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Inflammatory bowel disease and pregnancy


Authors: Karel Lukáš 1;  prof. MUDr. Antonín Pařízek, CSc. 2;  Jaroslav Kotlas 3;  Aleš Novotný 1
Authors‘ workplace: Univerzita Karlova v Praze, 1. lékařská fakulta, IV. interní klinika VFN 1;  Univerzita Karlova v Praze, 1. lékařská fakulta, Gynekologicko-porodnická klinika VFN 2;  Univerzita Karlova v Praze, 1. lékařská fakulta, Ústav biologie a lékařské genetiky 3
Published in: Čas. Lék. čes. 2010; 149: 163-172
Category: Review Article

Overview

Inflammatory bowel disease (IBD) commonly affects women during the reproductive years. Opinion on the effect of IBD on fertility, conception, pregnancy and breastfeeding is varied. IBD does not have probably adverse effect on the outcome of pregnancy. Pregnancy in IBD patients should be closely monitored. This review provides the most current information on the inheritance, fertility, pregnancy, outcomes, foetal development and management of disease during pregnancy, and safety of medications in pregnancy and breastfeeding.

Key words:
inflammatory bowel disease, Crohn’s disease, ulcerative colitis, fertility, pregnancy, breastfeeding, therapy.


Sources

1. Bortoli A, Saibeni S, Tatarella M, Prada A, Beretta L, Rivolta R, Politi P, Ravelli P, Imperiali G, Colombo E, Pera A, Daperno M, Carnovali M, de Franchis R, Vecchi M. Study Group for Inflammatory Bowel Diseases GSMII: Pregnancy before and after the diagnosis of inflammatory bowel diseases: retrospective case-control study. J Gastroenterol Hepatol 2007; 22(4): 542–549.

2. Dignass AU, Hartmann F, Sturm A, Stein J. Management of inflammatory bowel diseases during pregnancy. Dig Dis 2009; 27(3): 341–346.

3. Mahadevan, U, Sandborn, WJ, Li D-K, Hakimian S, Kane S, Corley DA. Pregnanacy Outcomes in Women With Inflammatory Bowel Disease: A Large Community-Based Study From Nothern Kalifornia. Gastreonterology 2007; 133(4): 1106–1112.

4. Cornish J, Tan E, Teare J, Teoh TG, Rai R, Clark SK, Tekis PP. A meta-analysis on the influence inflammatory bowel disease on pregnancy. Gut 2007; 56: 830–837.

5. Sigmund B, Zeitz M. Inflammatory bowel disease and pregnancy. Z Gastroenterol 2009; 47(10): 1069–1074.

6. Cohen RD. Inflammatory Bowel Dis. Totowa New Jersey: Humana Press 2003; s. 299.

7. Godet PG,May GR, Sutherland LR. Meta-analysis of the role of oral contraceptive agents in inflammatory bowel disease. Gut 1995; 37: 668–673.

8. Timmer A, Sutherland LR, Martin F. Oral contraceptive use and smoking are risk factors for relapse in Crohn‘s disease. The Canadian Mesalamine for Remission of Crohn‘s Disease Study Group. Gastroenterology 1998; 114(6): 1143–1150.

9. Cottone M, Orlando A, Viscido A, Calabrese E, Cammą C, Casą A. Review article: prevention of postsurgical relapse and recurrence in Crohn‘s disease. Aliment Pharmacol Ther 2003; 17 (Suppl 2): 38–42.

10. Cosnes J, Carbonnel F, Carrat F, Beaugerie L, Gendre JP. Oral contraceptive use and the clinical course of Crohn‘s disease: a prospective cohort study. Gut 1999; 45(2): 218–222.

11. Cornish JA, Tan E, Simillis C, Clark SK, Teare J, Tekkis PP. The risk of oral contraceptives in the etiology of inflammatory bowel disease: a meta-analysis. Am J Gastroenterol 2008; 103(9): 2394–2400.

12. Ida A, Koyama K. Ulcerative colitis and pregnancy. Nippon Rinsho 1999; 57(11): 2603–2607.

13. Alstead EM. Inflammatory bowel disease in pregnancy. Postgrad Med J 2002; 78(923): 572.

14. 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(7): 821–825.

15. Zimmermann EM. Approach to Gastrointestinal Disease in the Female Patiens. In: Textbook of Gastroenterology. Yamada, T. ed.: Lippincott Williams & Wilkins 1999, s. 1059–1080.

16. Korelitz BI. Inflammatory bowel disease and pregnancy. Gastreonterol Clin N Amer 1998; 27(1): 213–224.

17. Heetun ZS, Byrnes C, Neary P, O‘Morain C. Review article: Reproduction in the patient with inflammatory bowel disease.Aliment Pharmacol Ther 2007; 26(4): 513–533.

18. Hinkes E, Plotkin D. Reversible drug-induced sterility in a patient with acute leukemia. JAMA 1973; 223(13): 1490–1491.

19. Rajapakse RO, Korelitz BI, Zlatanic J, Baiocco PJ, Gleim GW. Outcome of pregnancies when fathers are treated with 6‑mercaptopurine for inflammatory bowel disease. Am J Gastroenterol 2000; 95(3): 684–688.

20. Suominen JS, Wang Y, Kaipia A, Toppari J. Tumor necrosis factor-alpha (TNF-alpha) promotes cell survival during spermatogenesis, and this effect can be blocked by infliximab, a TNF-alpha antagonist. Eur J Endocrinol 2004; 151(5): 629–640.

21. Cornish JA, Tan E, Teare J, Teoh TG, Rai R, Darzi AW, Paraskevas P, Clark SK, Tekkis PP. The effect of restorative proctocolectomy on sexual function, urinary function, fertility, pregnancy and delivery: a systematic review. Dis Colon Rectum 2007; 50(8): 1128–1138.

22. Pintérová Kolesárová M, Pintér M, Rejchrt S, et al. Vliv idiopatického střevního zánětu na interval potřebný pro početí pacientek. Čes Gynek 2008; 73: 109–112.

23. Zbořil V, et al. Imunosupresiva v éčbě idiopatických střevních zánětů. Praha: Grada Publishing 2007; s. 100–112.

24. Mogadam M, Korelitz BI, Ahmed SW, Dobbins WO 3rd, Baiocco PJ. The course of inflammatory bowel disease during pregnancy and postpartum.. Am J Gastroenterol 1981; 75(4): 265–269.

25. Miller JP. Inflammatory bowel disease in pregnancy: a review. J R Soc Med 1986; 79(4): 221–225.

26. Reddy D, Murphy SJ, Kane SV, Present DH, Kornbluth AA. Relapses of inflammatory bowel disease during pregnancy: in-hospital management and birth outcomes. Am J Gastroenterol 2008; 103(5): 1203–1209.

27. Mountfield 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): 720–725.

28. Sonnenberg A. Date of birth in the occurrence of inflammatory bowel disease. Inflamm Bowel Dis 2009; 15(2): 206–211.

29. Dominitz JA, Young JC, Boyko EJ. Outcomes of infants born to mothers with inflammatory bowel disease: a population-based cohort study. Am J Gastroenterol 2002; 97(3): 641–648.

30. Van Assche G, Dignass A, Reinisch W, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Speciál situations. Journal of Crohn’s Colitis (2010), doi: 10.1016/j.crohns.2009.09.009.

31. American Gastroenterological Association Institute: American Gastroenterological Association Institute Position Statement on the Use Gastrointestinal Medications in Pregnancy. Gastroenterology 2006; 131: 278–282, 283–311.

32. Ferrero S, Ragni N. Inflammatory bowel disease: management issues during pregnancy. Arch Gynecol Obstet 2004; 270(2): 79–85.

33. Mogadam M, Dobbins WO 3rd, Korelitz BI, Ahmed SW. Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome. Gastroenterology 1981; 80(1): 72–76.

34. Dubinsky M, Abraham B, Mahadevan U. Management of the pregnant IBD patient.. Inflamm Bowel Dis 2008; 14(12): 1736–1750.

35. Brar H, Einarson A. Effects and treatment of inflammatory bowel disease during pregnancy. Can Fam Physician 2008; 54(7): 981–983.

36. Habal FM, Hui G, Greenberg GR. Oral 5-aminosalicylic acid for inflammatory bowel disease in pregnancy: safety and clinical course. Gastroenterology 1993; 105(4): 1057–1060.

37. Marteau P, Devaux CB. Mesalazine during pregnancy. Lancet 1994; 344(8938): 1708–1709.

38. Marteau P, Tennenbaum R, Elefant E, Lémann M, Cosnes J. Foetal outcome in women with inflammatory bowel disease treated during pregnancy with oral mesalazine microgranules. Aliment Pharmacol Ther 1998; 12(11): 1101–1108.

39. Trallori G, d‘Albasio G, Bardazzi G, Bonanomi AG, Amorosi A, Del Carlo P, Palli D, Galli M, Pacini F. 5-Aminosalicylic acid in pregnancy: clinical report. Ital J Gastroenterol 1994; 26(2): 75–78.

40. NŅrgĆrd B, Puho E, Pedersen L, Czeizel AE, SŅrensen HT. Risk of congenital abnormalities in children born to women with ulcerative colitis: a population-based, case-control study. Am J Gastroenterol 2003; 98(9): 2006–2010.

41. Czeizel AE, Rockenbauer M. A population based case-control teratologic study of oral metronidazole treatment during pregnancy. Br J Obstet Gynaecol 1998; 105(3): 322–327.

42. Czeizel AE, Tóth M. Birth weight, gestational age and medications during pregnancy. Int J Gynaecol Obstet 1998; 60(3): 245–249.

43. Niebyl JR. Antibiotics and other anti-infective agents in pregnancy and lactation. Am J Perinatol 2003; 20(8): 405–414.

44. Loebstein R, Addis A, Ho E, Andreou R, Sage S, Donnenfeld AE, Schick B, Bonati M, Moretti M, Lalkin A, Pastuszak A, Koren G. Pregnancy outcome following gestational exposure to fluoroquinolones: a multicenter prospective controlled study. Antimicrob Agents Chemother 1998; 42(6): 1336–1339.

45. Larsen H, Nielsen GL, SchŅnheyder HC, Olesen C, SŅrensen HT. Birth outcome following maternal use of fluoroquinolones. Int J Antimicrob Agents 2001; 18(3): 259–262.

46. Rodríguez-Pinilla E, Martínez-Frías ML. Corticosteroids during pregnancy and oral clefts: a case-control study. Teratology 1998; 58(1): 2–5.

47. Gur C, Diav-Citrin O, Shechtman S, Arnon J, Ornoy A. Pregnancy outcome after first trimester exposure to corticosteroids: a prospective controlled study. Reprod Toxicol 2004; 18(1): 93–101.

48. Boulton R, Hamilton M, Lewis A, Walker P, Pounder R. Fulminant ulcerative colitis in pregnancy. Am J Gastroenterol 1994; 89(6): 931–933.

49. Kment M, a kol. Choroby gastrointestinálního traktu v raviditě. Praha: Triton 2003; 58 s.

50. Gluck JC, Gluck PA. Asthma controller therapy during pregnancy. Am J Obstet Gynecol 2005; 192(2): 369–380.

51. Gluck PA, Gluck JC. A review of pregnancy outcomes after exposure to orally inhaled or intranasal budesonide. Curr Med Res Opin 2005; 21(7): 1075–1084.

52. Norjavaara E, de Verdier MG. Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide. J Allergy Clin Immunol 2003; 111(4): 736–742.

53. Källén B, Rydhstroem H, Aberg A. Congenital malformations after the use of inhaled budesonide in early pregnancy. Obstet Gynecol 1999; 93(3): 392–395.

54. Beaulieu DB, Ananthakrishnan AN, Issa M, Rosenbaum L, Skaros S, Newcomer JR, Kuhlmann RS, Otterson MF, Emmons J, Knox J, Binion DG. Budesonide induction and maintenance therapy for Crohn‘s disease during pregnancy. Inflamm Bowel Dis 2009; 15(1): 25–28.

55. Del Campo M, Kosaki K, Bennett FC, Jones KL. Developmental delay in fetal aminopterin/methotrexate syndrome. Teratology 1999; 60(1): 10–12.

56. Stenson WF, Hanauer SB, Cohen RD. Inflammatory bowel disease. In: Texbook of Gastroenterology. Yamada, T. ed.: Willey-Blackwell; Oxford: Hoboken 2009; 1386–1472.

57. Lichtenstein GR, Hanauer SB, Sandborn WJ, The Practice Parameters Comittee of the American College of Gastroenterology. Management of Crohn’s Disease in Adults. Amer J Gastroenterol 2009; 104: www.amjgastro.com.

58. Angelberger S, Reinisch W, Dejaco C. Prevention of abortion by ciclosporin treatment of fulminant ulcerative colitis during pregnancy. Gut 2006; 55(9): 1364–1365.

59. Bertschinger P, Himmelmann A, Risti B, Follath F. Cyclosporine treatment of severe ulcerative colitis during pregnancy. Am J Gastroenterol 1995; 90(2): 330.

60. Reindl W, Schmid RM, Huber W. Cyclosporin A treatment of steroid-refractory ulcerative colitis during pregnancy: report of two cases. Gut 2007; 56(7): 1019.

61. Coburn LA, Wise PE, Schwartz DA. The successful use of adalimumab to treat active Crohn‘s disease of an ileoanal pouch during pregnancy. Dig Dis Sci 2006; 51(11): 2045–2047.

62. Mishkin DS, Van Deinse W, Becker JM, Farraye FA. Successful use of adalimumab (Humira) for Crohn‘s disease in pregnancy. Inflamm Bowel Dis 2006; 12(8): 827–828.

63. Hoentjen F, van Bodegraven AA. Safety of anti-tumor necrosis factor therapy in inflammatory bowel disease. World J Gastroenterol 2009; 15(17): 2067–2073.

64. Ehrenpreis ED, Kane SV, Cohen LB, Cohen RD, Hanauer SB. Thalidomide therapy for patients with refractory Crohn‘s disease: an open-label trial. Gastroenterology 1999; 117(6): 1271–1277.

65. Griffiths AM, Ohlsson AP, Herman M, et al. Meta-analysis of enteral nutrition as a primary treatment of active Crohn’s disease. Gastroenterology 1995; 108: 1056.

66. Griffiths AM. Inflammatory bowel disease. Nutrition 1998; 14: 788.

67. ESPEN Doporučené postupy pro enterální výživu: Gastroenterologie. http: //www.nutriciamedical.sk/tinymce/ jscripts/tiny_mce/plugins/filemanager/files/espen_guidelines.pdf.

68. Kilpatrick CC, Monga M. Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am 2007; 34(3): 389–402.

69. Upadhyay A, Stanten S, Kazantsev G, Horoupian R, Stanten A. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy. Surg Endosc 2007; 21(8): 1344–1348.

70. Katz JA. Pregnancy and inflammatory bowel disease. Curr Opin Gastroenterol 2004; 20(4): 328–332.

71. Mottet C, Juillerat P, Gonvers JJ, Froehlich F, Burnand B, Vader JP, Michetti P, Felley C. Pregnancy and Crohn‘s disease. Digestion 2005; 71(1): 54–61.

72. Guessous I, Juillerat P, Pittet V, Froehlich F, Burnand B, Mottet C, Felley C, Michetti P, Vader JP. Evaluating appropriateness of treatment for Crohn‘s disease: feasibility of an explicit approach. Digestion 2007; 75(1): 46–52.

73. 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(11): 1918–1922.

74. Gould SR, Brash AR, Conolly ME, Lennard-Jones JE. Studies of prostaglandins and sulphasalazine in ulcerative colitis. Prostaglandins Med 1981; 6(2): 165–182.

75. Baird DD, Narendranathan M, Sandler RS. Increased risk of preterm birth for women with inflammatory bowel disease. Gastroenterology 1990; 99(4): 987–994.

76. Wilcox AJ, Weinberg CR, Baird DD. Risk factors for early pregnancy loss. Epidemiology 1990; 1(5): 382–385.

77. Morales LS, Staiger D, Horbar JD, Carpenter J, Kenny M, Geppert J, Rogowski J. Mortality among very low-birthweight infants in hospitals serving minority populations. Am J Public Health 2005; 95(12): 2206–2212.

78. Fedorkow DM, Persaud D, Nimrod CA. Inflammatory bowel disease: a controlled study of late pregnancy outcome. Am J Obstet Gynecol 1989; 160(4): 998–1001.

79. Larzilliere I, Beau P. Chronic inflammatory bowel disease and pregnancy. Case control study Gastroenterol Clin Biol 1998; 22(12): 1056–1060.

80. Kornfeld D, Cnattingius S, Ekbom A. Pregnancy outcomes in women with inflammatory bowel disease – a population-based cohort study. Am J Obstet Gynecol 1997; 177(4): 942–946.

81. Elbaz G, Fich A, Levy A, Holcberg G, Sheiner E. Inflammatory bowel disease and preterm delivery. Int J Gynaecol Obstet 2005; 90(3): 193–197.

82. UbiĖa-Aznar E, De Sola-Earle C, Rivera-Irigoin R, Fernández-Moreno N, Vera-Rivero F, Fernández-Pérez F, Navarro-Jarabo JM, García-Fernández G, Moreno-Mejías P, Pérez-Aisa A, Perea-Milla E. Crohn‘s disease and pregnancy. A descriptive and retrospective study. Gastroenterol Hepatol 2006; 29(5): 277–280.

83. Fonager K, SŅrensen HT, Olsen J, Dahlerup JF, Rasmussen SN. Pregnancy outcome for women with Crohn‘s disease: a follow-up study based on linkage between national registries. Am J Gastroenterol 1998; 93(12): 2426–2430.

84. Moser MA, Okun NB, Mayes DC, Bailey RJ. Crohn‘s disease, pregnancy, and birth weight. Am J Gastroenterol 2000; 95(4): 1021–1026.

85. NŅrgĆrd B, Puho E, Pedersen L, Czeizel AE, SŅrensen HT. Risk of congenital abnormalities in children born to women with ulcerative colitis: a population-based, case-control study. Am J Gastroenterol 2003; 98(9): 2006–2010.

86. Reinisch JM, Simon NG, Karow WG, Gandelman R. Prenatal exposure to prednisone in humans and animals retards intrauterine growth. Science 1978; 202(4366): 436–438.

87. Nielsen OH, Andreasson B, Bondesen S, Jarnum S. Pregnancy in ulcerative colitis. Scand J Gastroenterol 1983; 18(6): 735–742.

88. NŅrgĆrd B, Fonager K, Pedersen L, Jacobsen BA, SŅrensen HT. Birth outcome in women exposed to 5-aminosalicylic acid during pregnancy: a Danish cohort study. Gut 2003; 52(2): 243–247.

89. NŅrgĆrd B, Pedersen L, Fonager K, Rasmussen SN, SŅrensen HT. Azathioprine, mercaptopurine and birth outcome: a population-based cohort study. Aliment Pharmacol Ther 2003; 17(6): 827–834.

90. Įstensen M, Sicher P, Förger F, Villiger PM. Activation markers of peripheral blood mononuclear cells in late pregnancy and after delivery: a pilot study. Ann Rheum Dis 2005; 64(2): 318–320.

91. Įstensen M, Förger F, Nelson JL, Schuhmacher A, Hebisch G, Villiger PM. Pregnancy in patients with rheumatic disease: anti-inflammatory cytokines increase in pregnancy and decrease post partum. Ann Rheum Dis 2005; 64(6): 839–844.

92. Jantchou P, Turck D, Baldé M, Gower-Rousseau C. Breastfeeding and risk of inflammatory bowel disease: results of a pediatric, population-based, case-control study. Am J Clin Nutr 2005; 82(2): 485–486.

93. Klement E, Cohen RV, Boxman J, Joseph A, Reif S. Breastfeeding and risk of inflammatory bowel disease: a systematic review with metaanalysis. Am J Clin Nutr 2004; 80: 1342–1352.

94. Baron S, Turck D, Leplat C, et al. Environmental risk factors in pediatric inflammatory bowel diseases: a population-based case-control study. Gut 2005; 54: 357– 363.

95. Farrukh A, Mayberry JF. Breastfeeding and Inflammatory Bowel Disease. Inflamm Bowel Dis 2008; 14 (Suppl 2): 39–40.

96. Sodhi A, Tripathi A. Prolactin induced production of cytokines in macrophages involves Ca++ and p42/44 MAP kinase signaling pathway. Growth Factors 2008; 26(4): 212–219.

97. Ost L, Wettrell G, Björkhem I, Rane A. Prednisolone excretion in human milk. J Pediatr 1985; 106(6): 1008–1011.

98. Physician Desk Reference, Thomson Health Care Inc, NJ 2008 (www.PDR.net).

99. Heisterberg L, Branebjerg PE. Blood and milk concentrations of metronidazole in mothers and infants. J Perinat Med 1983; 11(2): 114–120.

100. Moretti ME, Verjee Z, Ito S, Koren G. Breast-feeding during maternal use of azathioprine. Ann Pharmacother 2006; 40(12): 2269–2272.

101. Gardiner SJ, Gearry RB, Roberts RL, Zhang M, Barclay ML, Begg EJ. Exposure to thiopurine drugs through breast milk is low based on metabolite concentrations in mother-infant pairs. Br J Clin Pharmacol 2006; 62(4): 453–456.

102. Gardiner SJ, Gearry RB, Barclay ML, Begg EJ. Two cases of thiopurine methyltransferase (TPMT) deficiency – a lucky save and a near miss with azathioprine. Br J Clin Pharmacol 2006; 62(4): 473–476.

103. Sau A, Clarke S, Bass J, Kaiser A, Marinaki A, Nelson-Piercy C. Azathioprine and breastfeeding: is it safe? Br J OBstet Gynecol 2007; 114(4): 498–501.

104. American Academy Ped Comittee on Drugs. Pediatrics 2001; 108: 776–789.

105. Moretti ME, Sgro M, Johnson DW, Sauve RS, Woolgar MJ, Taddio A, Verjee Z, Giesbrecht E, Koren G, Ito S. Cyclosporine excretion into breast milk. Transplantation 2003; 75(12): 2144–2146.

106. Mikhailov TA, Furner SE. Breastfeeding and genetic factors in the etiology of inflammatory bowel disease in children. World J Gastroenterol 2009; 15(3): 270–279. http: //www.ncbi.nlm. nih.gov/sites/entrez?db=omim

107. http://www.ncbi.nlm.nih.gov/sites/entrez?db=omim

108. Zhang H, Massey D, Tremelling M, Parkes M. Genetics of inflammatory bowel disease: clues to pathogenesis. Review. Br Med Bull 2008; 87: 17–30.

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