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©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Jun 21, 2014; 20(23): 7123-7136
Published online Jun 21, 2014. doi: 10.3748/wjg.v20.i23.7123
Published online Jun 21, 2014. doi: 10.3748/wjg.v20.i23.7123
Table 1 Safety indications for drugs in pregnancy and breastfeeding
UC | ECCO ratingpregnancy | ECCO ratingbreastfeeding | Personal observations | |
5-ASA (except sulfasalazine) | B | Safe | Safe | Avoid high doses for long time, asacol preparations may be switched to another mesalamine |
Sulfasalazine | B | Safe | Safe | Folate supplements are required |
AZA/6-MP | D | Safe | Probably safe | Discuss breastfeeding with the patient. Avoid lactation in the four hours after intake of the drug |
Cyclosporine A | C | Probably safe | Contraindicated | Use only in severe cases of UC to avoid urgent colectomy during pregnancy |
Methotrexate | X | Contraindicated | Contraindicated | Discontinue at least 4 mo prior to conception |
Corticosteroids | C | Safe | Safe | Very low risk of malformations. If possible, not use for long time |
Infliximab | B | Probably safe | Safe | Can be used safely in the first two trimesters of pregnancy. If possible, avoid in the third trimester |
Adalimumab | B | Probably safe | No data | Can be used safely in the first two trimesters of pregnancy. If possible, avoid in the third trimester |
Metronidazole | B | Probably safe | Best avoided | Very slight increase of cleft lip. Use only if strictly necessary |
Ciprofloxacin | C | Probably safe | Probably safe | Use only for short periods and avoid in the first trimester |
Thalidomide | X | Contraindicated | Contraindicated |
Table 2 Effects of inflammatory bowel disease medications on erectile dysfunction, male infertility and partner’s pregnancy
Erectile dysfunction | Infertility | Pregnancy complications | Recommendations | |
5-ASA (except sulfasalazine) | No | Single reversible case | No reports | No recommendations to discontinue prior to conception |
Sulfasalazine | Single case | Yes, reversible, not dose dependent | One study | Switch to other 5-ASA preparations |
AZA/6-MP | No reports | No | Controversial | No recommendations to discontinue prior to conception |
Cyclosporine A | No reports | No | No reports | No recommendations to discontinue prior to conception |
Methotrexate | Yes | Controversial | No reports | Discontinue 3-4 mo prior to conception |
Steroids | No reports | No | No reports | Lack of data to discontinue |
TNF-α inhibitors (infliximab, and only a case report for adalimumab) | No reports | Reduce sperm quality, but no infertility | No | No recommendations to discontinue prior to conception, but barrier methods during pregnancy |
- Citation: Palomba S, Sereni G, Falbo A, Beltrami M, Lombardini S, Boni MC, Fornaciari G, Sassatelli R, La Sala GB. Inflammatory bowel diseases and human reproduction: A comprehensive evidence-based review. World J Gastroenterol 2014; 20(23): 7123-7136
- URL: https://www.wjgnet.com/1007-9327/full/v20/i23/7123.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i23.7123