Pregnancy and Crohn's disease

If Crohn's disease flares up during pregnancy, sulphasalazine and steroids are permitted. Azathioprine and metronidazole should be avoided unless advised by a specialist. However, note that there is no convincing proof that azathioprine has been responsible for foetal abnormalities and many inflammatory bowel disease specialists now recommend continuing the drug for those patients in whom relapse would be a major problem.

There is no predicatable pattern to inflammatory bowel disease in pregnancy. Patients with inflammatory bowel disease often seem to be healthier during pregnancy, but at a risk of a flare-up in the postpartum period. The chance of a flare-up is not increased by pregnancy however it is advised to wait until disease is inactive before conception (3).

If patients conceive during a flare of Crohn's disease:

• about 1/3 get better, 1/3 get worse and 1/3 stay the same (3)

Women with Crohn's disease tend to have more preterm births and babies with lower birth weights (3)

A meta-analysis revealed a higher incidence of adverse pregnancy outcomes in patients with inflammatory bowel disease (4).

There has been FSRH guidance regarding Inflammatory bowel disease (IBD) and Pregnancy (5)

• women with IBD should be advised to plan to conceive when the disease is well controlled
• appropriate referral for pre-pregnancy counselling should be available for men and women in order to optimise their IBD management prior to conception
• there is controversy regarding the most appropriate mode of delivery (Caesarean section or vaginal) following ileal pouch-anal anastomosis surgery. Women should be guided in their decision by the advice of the obstetric and gastrointestinal specialists in charge of their care
• If either partner is taking methotrexate, pregnancy should be prevented by use of effective contraception during and for at least 3 months after treatment
• effective contraception must be used by women treated with infliximab or adalimumab and for at least 6 or 5 months, respectively, after treatment
• health professionals should check the Summary of Product Characteristics for each medication for specific advice on use while trying to conceive, and while pregnant or breastfeeding.
• the decision to stop any treatment requires expert clinical judgement, balancing the risks of stopping the drug against the risks associated with continuing
• health professionals should consider ectopic pregnancy in their differential diagnosis of abdominal pain and gastrointestinal symptoms in sexually active women with IBD

Reference:

• (1) Rhodes, J. Prescriber's Journal 1986: 26.
• (2) Sanderson, JD. IBD: diagnosis and control. The Practitioner 1997; 241: 120-30.
• (3) Loft D. Protected Learning Time Event. Coventry PCT. September 2004.
• (4) Cornish J et al. A meta-analysis on the influence of inflammatory bowel disease on pregnancy.Gut. 2007 Jun;56(6):830-7
• (5) FSRH (2009).Sexual and Reproductive Health for Individuals with Inflammatory Bowel Disease.