Australian inflammatory bowel disease consensus statements for preconception, pregnancy and breast feeding

Gut. 2023 Jun;72(6):1040-1053. doi: 10.1136/gutjnl-2022-329304.Epub 2023 Mar 21.


Robyn Laube 1 2Christian P Selinger 3Cynthia H Seow 4Britt Christensen 5Emma Flanagan 6Debra Kennedy 7Reme Mountifield 8Sean Seeho 9Antonia Shand 10Astrid-Jane Williams 11Rupert W Leong 12 2 13 14


Author information

1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.

2Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia.

3Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

4Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

5Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

6Department of Gastroenterology, University of Melbourne, Melbourne, Victoria, Australia.

7MotherSafe, Royal Hospital for Women, Sydney, New South Wales, Australia.

8Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia.

9Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.

10Department of Maternal Foetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.

11Department of Gastroenterology, Liverpool Hospital, Liverpool, New South Wales, Australia.

12Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia rupertleong@outlook.com.

13Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord, New South Wales, Australia.

14The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.


Objective: Because pregnancy outcomes tend to be worse in women with inflammatory bowel disease (IBD) than in those without, we aimed to update consensus statements that guide the clinical management of pregnancy in patients with IBD.

Design: A multidisciplinary working group was established to formulate these consensus statements. A modified RAND/UCLA appropriateness method was used, consisting of a literature review, online voting, discussion meeting and a second round of voting. The overall agreement among the delegates and appropriateness of the statement are reported.

Results: Agreement was reached for 38/39 statements which provide guidance on management of pregnancy in patients with IBD. Most medications can and should be continued throughout pregnancy, except for methotrexate, allopurinol and new small molecules, such as tofacitinib. Due to limited data, no conclusion was reached on the use of tioguanine during pregnancy. Achieving and maintaining IBD remission before conception and throughout pregnancy is crucial to optimise maternofetal outcomes. This requires a multidisciplinary approach to engage patients, allay anxieties and maximise adherence tomedication. Intestinal ultrasound can be used for disease monitoring during pregnancy, and flexible sigmoidoscopy or MRI where clinically necessary.

Conclusion: These consensus statements provide up-to-date, comprehensive recommendations for the management of pregnancy in patients with IBD. This will enable a high standard of care for patients with IBD across all clinical settings.

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