Top

Current Treatment Options in Gastroenterology

Published in:

01-09-2020 | Fertility | Inflammatory Bowel Disease (G Lichtenstein, Section Editor)

Update on Pregnancy in Patients with IBD

Authors: Rachel W. Winter, MD, MPH, Sonia Friedman, MD

Published in: Current Treatment Options in Gastroenterology | Issue 3/2020

Abstract

Purpose of review

This review summarizes the most current clinical research and latest clinical guidelines in managing inflammatory bowel disease (IBD) before, during, and after pregnancy.

Recent findings

Recent guidelines emphasize the safety of thiopurines and biologics during pregnancy and nursing. Patients should be in remission for 3–6 months prior to conceiving and remain in remission to decrease the risk of poor pregnancy outcomes. Fertility is decreased in women with active IBD and in women who have had anal or rectal resection. Women with IBD, especially those with Crohn’s disease (CD) who have had surgery, have an increased time to pregnancy. Women with CD and ulcerative colitis who need assisted reproduction have a decreased chance of a live birth compared with women in the general population. Indications for caesarian section include active perianal disease.

Summary

Most IBD medications are safe during pregnancy and should be continued to ensure remission. Preconception counseling and a multidisciplinary team approach are the best ways to support a healthy pregnancy and delivery.

De Lima-Karagiannis A, Zelinkova-Detkova Z, Van Der Woude CJ. The effects of active IBD during pregnancy in the era of novel IBD therapies. Am J Gastroenterol. 2016;111(9):1305–12. https://doi.org/10.1038/ajg.2016.254.PubMedCrossRef

Kammerlander H, Nielsen J, Kjeldsen J, Knudsen T, Friedman S, Nørgård B. The effect of disease activity on birth outcomes in a nationwide cohort of women with moderate to severe inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(6):1011–8. https://doi.org/10.1097/MIB.0000000000001102.PubMedCrossRef

Bengtson MB, Martin CF, Aamodt G, Vatn MH, Mahadevan U. Inadequate gestational weight gain predicts adverse pregnancy outcomes in mothers with inflammatory bowel disease: results from a prospective US pregnancy cohort. Dig Dis Sci. 2017;62(8):2063–9. https://doi.org/10.1007/s10620-017-4547-5.PubMedCrossRef

Bengtson MB, Aamodt G, Mahadevan U, Vatn MH. Inadequate gestational weight gain, the hidden link between maternal IBD and adverse pregnancy outcomes: results from the Norwegian mother and child cohort study. Inflamm Bowel Dis. 2017;23(7):1225–33. https://doi.org/10.1097/MIB.0000000000001123.PubMedCrossRef

Mountifield R, Bampton P, Prosser R, Muller K, Andrews JM. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis. 2009;15(5):720–5. https://doi.org/10.1002/ibd.20839.PubMedCrossRef

Selinger CP, Eaden J, Selby W, Jones DB, Katelaris P, Chapman G, et al. Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohn's Colitis. 2013;7(6):206–13. https://doi.org/10.1016/j.crohns.2012.09.010.CrossRef

Selinger CP, Ghorayeb J, Madill A. What factors might drive voluntary childlessness (VC) in women with IBD? Does IBD-specific pregnancy-related knowledge matter? J Crohn's Colitis. 2016;10(10):1151–8. https://doi.org/10.1093/ECCO-JCC/JJW078.CrossRef

Padhan RK, Kedia S, Garg SK, Bopanna S, Mouli VP, Dhingra R, et al. Long-term disease course and pregnancy outcomes in women with inflammatory bowel disease: an Indian cohort study. Dig Dis Sci. 2017;62(8):2054–62. https://doi.org/10.1007/s10620-016-4353-5.PubMedCrossRef

Pedersen N, Bortoli A, Duricova D, D′Inca R, Panelli MR, Gisbert JP, et al. The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom study of 209 pregnant women. Aliment Pharmacol Ther. 2013;38(5):501–12. https://doi.org/10.1111/apt.12412.PubMedCrossRef

10.

Riis L, Vind I, Politi P, Wolters F, Vermeire S, Tsianos E, et al. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease. Am J Gastroenterol. 2006;101(7):1539–45. https://doi.org/10.1111/j.1572-0241.2006.00602.x.PubMedCrossRef

11.

Moller FT, Andersen V, Wohlfahrt J, Jess T. Familial risk of inflammatory bowel disease: a population-based cohort study 1977-2011. Am J Gastroenterol. 2015;110(4):564–71. https://doi.org/10.1038/ajg.2015.50.PubMedCrossRef

12.

Jølving LR, Nielsen J, Beck-Nielsen SS, Nielsen RG, Friedman S, Kesmodel US, et al. The association between maternal chronic inflammatory bowel disease and long-term health outcomes in children - a nationwide cohort study. Inflamm Bowel Dis. 2017;23(8):1440–6. https://doi.org/10.1097/MIB.0000000000001146.PubMedCrossRef

13.

Orholm M, Binder V, Sorensen TIA, Rasmussen LP, Kyvik KO. Concordance of inflammatory bowel disease among Danish twins: results of a nationwide study. Scand J Gastroenterol. 2000;35(10):1075–81. https://doi.org/10.1080/003655200451207.PubMedCrossRef

14.

Halfvarson J, Bodin L, Tysk C, Lindberg E, Järnerot G. Inflammatory bowel disease in a Swedish twin cohort: a long- term follow-up of concordance and clinical characteristics. Gastroenterology. 2003;124(7):1767–73. https://doi.org/10.1016/S0016-5085(03)00385-8.PubMedCrossRef

15.

Thompson NP, Driscoll R, Pounder RE, Wakefield AJ, Bowel I. Genetics versus environment in inflammatory bowel disease: results of a British twin study. Br Med J. 1996;312(7023):95–6. https://doi.org/10.1136/bmj.312.7023.95.CrossRef

16.

Bernstein CN, Burchill C, Targownik LE, Singh H, Roos LL. Events within the first year of life, but not the neonatal period, affect risk for later development of inflammatory bowel diseases. Gastroenterology. 2019;156(8):2190–7. https://doi.org/10.1053/j.gastro.2019.02.004.PubMedCrossRef

17.

Moller FT, Andersen V, Wohlfahrt J, Jess T. Familial risk of inflammatory bowel disease: A population-based cohort study 1977–2011. Am J Gastroenterol. 2015;110(4). https://doi.org/10.1038/ajg.2015.50

18.

Hemminki K, Li X, Sundquist K, Sundquist J. Familial association of inflammatory bowel diseases with other autoimmune and related diseases. Am J Gastroenterol. 2010;105(1):139–47. https://doi.org/10.1038/ajg.2009.496.PubMedCrossRef

19.••

Mahadevan U, Robinson C, Bernasko N, et al. Inflammatory Bowel disease in pregnancy clinical care pathway: a report from the American Gastroenterological Association IBD parenthood project working group. Am J Obstet Gynecol. 2019;220(4):308–23. https://doi.org/10.1016/j.ajog.2019.02.027This article includes national guidelines on treating IBD during pregnancy and postpartum and is recommended for any provider treating pregnant patients with IBD.PubMedCrossRef

20.

U.S. Food and Drug Administration. [Accessed June 6, 2020] Methotrexate Sodium Label Information. http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/011719s117lbl.pdf.

21.

U.S. Food and Drug Administration. [Accessed June 6, 2020] Methotrexate Sodium Label Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/008085s066lbl.pdf.

22.

Friedman S, Nielsen J, Nohr E, Jolving L, Norgaard B. Comparison of time to pregnancy in women with and without inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2020;18(7):1537–44.PubMedCrossRef

23.

de Silva PS, O’Toole A, Marc LG, Ulysse CA, Testa MA, Julsgaard M, et al. Development of a sexual dysfunction scale for women with inflammatory bowel disease. Inflamm Bowel Dis. 2018;24(11):2350–9. https://doi.org/10.1093/IBD/IZY202.PubMedPubMedCentralCrossRef

24.

O’Toole A, De Silva PS, Marc LG, et al. Sexual dysfunction in men with inflammatory bowel disease: a new IBD-specific scale. Inflamm Bowel Dis. 2018;24(2):310–6. https://doi.org/10.1093/ibd/izx053.PubMedPubMedCentralCrossRef

25.

Fréour T, Miossec C, Bach-Ngohou K, Dejoie T, Flamant M, Maillard O, et al. Ovarian reserve in young women of reproductive age with Crohn’s disease. Inflamm Bowel Dis. 2012;18(8):1515–22. https://doi.org/10.1002/ibd.21872.PubMedCrossRef

26.

Şenateş E, Çolak Y, Erdem ED, Yeşil A, Coşkunpınar E, Şahin Ö, et al. Serum anti-Müllerian hormone levels are lower in reproductive-age women with Crohn’s disease compared to healthy control women. J Crohn's Colitis. 2013;7(2):e29–34. https://doi.org/10.1016/j.crohns.2012.03.003.CrossRef

27.

Zhao Y, Chen B, He Y, Zhang S, Qiu Y, Feng R, et al. Risk factors associated with impaired ovarian reserve in young women of reproductive age with Crohn’s disease. Intest Res. 2020;18(2):200–9. https://doi.org/10.5217/ir.2019.00103.PubMedPubMedCentralCrossRef

28.

Ban L, Tata LJ, Humes DJ, Fiaschi L, Card T. Decreased fertility rates in 9639 women diagnosed with inflammatory bowel disease: a United Kingdom population-based cohort study. Aliment Pharmacol Ther. 2015;42(7):855–66. https://doi.org/10.1111/apt.13354.PubMedCrossRef

29.•

Gorgun E, Cengiz TB, Aytac E, et al. Does laparoscopic ileal pouch-anal anastomosis reduce infertility compared with open approach? In: Surgery (United States). Vol 166. ; 2019:670–677. doi:https://doi.org/10.1016/j.surg.2019.04.045. This is the largest study of laparoscopic IPAA surgery versus open surgery in patients with IBD. Patients who underwent laparoscopic surgery had improved fertility when compared to those who had had open surgery.

30.

Bartels SAL, D’Hoore A, Cuesta MA, Bensdorp AJ, Lucas C, Bemelman WA. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg. 2012;256(6):1045–8. https://doi.org/10.1097/SLA.0b013e318250caa9.PubMedCrossRef

31.

Beyer-Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y. A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: A 2-center study. Ann Surg. 2013;258(2). https://doi.org/10.1097/SLA.0b013e3182813741.

32.

Waljee A, Waljee J, Morris AM, Higgins PDR. Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut. 2006;55(11):1575–80. https://doi.org/10.1136/gut.2005.090316.PubMedPubMedCentralCrossRef

33.

Wikland M, Jansson I, Asztély M, et al. Gynaecological problems related to anatomical changes after conventional proctocolectomy and ileostomy. Int J Color Dis. 1990;5(1):49–52. https://doi.org/10.1007/BF00496151.CrossRef

34.••

Nørgård BM, Larsen PV, Fedder J, De Silva PS, Larsen MD, Friedman S. Live birth and adverse birth outcomes in women with ulcerative colitis and Crohn’s disease receiving assisted reproduction: A 20-year nationwide cohort study. Gut. 2016;65(5):767–76. https://doi.org/10.1136/gutjnl-2015-311246This is the first population-based study of the efficacy of assisted reproduction technology treatment in women with IBD. This paper shows that women with UC and CD have a decreased chance of achieving a live birth when compared to women without IBD in the general population who undergo assisted reproduction.PubMedCrossRef

35.

Friedman S, Larsen PV, Fedder J, Nørgård BM. The reduced chance of a live birth in women with IBD receiving assisted reproduction is due to a failure to achieve a clinical pregnancy. Gut. 2017;66(3):556–8. https://doi.org/10.1136/gutjnl-2016-311805.PubMedCrossRef

36.

Friedman S, Larsen PV, Fedder J, Nørgård BM. The efficacy of assisted reproduction in women with inflammatory bowel disease and the impact of surgery - a nationwide cohort study. Inflamm Bowel Dis. 2017;23(2):208–17. https://doi.org/10.1097/MIB.0000000000000996.PubMedCrossRef

37.

Dunsmore G, Koleva P, Ghobakhloo N, Sutton R, Ambrosio L, Meng X, et al. Lower abundance and impaired function of CD71 + Erythroid cells in inflammatory bowel disease patients during pregnancy. J Crohn's Colitis. 2019;13(2):230–44. https://doi.org/10.1093/ecco-jcc/jjy147.CrossRef

38.

Julsgaard M, Hvas CL, Gearry RB, Vestergaard T, Fallingborg J, Svenningsen L, et al. Fecal Calprotectin is not affected by pregnancy: clinical implications for the management of pregnant patients with inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(7):1240–6. https://doi.org/10.1097/MIB.0000000000001136.PubMedCrossRef

39.

Balint A, Berenyi A, Farkas K, et al. Pregnancy does not affect fecal calprotectin concentration in healthy women. Turk J Gastroenterol. 2017;28(3):171–5. https://doi.org/10.5152/tjg.2017.16711.PubMedCrossRef

40.

Kammerlander H, Nielsen J, Kjeldsen J, Knudsen T, Gradel KO, Friedman S, et al. Fecal Calprotectin during pregnancy in women with moderate-severe inflammatory bowel disease. Inflamm Bowel Dis. 2018;24(4):839–48. https://doi.org/10.1093/ibd/izx055.PubMedCrossRef

41.

Tandon P, Leung K, Yusuf A, Huang VW. Noninvasive methods for assessing inflammatory bowel disease activity in pregnancy: a systematic review. J Clin Gastroenterol. 2019;53(8):574–81. https://doi.org/10.1097/MCG.0000000000001244.PubMedCrossRef

42.

Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA - J Am Med Assoc. 2016;316(9):952–61. https://doi.org/10.1001/jama.2016.12126.CrossRef

43.

Youngblood ME, Williamson R, Bell KN, Johnson Q, Kancherla V, Oakley GP. 2012 update on global prevention of folic acid-preventable spina bifida and anencephaly. Birth Defects Res Part A - Clin Mol Teratol. 2013;97(10):658–63. https://doi.org/10.1002/bdra.23166.CrossRef

44.

Mills JL. Strategies for preventing folate-related neural tube defects supplements, fortified foods, or both? JAMA - J Am Med Assoc. 2017;317(2):144–5. https://doi.org/10.1001/jama.2016.19894.CrossRef

45.

Lee S, Seow C, Adhikari K, Metcalfe A. Pregnant women with IBD are more likely to be adherent to biologic therapies than other medications. Aliment Pharmacol Ther. 2020;51(5):544–52.PubMedCrossRef

46.

Nguyen GC, Seow CH, Maxwell C, Huang V, Leung Y, Jones J, et al. The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy. Gastroenterology. 2016;150(3):734–57. https://doi.org/10.1053/j.gastro.2015.12.003.PubMedCrossRef

47.

Nørgård B, Pedersen L, Christensen LA, Sørensen HT. Therapeutic drug use in women with Crohn’s disease and birth outcomes: a Danish nationwide cohort study. Am J Gastroenterol. 2007;102(7):1406–13. https://doi.org/10.1111/j.1572-0241.2007.01216.x.PubMedCrossRef

48.

Nørgård B, Pedersen L, Fonager K, Rasmussen SN, Sørensen HT. Azathioprine, mercaptopurine and birth outcome: a population-based cohort study. Aliment Pharmacol Ther. 2003;17:827–34. https://doi.org/10.1046/j.1365-2036.2003.01537.x.PubMedCrossRef

49.

Akbari M, Shah S, Velayos FS, Mahadevan U, Cheifetz AS. Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:15–22. https://doi.org/10.1002/ibd.22948.PubMedCrossRef

50.

Angelberger S, Reinisch W, Messerschmidt A, Miehsler W, Novacek G, Vogelsang H, et al. Long-term follow-up of babies exposed to azathioprine in utero and via breastfeeding. J Crohn's Colitis. 2011;5(2):95–100. https://doi.org/10.1016/j.crohns.2010.10.005.CrossRef

51.

De Meij TGJ, Jharap B, Kneepkens CMF, Van Bodegraven AA, De Boer NKH. Long-term follow-up of children exposed intrauterine to maternal thiopurine therapy during pregnancy in females with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;38(1):38–43. https://doi.org/10.1111/apt.12334.PubMedCrossRef

52.

Marder W, Ganser MA, Romero V, Hyzy MA, Gordon C, McCune WJ, et al. In utero azathioprine exposure and increased utilization of special educational services in children born to mothers with systemic lupus erythematosus. Arthritis Care Res. 2013;65(5):759–66. https://doi.org/10.1002/acr.21888.CrossRef

53.

Seow CH, Leung Y, Vande Casteele N, Ehteshami Afshar E, Tanyingoh D, Bindra G, et al. The effects of pregnancy on the pharmacokinetics of infliximab and adalimumab in inflammatory bowel disease. Aliment Pharmacol Ther. 2017;45(10):1329–38. https://doi.org/10.1111/apt.14040.PubMedCrossRef

54.•

Luu M, Benzenine E, Doret M, et al. Continuous Anti-TNFα Use Throughout Pregnancy: Possible Complications For the Mother But Not for the Fetus. A Retrospective Cohort on the French National Health Insurance Database (EVASION). Am J Gastroenterol. 2018;113(11):1669–77 This reports on the largest cohort of children exposed to anti-TNF in utero. This paper showed that there was no increased risk of in-hospital infections during the first year of life among 797 children born to anti-TNF-exposed mothers. These reassuring results were one of the foundations of the Parenthood Project Guidelines.PubMedCrossRef

55.

Julsgaard M, Hvas C, Gearry R, et al. Anti-TNF therapy in pregnant women with inflammatory bowel disease: effects of therapeutic strategies on disease behavior and birth outcomes. Inflamm Bowel Dis. 2020;26(1):93–102.PubMedCrossRef

56.

Matro R, Martin CF, Wolf D, Shah SA, Mahadevan U. Exposure concentrations of infants breastfed by women receiving biologic therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development. Gastroenterology. 2018;155(3):696–704. https://doi.org/10.1053/j.gastro.2018.05.040.PubMedCrossRef

57.

Julsgaard M, Christensen LA, Gibson PR, Gearry RB, Fallingborg J, Hvas CL, et al. Concentrations of adalimumab and infliximab in mothers and newborns, and effects on infection. Gastroenterology. 2016;151(1):110–9. https://doi.org/10.1053/j.gastro.2016.04.002.PubMedCrossRef

58.

Chaparro M, Verreth A, Lobaton T, Gravito-Soares E, Julsgaard M, Savarino E, et al. Long-term safety of in utero exposure to anti-TNFα drugs for the treatment of inflammatory bowel disease: results from the multicenter European TEDDY study. Am J Gastroenterol. 2018;113(3):396–403. https://doi.org/10.1038/ajg.2017.501.PubMedCrossRef

59.

Duricova D, Dvorakova E, Hradsky O, Mitrova K, Durilova M, Kozeluhova J, et al. Safety of anti-TNF-alpha therapy during pregnancy on long-term outcome of exposed children: a controlled, Multicenter Observation. Inflamm Bowel Dis. 2019;25(4):789–96.PubMedCrossRef

60.

Mahadevan U, Wolf DC, Dubinsky M, Cortot A, Lee SD, Siegel CA, et al. Placental transfer of anti-tumor necrosis factor agents in pregnant patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2013;11(3):286–92. https://doi.org/10.1016/j.cgh.2012.11.011.PubMedCrossRef

61.

Moens A, Van Hoeve K, Humblet E, et al. Outcome of pregnancies in female patients with inflammatory bowel diseases treated with vedolizumab. J Crohn's Colitis. 2019;13(1):12–8. https://doi.org/10.1093/ecco-jcc/jjy142.CrossRef

62.

Moens A, van der Woude C, Julsgaard M, Humblet E, Sheridan J, Baumgart D. Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study. Aliment Pharmacol Ther. 2020;51(1):129–38.PubMedCrossRef

63.

Morris J, Lopez-Leon S, Geissbühler Y, Sabidó M, Turkson M, Wahlich C. A systematic review and meta-analyses of pregnancy and fetal outcomes in women with multiple sclerosis: a contribution from the IMI2 ConcePTION project. J Neurol. 2020. https://doi.org/10.1007/s00415-020-09913-1.

64.

MacDonald SC, McElrath TF, Hernández-Díaz S. Use and safety of disease-modifying therapy in pregnant women with multiple sclerosis. Pharmacoepidemiol Drug Saf. 2019;28(4):556–60. https://doi.org/10.1002/pds.4735.PubMedCrossRef

65.

Mahadevan U, Naureckas S, Sharma B, et al. Pregnancy Outcomes in Women Exposed to Ustekinumab. Gastroenterology. 2018;154:S-588–9.CrossRef

66.

Mahadevan U, Dubinsky M, Su C, et al. Outcomes of pregnancies with maternal/paternal exposure in the Tofacitinib safety databases for ulcerative colitis. Inflamm Bowel Dis. 2018;24(12):2494–500.PubMedPubMedCentralCrossRef

67.

Clowse MEB, Feldman SR, Isaacs JD, Kimball AB, Strand V, Warren RB, et al. Pregnancy outcomes in the Tofacitinib safety databases for rheumatoid arthritis and psoriasis. Drug Saf. 2016;39(8):755–62. https://doi.org/10.1007/s40264-016-0431-z.PubMedPubMedCentralCrossRef

68.

Tsao NW, Lynd LD, Sayre EC, Sadatsafavi M, Hanley G, De Vera MA. Use of biologics during pregnancy and risk of serious infections in the mother and baby: A Canadian population-based cohort study. BMJ Open. 2019;9(2). https://doi.org/10.1136/bmjopen-2018-023714.

69.

Truta B, Leeds IL, Canner JK, et al. Early Discontinuation of Infliximab in Pregnant Women With Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019;epub.

70.

Lichtenstein GR, Feagan BG, Mahadevan U, Salzberg BA, Langholff W, Morgan JG, et al. Pregnancy outcomes reported during the 13-year TREAT registry: a descriptive report. Am J Gastroenterol. 2018;113(11):1678–88. https://doi.org/10.1038/s41395-018-0202-9.PubMedCrossRef

71.

Koslowsky B, Sadeh C, Grisaru-Granovsky S, Miskin H, Goldin E, Bar-Gil SA. Thiopurine therapy for inflammatory Bowel disease during pregnancy is not associated with Anemia in the infant. Dig Dis Sci. 2019;64(8):2286–90. https://doi.org/10.1007/s10620-019-05555-0.PubMedCrossRef

72.

Dowty ME, Lin J, Ryder TF, Wang W, Walker GS, Vaz A, et al. The pharmacokinetics, metabolism and clearance mechanisms of tofacitinib, a janus kinase inhibitor, in humans. Drug Metab Dispos. 2014;42(4):759–73. https://doi.org/10.1124/dmd.113.054940.PubMedCrossRef

73.

Rasmussen AS, Christiansen CF, Ulrichsen SP, Uldbjerg N, Norgaard M. Non-obstetric abdominal surgery during pregnancy and birth outcomes: a Danish registry-based cohort study. Acta Obs Gynecol Scand. 2019;epub.

74.

Foulon A, Dupas JL, Sabbagh C, Chevreau J, Rebibo L, Brazier F, et al. Defining the most appropriate delivery mode in women with inflammatory bowel disease: a systematic review. Inflamm Bowel Dis. 2017;23(5):712–20. https://doi.org/10.1097/MIB.0000000000001112.PubMedCrossRef

75.

Burke KE, Haviland MJ, Hacker MR, Shainker SA, Cheifetz AS. Indications for mode of delivery in pregnant women with inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(5):721–6. https://doi.org/10.1097/MIB.0000000000001113.PubMedCrossRef

76.

Remzi FH, Gorgun E, Bast J, Schroeder T, Hammel J, Philipson E, et al. Vaginal delivery after ileal pouch-anal anastomosis: a word of caution. Dis Colon Rectum. 2005;48(9):1691–9. https://doi.org/10.1007/s10350-005-0124-7.PubMedCrossRef

77.

Brodribb W. ABM clinical protocol #9: use of galactogogues in initiating or augmenting maternal Milk production, second revision 2018. Breastfeed Med. 2018;13(5):307–14. https://doi.org/10.1089/bfm.2018.29092.wjb.PubMedCrossRef

78.

Kim YH, Pfaller B, Marson A, et al. The risk of venous thromboembolism in women with inflammatory bowel disease during pregnancy and the postpartum period: A systematic review and meta-analysis. Med (United States). 2019;98(38). https://doi.org/10.1097/MD.0000000000017309

79.

Nguyen GC, Bernstein CN, Bitton A, Chan AK, Griffiths AM, Leontiadis GI, et al. Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian association of gastroenterology. Gastroenterology. 2014;146:835–48. https://doi.org/10.1053/j.gastro.2014.01.042.PubMedCrossRef

80.

Bates SM, Middeldorp S, Rodger M, James AH, Greer I. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):92–128. https://doi.org/10.1007/s11239-015-1309-0.PubMedPubMedCentralCrossRef

Title: Update on Pregnancy in Patients with IBD
Authors: Rachel W. Winter, MD, MPH
Sonia Friedman, MD
Publication date: 01-09-2020
Publisher: Springer US
Keywords: Fertility
Ulcerative Colitis
Crohn's Disease
Chronic Inflammatory Bowel Disease
Published in: Current Treatment Options in Gastroenterology / Issue 3/2020
Print ISSN: 1092-8472
Electronic ISSN: 1534-309X
DOI: https://doi.org/10.1007/s11938-020-00303-0

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of review

Recent findings

Summary

Please log in to get access to this content

Other articles of this Issue 3/2020

Gastritis: An Update in 2020

Obscure Gastrointestinal Bleeding Due to Colonic Source

Novel Therapeutics for the Treatment of IBD: Current Status and Future Directions

7RECENT Advances in Endoscopic Treatments for Gastroesophageal Reflux Disease

Update on the Management of Helicobacter pylori Infection

Correction to: RECENT Advances in Endoscopic Treatments for Gastroesophageal Reflux Disease

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage