Aust J Gen Pract. 2022 Oct;51(10):747-753. doi: 10.31128/AJGP-04-22-6400.

Ralley Prentice ¹, Emily K Wright ², Emma Flanagan ³, Lani Prideaux ⁴, Rimma Goldberg ⁴, Sally J Bell ⁵

Author information

¹MBBS, FRACP, Inflammatory Bowel Disease in Pregnancy Fellow, St Vincent@s Hospital, Melbourne, Vic; Inflammatory Bowel Disease in Pregnancy Fellow, Monash Health, Melbourne, Vic.

²MBBS, FRACP, PhD, Head of Intestinal Ultrasound, Consultant Gastroenterologist, St Vincent@s Hospital, Melbourne, Vic.

³MBBS, FRACP, PhD, Head of Inflammatory Bowel Disease in Pregnancy Clinic, St Vincent@s Hospital, Melbourne, Vic.

⁴MBBS, FRACP, PhD, Consultant Gastroenterologist, Monash Health, Melbourne, Vic.

⁵MBBS, FRACP, MD, Consultant Gastroenterologist, Monash Health, Melbourne, Vic.

Abstract

Background: Inflammatory bowel disease (IBD), comprising ulcerative colitis and Crohn's disease, commonly affects individuals of childbearing age. Pregnancy in women with IBD presents an anxiety-provoking prospect for practitioners and patients alike, with disease flares occurring in between 20% and 55% of patients antenatally.

Objective: The aim of this review is to provide an overview of antenatal IBD management principles and therapeutic goals, with a specific focus on the role of general practitioners.

Discussion: A collaborative approach is favoured in managing pregnancy and IBD. Preconception counselling should be prioritised, with emphasis on the importance of achieving three months of preconception corticosteroid-free remission. Close monitoring of disease activity in pregnancy is crucial, warranting the careful interpretation of both clinical and biochemical parameters. Reassurance regarding the safety of IBD medications in pregnancy and vaginal delivery can be provided in the majority of cases. Specialist support should be sought expeditiously in the setting of disease flare, particularly where symptoms and biochemical parameters are refractory to escalation of 5-aminosalicylates or topical therapies, corticosteroids or biologic agents are required, or an emergent IBD complication is suspected.