Inflammatory bowel disease during pregnancy

  • Ramona Rajapakse
  • Burton I. Korelitz

Opinion statement

The management of both male and female patients with inflammatory bowel disease (IBD) who wish to have a baby is challenging. For women, the most important factor to bear in mind is that the outcome of pregnancy is largely influenced by disease activity at the time of conception. Women with quiescent disease are likely to have an uncomplicated pregnancy with the delivery of a healthy baby, whereas women with active disease are more likely to have complications such as spontaneous abortions, miscarriages, stillbirths, and exacerbation of the disease. This is more true of patients with Crohn’s disease than of patients with ulcerative colitis. Although the safety of medications used during pregnancy is an important issue, the impact of the medications used to treat IBD is less important in comparison to disease activity itself. 5-Aminosalicylic acid (5-ASA) products appear to be safe during pregnancy; corticosteroids are probably safe; 6-mercaptopurine and azathioprine should be used with caution; and methotrexate is contraindicated. There are inadequate data on the use of infliximab during pregnancy. In regard to men with IBD, the disease itself does not seem to have any negative impact on fertility. However, there is controversy about the effects of using 6-mercaptopurine and azathioprine prior to and during fertilization. In view of possible adverse pregnancy outcomes, it would be prudent to withhold 6-mercaptopurine and azathioprine therapy in men with IBD for 3 months prior to conception, when feasible. Most IBD medications should be continued before, during, and after pregnancy, with careful attention to the known cautions and exceptions. If IBD in a pregnant patient is in remission, the prognosis for pregnancy is the same as if she did not have IBD. Active disease should therefore be treated aggressively and remission accomplished before pregnancy is attempted. Similarly, a woman who unexpectedly becomes pregnant while her IBD is active should be treated aggressively, as remission remains the greatest investment for a favorable pregnancy outcome.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Korelitz BI: Inflammatory bowel disease and pregnancy. Gastroenterol Clin North Am 1998, 27:213–224. A comprehensive review that addresses all aspects of pregnancy and IBD, including the effects of the disease and medications on pregnant patients.PubMedCrossRefGoogle Scholar
  2. 2.
    Willoughby CP, Truelove SC: Ulcerative colitis and pregnancy. Gut 1980, 21:469–474.PubMedGoogle Scholar
  3. 3.
    Mayberry JF, Weterman IT: European survey of fertility and pregnancy in women with Crohn’s disease: a case control study by European collaborative group. Gut 1986, 27:821–825.PubMedGoogle Scholar
  4. 4.
    Baiocco PJ, Korelitz BI: The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome. J Clin Gastroenterol 1984, 6:211–216.PubMedGoogle Scholar
  5. 5.
    Birnic GG, Mcleod TF, Watkinson G: Incidence of sulfasalazine induced male fertility. Gut 1981, 22:452–455.Google Scholar
  6. 6.
    Toovey S, Hudson E, Hendry WF, et al.: Sulfasalazine and male infertility: reversibility and possible mechanisms. Gut 1981, 22:445–451.PubMedGoogle Scholar
  7. 7.
    Hanan IM, Kirsner JB: Inflammatory bowel disease in pregnant women. Clin Perinatol 1985, 12:682–699.Google Scholar
  8. 8.
    Brandt LJ, Estabrook SG, Reinus JF: Results of a survey to evaluate whether vaginal delivery and episiotomy lead to perineal involvement in women with Crohn’s disease. Am J Gastroenterol 1995, 90:1918–1922.PubMedGoogle Scholar
  9. 9.
    Macdougall I: Ulcerative colitis and pregnancy. Lancet 1956, 2:641–643.CrossRefGoogle Scholar
  10. 10.
    Connell WR: Safety of drug therapy for inflammatory bowel disease in pregnant and nursing women. Inflamm Bowel Dis 1996, 2:33–47. A useful overview of the safety of pharmacologic therapy in pregnant women with IBD.CrossRefGoogle Scholar
  11. 11.
    Briggs GG, Freeman RK, Yaffe SJ: Sulfasalazine. In Drugs in Pregnancy and Lactation, edn 4. Baltimore: Williams & Wilkins; 1994:793–795.Google Scholar
  12. 12.
    Habal FM, Hamat H: Safety of topical 5-aminosalicylic acid in pregnancy [abstract]. Gastroenterology 1994, 106:A9.Google Scholar
  13. 13.
    Diav-Citrin O, Park Y, Veersuntharam G, et al.: The safety of mesalamine in human pregnancy: a prospective controlled cohort study. Gastroenterology 1998, 114:23–28. This study provides reassurances about the safety of 5-ASA medications in patients during pregnancy.PubMedCrossRefGoogle Scholar
  14. 14.
    Marteau PH, Devaux CB: Mesalamine during pregnancy. Lancet 1994, 344:1708–1709.PubMedCrossRefGoogle Scholar
  15. 15.
    Mogadam DM, Dobbins WO III, Korelitz BI, et al.: Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcomes. Gastroenterology 1981, 80:72–76.PubMedGoogle Scholar
  16. 16.
    DeCosta EJ, Abelman MA: Cortisone and pregnancy: an experimental and clinical study of the effects of cortisone on gestation. Am J Obstet Gynecol 1952, 64:746–767.PubMedGoogle Scholar
  17. 17.
    Rosa EW, Baum C, Shaw M: Pregnancy outcomes after first trimester vaginitis during drug therapy. Obstet Gynecol 1987, 69:751–755.PubMedGoogle Scholar
  18. 18.
    Berkovitch M, Pastuszak A, Gazarian M, et al.: Safety of the new quinolones in pregnancy. Obstet Gynecol 1994, 84:535–538.PubMedGoogle Scholar
  19. 19.
    Huynh, Min D: Outcomes of pregnancy and the management of immunosuppressive agents to minimize fetal risks in organ transplant recipients. Ann Pharmacother 1994, 28:1355–1356.PubMedGoogle Scholar
  20. 20.
    Alstead EM, Ritchie JR, Lennard Jones JE, et al.: Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology 1990, 99:443–446.PubMedGoogle Scholar
  21. 21.
    Francella A, Dayan A, Rubin P, et al.: 6-mercaptopurine is safe therapy for child bearing patients with inflammatory bowel disease: a case controlled study [abstract]. Gastroenterology 1996, 110:A909.Google Scholar
  22. 22.
    Zlatanic J, Korelitz BI, Rajapakse R, et al.: Long term outcome of pregnancies following treatment with 6-MP in patients with inflammatory bowel disease [abstract]. Am J Gastroenterol 1997, 92:A335.Google Scholar
  23. 23.
    Rajapakse R, Korelitz BI, Zlatanic J, et al.: outcome of pregnancies when fathers are treated with 6-mercaptopurine for inflammatory bowel disease. Am J Gastroenterol 2000, 95:684–688.PubMedCrossRefGoogle Scholar
  24. 24.
    Lichtiger S, Present DH, Kornbluth A, et al.: Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994, 330:1841–1845.PubMedCrossRefGoogle Scholar
  25. 25.
    Hanauer SB, Shulman MI: New therapeutic approaches. Gastroenterol Clin North Am 1995, 24:523–540.PubMedGoogle Scholar
  26. 26.
    Al-Khader AA, Absy M, Al-Hasani MK, et al.: Successful pregnancy in renal transplant recipients treated with cyclosporine. Transplantation 1988, 45:987–988.PubMedCrossRefGoogle Scholar
  27. 27.
    Weinstein GD: Methotrexate. Ann Intern Med 1977, 86:199–204.PubMedGoogle Scholar
  28. 28.
    Hudson CN: Ileostomy in pregnancy. Proc R Soc Med 1972, 65:281–285.PubMedGoogle Scholar
  29. 29.
    Farouk R, Pemberton JH, Wolff BG, et al.: Functional outcomes after ileal pouch anal anastomosis for chronic ulcerative colitis. Ann Surg 2000, 231:919–926.PubMedCrossRefGoogle Scholar
  30. 30.
    Hill J, Clark A, Scott NA: Surgical treatment of acute manifestations of colonic disease during pregnancy. J R Soc Med 1997, 90:64–68.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Ramona Rajapakse
    • 1
  • Burton I. Korelitz
  1. 1.Division of Gastroenterology, Department of MedicineLenox Hill HospitalNew YorkUSA

Personalised recommendations