Pregnancy and inflammatory bowel disease

Purpose of review Inflammatory bowel disease commonly affects women during the childbearing years, and young couples are often concerned about the potential effects of inflammatory bowel disease on fertility, pregnancy, and the fetus. This review will critically consider advances over the past 2 years in our knowledge of the effects of inflammatory bowel disease on fertility and pregnancy outcome and the safety and efficacy of medical therapy in the pregnant woman with inflammatory bowel disease. Recent findings The past several years have witnessed significant additions to our knowledge of the effects of ulcerative colitis and Crohn disease on fetal outcome. In addition, important studies have added to the growing database pointing to the overall safety of medical therapy with aminosalicylates and immunomodulators during pregnancy. Limited new data also suggest that inadvertent exposure to infliximab appears not to be harmful to the fetus. Summary Women with Crohn disease appear to be at risk for early delivery and low birthweight infants, and women with ulcerative colitis may be at increased risk for giving birth to children with congenital abnormalities. The clinical significance of these results may be diluted, however, by inability to adequately assess the confounding influence of disease activity or drug treatment. Despite lingering concerns, the most recent data support the overall safety of the 5-aminosalicylate drugs as well as azothiaprine/6-mercaptopurine during pregnancy. Despite these advances, the potential complications of inflammatory bowel disease and its therapies during pregnancy continue to require careful discussion with each individual couple before conception.