Treatment of pregnant women with a diagnosis of inflammatory bowel disease

Table 2 Safety of inflammatory bowel disease medications during pregnancy and breastfeeding

Medication	FDA category	Comments during pregnancy	Comments during breastfeeding
Adalimumab	B	Low risk: Transported through the placenta late in the second and third trimester; avoid treatment in the last trimester	Compatible
5-Aminosalicylic acid preparations1	B	Low risk: Limited data for olsalazine; if using sulfasalazine, folic acid supplementation is mandatory	Enters breast milk; probably compatible
Amoxicillin/clavulanate	B	Low risk	Enters breast milk; probably compatible
Azathioprine/6-mercaptopurine	D	Low risk	Low transfer to infant; appears in the milk 4 h after ingestion
Budesonide/prednisone	C	Probably low risk, avoid during first trimester (potential risk of oral clefts)	Probably compatible; enters breast milk
Certolizumab	B	Low risk	Limited data; probably compatible
Ciprofloxacin	C	Limited data; not recommended	Compatible
Cyclosporine	C	Low risk	Contraindicated
Methotrexate	X	Contraindicated: Teratogenic	Contraindicated
Metronidazole	B	Low risk, avoid during the first trimester	Enters breast milk, not recommended
Natalizumab	C	Limited data; low risk	Limited data; probably compatible
Tacrolimus	C	Limited data; no increase in congenital anomalies	Contraindicated
Thalidomide	X	Contraindicated: Teratogenic	No data available; potential toxicity

¹Asacol HD (due to the dibutyl phthalate content) and olsalazine are category C drugs. FDA: Food and Drug Administration.