Treatment of Crohn’s disease in pregnant women: Drug and multidisciplinary approaches

Abstract

Inflammatory bowel disease affects a substantial number of women in their reproductive years. Pregnancy presents a number of challenges for clinicians and patients; the health of the baby needs to be balanced with the need to maintain remission in the mother. Historically, treatments for Crohn’s disease (CD) were often discontinued during the pregnancy, or nursing period, due to concerns about teratogenicity. Fortunately, observational data has reported the relative safety of many agents used to treat CD, including 5-aminosalicylic acid, thiopurines, and tumor necrosis factor. Data on the long-term development outcomes of children exposed to these therapies in utero are still limited. It is most important that physicians educate the patient regarding the optimal time to conceive, discuss the possible risks, and together decide on the best management strategy.

Keywords: Pregnancy; Drugs; Inflammatory bowel disease; Crohn’s disease; Breastfeeding

Core tip: Patients should be encouraged to postpone conception until their Crohn’s disease (CD) is in remission. Monitoring of nutritional status remains important in patients with small bowel CD; folic acid, vitamin D and vitamin B12 may all need to be supplemented. Most drug treatments are safe in pregnancy, based on observational data, including 5-aminosalicylic acid, thiopurines, anti-tumor necrosis factor, and anti-integrins. Methotrexate should be avoided due to its teratogenicity. Cesarean section is only indicated from a CD perspective in women with active perianal disease at the time of delivery; all others can have a normal vaginal delivery.