation. The greatest risk to the pregnancy is active disease, which can be precipitated by discontinuation of effective maintenance medications. Preconception counseling should include education regarding the low risk of most inflammatory bowel disease medications during pregnancy and lactation and the high risk of a significant disease flare during pregnancy. This review outlines important considerations for obstetricians caring for women with inflammatory bowel disease before and during pregnancy and in the postpartum period.

Pregnant women with inflammatory bowel disease have an increased risk of adverse maternal and fetal outcomes and should be evaluated by a multidisciplinary team.

Department of Medicine, University of California at San Francisco Center for Colitis and Crohn's Disease, San Francisco, California.

Corresponding author: Uma Mahadevan, MD, Professor of Medicine, UCSF Center for Colitis and Crohn's Disease, 1701 Divisadero Street #120, San Francisco, CA 94115; e-mail: uma.mahadevan@ucsf.edu.

Financial Disclosure Dr. Mahadevan is a consultant for Abbvie, Janssen, UCB, and Takeda. Dr. Matro did not report any potential conflicts of interest.

Continuing medical education for this article is available at http://links.lww.com/AOG/A664.

© 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.