Crohns Colitis. 2024 Oct 30;18(Supplement_2):ii16-ii30.doi: 10.1093/ecco-jcc/jjae048.

Paula Sousa ¹, Javier P Gisbert ², Mette Julsgaard ^3 4, Christian Philipp Selinger ^5 6, María Chaparro ²

Author information

¹Department of Gastroenterology, Hospital São Teotónio - Unidade Local de Saúde Dão Lafões, Viseu, Portugal.

²Department of Gastroenterology, Inflammatory Bowel Disease Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-Princesa], Universidad Autónoma de Madrid [UAM], Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain.

³Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.

⁴Centre for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.

⁵Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

⁶University of Leeds, Leeds, UK.

Abstract

Inflammatory bowel disease [IBD] is often diagnosed in patients during their reproductive years. It is crucial that both healthcare providers and patients are adequately informed to avoid misguided decisions regarding family planning. One of the most important aspects during conception and pregnancy is to maintain disease remission, as disease activity is associated with adverse pregnancy outcomes. Apart from methotrexate, most conventional drugs used in IBD are considered low risk during conception and pregnancy. For newer agents, evidence is still limited. If needed, surgery must not be postponed and should ideally be performed in specialized centres. In most patients, delivery should be vaginal except for patients with complex perianal disease, with an ileoanal pouch anastomosis, or if there is an obstetric contraindication. In children exposed to biological treatments during pregnancy, the risk of infections appears to be low, and psychomotor development is probably not affected. Regarding immunizations, the standard vaccination schedule for inactivated vaccines should be followed for children exposed to biologics in utero. In the case of live vaccines, such as rotavirus, decisions should be individualized and take into consideration the risk-benefit ratio, particularly in developing countries. In this review, we provide a comprehensive and updated overview of aspects related to fertility, pregnancy, breastfeeding, and the impact on the care of children born to mothers with IBD. Both the available evidence and areas of uncertainty are discussed, with the goal of assisting healthcare professionals caring for IBD patients during this important stage of their lives.

Keywords: Crohn’s disease; Fertility; breastfeeding; gestation; inflammatory bowel disease; lactation; offspring; pregnancy; ulcerative colitis.