Inflammatory bowel diseases and human reproduction: A comprehensive evidence-based review

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

5-ASA: 5-aminosalicylates; AZA: Azathioprine; 6-MP: 6-mercaptopurine; ECCO: European Crohn’s Colitis Organisation; UC: Ulcerative colitis.

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

5-ASA: 5-aminosalicylates; AZA: Azathioprine; 6-MP: 6-mercaptopurine; TNF: Tumor necrosis factor.