Issue 21

Clinical Question

For individuals considering pregnancy, or who are pregnant, how should IBD treatments be modified to ensure that the mother’s disease is well treated and yet are safe for the developing fetus?

Editor’s Bottom Line

Optimal management of IBD before and during pregnancy is essential to achieving favourable maternal and neonatal outcomes and should be directed by a specialist in IBD.

Reference

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):734–57. https://www.ncbi.nlm.nih.gov/pubmed/26688268

Synopsis

A systematic literature search identified studies on the management of IBD during pregnancy. The quality of their evidence was assessed using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. The aim of the recommendations was to optimize IBD therapy for flare prevention during pregnancy.

Optimal management of IBD before and during pregnancy is essential to achieve favorable maternal and neonatal outcomes. Specifically:

• Parents should receive preconception counseling and the mother should receive specialist IBD care during and after pregnancy
• Mothers should continue 5-ASA, thiopurine, or anti-TNF monotherapy (changes should be implemented only in patients at low-risk for flares)
• Corticosteroids should be used to treat mild-to-moderate flares
• Anti-TNFs are used for steroid-resistant flares
• Endoscopy or urgent surgery should be performed if indicated (delays until birth are not recommended)
• Cesarean delivery is at the discretion of the obstetrician and patient, unless the mother has perianal Crohn’s disease
• Mothers can breastfeed unless they are taking methotrexate
• Infants born to mothers receiving anti-TNF therapy should not have live vaccinations before the age of 6 months.

Details

Study Design: Expert, consensus-based opinions
Funding: None
Allocation: n/a
Setting: n/a
Level of Evidence: 1a (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.