Review of pregnancy in Crohn's disease and ulcerative colitis

被引:30
作者
Laube, Robyn [2 ,3 ]
Paramsothy, Sudarshan [2 ,3 ,4 ]
Leong, Rupert W. [1 ,2 ,3 ]
机构
[1] Concord Repatriat Gen Hosp, Dept Gastroenterol & Hepatol, Hosp Rd, Concord, NSW 2137, Australia
[2] Macquarie Univ, Fac Med & Hlth Sci, Sydney, NSW, Australia
[3] Macquarie Univ Hosp, Dept Gastroenterol, Sydney, NSW, Australia
[4] Concord Repatriat Gen Hosp, Dept Gastroenterol & Hepatol, Sydney, NSW, Australia
关键词
complications; fertility; inflammatory bowel disease; management; pregnancy; vaccinations; INFLAMMATORY-BOWEL-DISEASE; POUCH-ANAL ANASTOMOSIS; IN-VITRO FERTILIZATION; TERM-FOLLOW-UP; BIRTH OUTCOMES; ASSISTED REPRODUCTION; MALE-INFERTILITY; RESTORATIVE PROCTOCOLECTOMY; CONGENITAL-ABNORMALITIES; VOLUNTARY CHILDLESSNESS;
D O I
10.1177/17562848211016242
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Inflammatory bowel disease (IBD) frequently affects women of childbearing age and can have implications in pregnancy. Most women with IBD have comparable fertility with women in the general population. Fertility is reduced in women with active disease or previous ileal-pouch-anal anastomosis (IPAA) surgery and is temporarily reduced in men taking sulfasalazine. Women with IBD have an increased risk of preterm delivery, low birth weight, small-for-gestational-age infants and Cesarean section (CS) delivery, however, no increased risk of congenital abnormalities. These adverse outcomes are particularly prevalent for women with active IBD compared with those with quiescent disease. Conception should occur during disease remission to optimize maternal and fetal outcomes and reduce the risk of disease exacerbations during pregnancy. Pre-conception counseling is therefore pertinent to provide patient education, medication review for risk of teratogenicity and objective disease assessment. Most medications are safe during pregnancy and breastfeeding, with the exception of methotrexate, ciclosporin, allopurinol and tofacitinib. Delivery modality should be guided by obstetric factors in most cases; however, CS is recommended for women with active perianal disease and can be considered for women with inactive perianal disease or IPAA. In conclusion, most women with IBD have uncomplicated pregnancies. Active IBD is the predominant predictor of poor outcomes and disease exacerbations; therefore, maintenance of disease remission during and before pregnancy is crucial.
引用
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页数:18
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