Pregnancy and medications for inflammatory bowel disease: An updated narrative review

Abstract

Inflammatory bowel disease (IBD) is often diagnosed during the peak reproductive years of young women. Women with active IBD around conception are at a significantly increased risk of disease relapse during pregnancy, which is associated with poor pregnancy and neonatal outcomes. Given these substantial risks, it is prudent that disease remission should ideally be achieved before conception. Unfortunately, some patients may experience a disease flare-up even if they are in a state of remission before pregnancy. Patients must continue their IBD medications to reduce the risk of disease flare and subsequent poor outcomes during the gestational and postpartum periods. When treating IBD flare-ups during pregnancy, the management is quite similar to the therapeutic approach for non-pregnant patients with IBD, including 5-aminosalicylate, steroids, calcineurin inhibitors (CNIs), and biologic therapies. While the data regarding the safety of CNIs in pregnant women with IBD is limited, the findings in our recent meta-analysis suggest that CNIs may be safer to use in those with IBD than in solid organ transplant recipients. There are several types of biologics and small-molecule therapies currently approved for IBD, and physicians should thoroughly understand their clinical benefits and safety profiles when utilizing these treatments in the context of pregnancy. This review highlights recent studies, including our systematic review and meta-analysis, and discusses the clinical advantages and safety considerations of biologics and small molecules for pregnant women with IBD.

Keywords: Inflammatory bowel disease, Pregnancy, Safety, Biologics, Small molecules

Core Tip: Anti-tumor necrosis factor monotherapy is safe during pregnancy in women with Inflammatory bowel disease (IBD). However, their use in combination with thiopurines may be associated increased risk of neonatal prematurity and infection, although these data are conflicting. According to meta-analyses, vedolizumab and ustekinumab may be associated with early pregnancy loss; however, these data might be biased by IBD activity or small sample sizes. Recent prospective studies have demonstrated these biologics are generally safe during pregnancy. Janus kinase inhibitors are contraindicated during pregnancy as animal studies have demonstrated harmful effects. Calcineurin inhibitors may be considered for pregnant women with IBD who develop clinical relapse.