Inflammatory bowel diseases in pregnant women - current state of knowledge
DOI:
https://doi.org/10.12775/JEHS.2023.22.01.008Keywords
inflammatory bowel disease (IBD), IBD, Pregnancy, Crohn's disease, ulcerative colitis (UC)Abstract
Introduction and objective: Inflammatory bowel diseases (IBD) are a group of chronic inflammatory diseases. Usually they affect young people, often during pregnancy. Insufficient knowledge about the evolution of the disease during pregnancy, as well as the effects of drugs used, often result in resignation from motherhood, while unfamiliarity with the principles of therapy or discontinuation of treatment during pregnancy are significant causes of obstetric failures. The aim of the study was to summarize the data available in the literature as well as recent reports, to enable a better understanding of the disease and care of pregnant women with IBD.
Materials and methods: The literature was reviewed in the Pubmed database, in the Via Medica Journals database, and in the guidelines of the Polish Society of Gastroenterology with the use of keywords.
State of knowledge: 85% of women with IBD become pregnant without complications, but the inflammation has a negative impact on both the course of pregnancy and the fetus itself. Complications, which often depend on the activity of the disease before and during pregnancy, may occur: i.e. premature birth, inadequate fetal weight, miscarriage, as well as complications in the child itself and flares of the underlying disease. Therefore, it is important to know rules of safe pharmacotherapy that apply before and after pregnancy in order to prevent the negative effects of the disease. Special situations caused by IBD, i.e. surgical or endoscopic procedures, can be successfully performed in pregnant patients with the observance of certain rules.
Conclusions: Understanding the causes of complications that may occur in the patient and the child allows them to be prevented. Both for the mother's health and for a positive course of pregnancy, education and pregnancy planning, preceded by the change of medications to safe for the fetus, are extremely important.
References
van der Woude C.J., Ardizzone S., Bengston M.B. i wsp. for the European Crohn’s and Colitis Organization. The second European evidenced-based consensus on reproduction and pregnancy In inflammatory bowel disease. J. Crohns Colitis 2015; 1–18.
Vermeire S., Carbonnel F., Coulie P.G. Management of inflammatory bowel disease in pregnancy. J. Crohns Colitis 2012; 6: 811–823.
Vestergaard T, Julsgaard M, Røsok JF, Vestergaard SV, Helmig RB, Friedman S, Kelsen J. Predictors of disease activity during pregnancy in women with inflammatory bowel disease-a Danish cohort study. Aliment Pharmacol Ther. 2023 Feb;57(3):335-344. doi: 10.1111/apt.17348. Epub 2022 Dec 14. PMID: 36514957.
Grigorescu RR, Husar-Sburlan IA, Rosulescu G, Bobirca A, Cerban R, Bobirca F, Florescu MM. Pregnancy in Patients with Inflammatory Bowel Diseases-A Literature Review. Life (Basel). 2023 Feb 9;13(2):475. doi: 10.3390/life13020475. PMID: 36836832; PMCID: PMC9961380.
Ban L., Tata L.J., Humes D.J., Fiaschi L., Card T. Decreased fertility rates in 9639 women diagnosed with inflammatory bowel disease: A United Kingdom population-based cohort study. Aliment. Pharmacol. Ther. 2015;42:855–866. doi: 10.1111/apt.13354.
Laube R., Yau Y., Selinger C.P., Seow C.H., Thomas A., Wei Chuah S., Hilmi I., Mao R., Ong D., Ng S.C., et al. Knowledge and Attitudes Towards Pregnancy in Females with Inflammatory Bowel Disease: An International, Multi-centre Study. J. Crohns Colitis. 2020;14:1248–1255. doi: 10.1093/ecco-jcc/jjaa047.
Selinger C.P., Nelson-Piercy C., Fraser A., Hall V., Limdi J., Smith L., Smith M., Nasur R., Gunn M., King A., et al. IBD in pregnancy: Recent advances, practical management. Frontline Gastroenterol. 2021;12:214–224. doi: 10.1136/flgastro-2019-101371.
Moller F.T., Andersen V., Wohlfahrt J., Jess T. Familial risk of inflammatory bowel disease: A population-based cohort study 1977-2011. Am. J. Gastroenterol. 2015;110:564–571. doi: 10.1038/ajg.2015.50.
Martin J., Kane S.V., Feagins L.A. Fertility and Contraception in Women With Inflammatory Bowel Disease. Gastroenterol. Hepatol. 2016;12:101–109.
Sultan A.A., West J., Ban L., Tata L.J., Fleming K.M., Nelson-Piercy C. Adverse pregnancy outcomes among women with inflammatory bowel disease: A population based study from England. Inflamm. Bowel Dis. 2016;22:1621–1630. doi: 10.1097/MIB.0000000000000802.
Szymańska E, Kisielewski R, Kierkuś J. Reproduction and Pregnancy in Inflammatory Bowel Disease - Management and Treatment Based on Current Guidelines. J Gynecol Obstet Hum Reprod. 2021 Mar;50(3):101777. doi: 10.1016/j.jogoh.2020.101777. Epub 2020 Apr 18. PMID: 32315763.
Meyer A., Drouin J., Weill A., Carbonnel F., Dray-Spira R. Pregnancy in women with inflammatory bowel disease: A French nationwide study 2010–2018. Aliment. Pharmacol. Ther. 2020;52:1480–1490. doi: 10.1111/apt.16074.
Boyd H.A., Basit S., Harpsøe M.C., Wohlfahrt J., Jess T. Inflammatory Bowel Disease and Risk of Adverse Pregnancy Outcomes. PLoS ONE. 2015;10:e0129567. doi: 10.1371/journal.pone.0129567
Burke K.E., Haviland M.J., Hacker M.R., Shainker S.A., Cheifetz A.S. Indications for mode of delivery in pregnant women with inflammatory bowel disease. Inflamm. Bowel Dis. 2017;23:721–726. doi: 10.1097/MIB.0000000000001113.
Hashash J.G., Kane S. Pregnancy and Inflammatory Bowel Disease. Gastroenterol. Hepatol. 2015;11:96–102.
Sharaf A.A., Nguyen G.C. Predictors of Cesarean Delivery in Pregnant Women with Inflammatory Bowel Disease. J. Can. Assoc. Gastroenterol. 2018;1:76–81. doi: 10.1093/jcag/gwy003.
Foulon A., Dupas J.-L., Sabbagh C., Chevreau J., Rebibo L., Brazier F., Bouguen G., Gondry J., Fumery M. Defining the Most Appropriate Delivery Mode in Women with Inflammatory Bowel Disease: A Systematic Review. Inflamm. Bowel Dis. 2017;23:712–720. doi: 10.1097/MIB.0000000000001112.
Isac S., Panaitescu A.M., Iesanu M.I., Zeca V., Cucu N., Zagrean L., Peltecu G., Zagrean A.-M. Maternal Citicoline-Supplemented Diet Improves the Response of the Immature Hippocampus to Perinatal Asphyxia in Rats. Neonatology. 2020;117:729–735. doi: 10.1159/000512145.
Wu R.Y., Tandon P., Ambrosio L., Dunsmore G., Hotte N., Dieleman L.A., Elahi S., Madsen K., Huang V. Post-neonatal Outcomes of Infants Born to Women with Active Trimester One Inflammatory Bowel Disease: A Pilot Study. Dig. Dis. Sci. 2022;67:5177–5186. doi: 10.1007/s10620-022-07430-x.
Bengtson M.-B., Martin C.F., Aamodt G., Vatn M.H., Mahadevan U. Inadequate Gestational Weight Gain Predicts Adverse Pregnancy Outcomes in Mothers with Inflammatory Bowel Disease: Results from a Prospective US Pregnancy Cohort. Dig. Dis. Sci. 2017;62:2063–2069. doi: 10.1007/s10620-017-4547-5.
Nørgård B.M, Jølving L.R, Larsen M.D, et al. Parental IBD and Long-term Health Outcomes in the Offspring. Inflamm Bowel Dis. 2019;25(8),1339-1348.
Mahadevan U, Sandborn W.J, Li D.K, et al. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology 2007;133(4), 1106-1112.
Ren T, Yu Y, Wang H, Li F, Zhang J, Li J. Maternal Inflammatory Bowel Disease During Pregnancy and Infectious Disease in Offspring Younger Than 5 Years: A Population-Based Cohort Study. Am J Gastroenterol. 2023 Mar 1;118(3):491-500. doi: 10.14309/ajg.0000000000002179. Epub 2023 Jan 9. PMID: 36695745.
Friedman S, Zegers FD, Jølving LR, Nielsen J, Nørgård BM. Increased Risk of Postpartum Infections After Caesarian and Vaginal Delivery in Women With Inflammatory Bowel Disease: A Danish Nationwide Cohort Study. Inflamm Bowel Dis. 2023 Feb 1;29(2):260-267. doi: 10.1093/ibd/izac088. PMID: 35472003.
Novacek G., Weltermann A., Sobala A. i wsp. Inflammatory bowel disease is a risk factor for recurrent venous thromboembolism. Gastroenterology 2010; 139: 7 79–U114.
Dickson I. Pregnancy safe and beneficial for women with IBD. Nat Rev Gastroenterol Hepatol. 2019;16(8):454.
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.
Riis L, Vind I, Politi P, et al. Does pregnancy change the disease course? A study in European cohort of patients with inflammatory bowel disease. Am. J. Gastroenterol. 2006; 101, 1539-1545.
Hoffmann P., Krueger J., Bashlekova T., Rupp C., Baumann L., Gauss A. Pregnancy with inflammatory bowel disease: Outcomes for mothers and their children at a European tertiary care center. J. Obstet. Gynaecol. Res. 2022;48:621–633. doi: 10.1111/jog.15136.
Malhi G., Tandon P., Perlmutter J.W., Nguyen G., Huang V. Risk Factors for Postpartum Disease Activity in Women With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Inflamm. Bowel Dis. 2022;28:1090–1099. doi: 10.1093/ibd/izab206.
Iesanu M.I., Zahiu C.D.M., Dogaru I.-A., Chitimus D.M., Pircalabioru G.G., Voiculescu S.E., Isac S., Galos F., Pavel B., O’Mahony S.M., et al. Melatonin–Microbiome Two-Sided Interaction in Dysbiosis-Associated Conditions. Antioxidants. 2022;11:2244. doi: 10.3390/antiox11112244.
Rahimi R., Nikfar S., Rezaie A., Abdollahi M. Pregnancy outcome in women with inflammatory bowel disease following exposure to 5-aminosalicylic acid drugs: A meta-analysis. Reprod. Toxicol. Elmsford N. 2008;25:271–275. doi: 10.1016/j.reprotox.2007.11.010.
Singh A., Martin C.F., Kane S.V., Dubinsky M., Nguyen D.D., McCabe R.P., Rubin D.T., Scherl E.J., Mahadevan U. Su1030 Is Asacol Use Associated With Congenital Anomalies? Results From a Nationwide Prospective Pregnancy Registry. Gastroenterology. 2013;144:S-379. doi: 10.1016/S0016-5085(13)61398-0.
Lin K., Martin C.F., Dassopoulos T., Esposti S.D.D., Wolf D.C., Esposti S.D.D., Beaulieu D.B., Mahadevan U. 2 Pregnancy Outcomes Amongst Mothers With Inflammatory Bowel Disease Exposed to Systemic Corticosteroids: Results of the PIANO Registry. Gastroenterology. 2014;146:S-1. doi: 10.1016/S0016-5085(14)60002-0.
Homar V., Grosek S., Battelino T. High-dose methylprednisolone in a pregnant woman with Crohn’s disease and adrenal suppression in her newborn. Neonatology. 2008;94:306–309. doi: 10.1159/000151652.
Team A.N. Potential Risks of Immunosuppressant Drugs to the Pregnant Patient. American College of Gastroenterology. 2015. [(accessed on 11 December 2022)]. Available online: https://gi.org/2015/10/07/oral-52-potential-risks-of-immunosuppressant-drugs-to-the-pregnant-patient/ [Ref list]
Kanis S.L., de Lima-Karagiannis A., de Boer N.K.H., van der Woude C.J. Use of Thiopurines During Conception and Pregnancy Is Not Associated With Adverse Pregnancy Outcomes or Health of Infants at One Year in a Prospective Study. Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc. 2017;15:1232–1241. doi: 10.1016/j.cgh.2017.02.041.
Weber-Schoendorfer C., Chambers C., Wacker E., Beghin D., Bernard N., Network of French Pharmacovigilance Centers. Shechtman S., Johnson D., Cuppers-Maarschalkerweerd B., Pistelli A., et al. Pregnancy outcome after methotrexate treatment for rheumatic disease prior to or during early pregnancy: A prospective multicenter cohort study. Arthritis Rheumatol. 2014;66:1101–1110. doi: 10.1002/art.38368.
Dalrymple J.M., Stamp L.K., O’Donnell J.L., Chapman P.T., Zhang M., Barclay M.L. Pharmacokinetics of oral methotrexate in patients with rheumatoid arthritis. Arthritis Rheum. 2008;58:3299–3308. doi: 10.1002/art.24034.
Paziana K., Del Monaco M., Cardonick E., Moritz M., Keller M., Smith B., Coscia L., Armenti V. Ciclosporin use during pregnancy. Drug Saf. 2013;36:279–294. doi: 10.1007/s40264-013-0034-x.
Reddy D., Murphy S.J., Kane S.V., Present D.H., Kornbluth A.A. Relapses of inflammatory bowel disease during pregnancy: In-hospital management and birth outcomes. Am. J. Gastroenterol. 2008;103:1203–1209. doi: 10.1111/j.1572-0241.2007.01756.x.
Nielsen O.H., Gubatan J.M., Juhl C.B., Streett S.E., Maxwell C. Biologics for Inflammatory Bowel Disease and Their Safety in Pregnancy: A Systematic Review and Meta-analysis. Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc. 2022;20:74–87. doi: 10.1016/j.cgh.2020.09.021.
Moens A., van der Woude C.J., Julsgaard M., Humblet E., Sheridan J., Baumgart D.C., Gilletta De Saint-Joseph C., Nancey S., Rahier J.-F., Bossuyt P., et al. Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: Results of the European CONCEIVE study. Aliment. Pharmacol. Ther. 2020;51:129–138. doi: 10.1111/apt.15539.
https://www.ema.europa.eu/en/documents/product-information/xeljanz-epar-product-information_ro.pdf
Koss C.A., Baras D.C., Lane S.D., Aubry R., Marcus M., Markowitz L.E., Koumans E.H. Investigation of metronidazole use during pregnancy and adverse birth outcomes. Antimicrob. Agents Chemother. 2012;56:4800–4805. doi: 10.1128/AAC.06477-11.
Ziv A., Masarwa R., Perlman A., Ziv D., Matok I. Pregnancy Outcomes Following Exposure to Quinolone Antibiotics—A Systematic-Review and Meta-Analysis. Pharm. Res. 2018;35:109. doi: 10.1007/s11095-018-2383-8.
Nielsen O.H., Maxwell C., Hendel J. IBD medications during pregnancy and lactation. Nat. Rev. Gastroenterol. Hepatol. 2014;11:116–127. doi: 10.1038/nrgastro.2013.135.
Meserve J., Luo J., Zhu W., Veeravalli N., Bandoli G., Chambers C.D., Singh A.G., Boland B.S., Sandborn W.J., Mahadevan U., et al. Paternal Exposure to Immunosuppressive and/or Biologic Agents and Birth Outcomes in Patients with Immune-Mediated Inflammatory Diseases. Gastroenterology. 2021;161:107–115.e3. doi: 10.1053/j.gastro.2021.03.020.
Mahadevan U., Robinson C., Bernasko N., Boland B., Chambers C., Dubinsky M., Friedman S., Kane S., Manthey J., Sauberan J., et al. Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology. 2019;156:1508–1524. doi: 10.1053/j.gastro.2018.12.022.
Ludvigsson J.F., Lebwohl B., Ekbom A., Kiran R.P., Green P.H.R., Höijer J., Stephansson O. Outcomes of Pregnancies for Women Undergoing Endoscopy While They Were Pregnant: A Nationwide Cohort Study. Gastroenterology. 2017;152:554–563. doi: 10.1053/j.gastro.2016.10.016.
Stern M.D., Kopylov U., Ben-Horin S., Apter S., Amitai M.M. Magnetic resonance enterography in pregnant women with Crohn’s disease: Case series and literature review. BMC Gastroenterol. 2014;14:146. doi: 10.1186/1471-230X-14-146.
Nguyen G.C., Seow C.H., Maxwell C., Huang V., Leung Y., Jones J., Leontiadis G.I., Tse F., Mahadevan U., van der Woude C.J., 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;150:734–757.e1. doi: 10.1053/j.gastro.2015.12.003.
Murji A., Crosier R., Rasuli P. Non-obstetric diagnostic imaging in pregnancy. CMAJ Can. Med. Assoc. J. 2015;187:1309. doi: 10.1503/cmaj.140901.
De Voogd F., Joshi H., Van Wassenaer E., Bots S., D’Haens G., Gecse K. Intestinal Ultrasound to Evaluate Treatment Response During Pregnancy in Patients With Inflammatory Bowel Disease. Inflamm. Bowel Dis. 2022;28:1045–1052. doi: 10.1093/ibd/izab216.
Bortoli A., Pedersen N., Duricova D. i wsp. Pregnancy outcome in inflammatory bowel disease: prospective European case-control ECCO-Epi-Com study, 2003–2006. Aliment. Pharmacol. Ther. 2011; 34: 724–734.
Seyedian SS, Nokhostin F, Malamir MD. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life. 2019 Apr-Jun;12(2):113-122. doi: 10.25122/jml-2018-0075. PMID: 31406511; PMCID: PMC6685307.
Kierkuś J, Szymańska E, Szymańska S, et al. Influence of inflammatory bowel disease on pregnancy and fertility - optimal treatment and management. Med Wieku Rozwoj. 2013;17(1):77-84.
Bell S.J, Flanagan E.K. Updates in the management of inflammatory bowel disease during pregnancy. Med J Aust. 2019;210(6):276-280.
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