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

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

Abstract

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.