May 24, 2012

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IBD Medication Use in Pregnancy: A Review of Evidence For and Against

Caroline Hwang, MD, and Uma Mahadevan, MD

Women with IBD are able to conceive at the same rate as women without IBD, but with an increased risk of adverse events. The biggest risk to pregnancy outcome, aside from a diagnosis of IBD, is disease activity. Therefore, continuing medications to maintain remission is important. Most IBD medications can be continued safely during pregnancy with the exception of methotrexate, which is contraindicated. Azathioprine and 6-mercaptopurine appear to be low risk. The biological agents (infliximab, adalimumab, certolizumab, and natalizumab) have not been associated with birth defects to date. However, placental transfer and high levels of anti-tumor necrosis factor agent in the newborn have been demonstrated and require careful monitoring and dose adjustment. Inflamm Bowel Dis Monit 2011;12(2):47–54.

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LATEST ARTICLES

Leading Articles
- IBD Medication Use in Pregnancy: A Review of Evidence For and Against
  
  Caroline Hwang, MD, and Uma Mahadevan, MD
  
  University of California–San Francisco, San Francisco, CA, USA
  
  Women with IBD are able to conceive at the same rate as women without IBD, but with an increased risk of adverse events. The biggest risk to pregnancy outcome, aside from a diagnosis of IBD, is disease activity. Therefore, continuing medications to maintain remission is important.
- Metabolomics and IBD
  
  Diane R Hildebrand, MB ChB, MRCS(Ed)¹, Natasha P Ross, MB ChB, MRCS(Ed)¹, and Angus JM Watson, MB ChB, FRCS(Ed), FRCS(Gen. Surg.)^1,2
  
  ¹Department of General Surgery, Raigmore Hospital, and ²University of Stirling, Inverness, Scotland, UK
  
  IBD is a chronic inflammatory condition with a high incidence in Northern Europe. Current biological markers are inadequate for detecting, phenotyping, and monitoring the disease. It is therefore imperative to find novel biomarkers that will not only help with diagnosis but that will also shed further light on the pathogenesis of IBD.
Clinical Reviews
Meeting Reports
- 1st British Society of Gastroenterology Supraregional Meeting
  
  Gareth-Rhys Jones, MBChB, BSc (Med Sci) Hons, MRCP
  
  Western General Hospital, Edinburgh, Edinburgh, UK
  Edinburgh, UK, September 15–16, 2011
  
  The inaugural supraregional meeting of the British Society of Gastroenterology was held in the scenic surroundings of Scotland’s capital, in the striking home of the Royal College of Physicians, Edinburgh. The conference boasted a number of domestic and international figures to address current thinking and pioneering research in pathogenesis within the field of IBD.
Commentary
- Pregnancy and Anti-TNF Use: Safety is Not Yet Assured
  
  C Janneke van der Woude, MD, PhD, and Zuzana Zelinkova, MD, PhD
  
  Department of Gastroenterology and Hepatology, ERASMUS MC, Rotterdam, The Netherlands
  
  In the Leading Article, IBD Medication Use in Pregnancy: Review of Evidence For and Against, presented in this issue of the IBD Monitor journal, Drs Caroline Hwang and Uma Mahadevan (University of California, San Francisco, CA, USA) offer an extensive overview that is undoubtedly useful for physicians managing IBD patients who wish to conceive.

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