Global group offers recommendations on IBD at all stages of pregnancy
A global consensus statement on the management of pregnancy in inflammatory bowel disease (IBD) provides advice on how to manage medications and reduce risk of complications, among other topics.
A new global consensus statement addresses disease management of inflammatory bowel disease (IBD) before, during, and after pregnancy.
The statement notes that existing guidelines by different societies and countries varied and reflected fears about treatments, including harm to a fetus, motivating a group of 39 experts and seven patient advocates from six continents to convene, assess current data, and come to agreement on best practices. The group noted that the recommendations were informed by the guiding principle that good maternal health best supports infant health. The committee divided topics into 10 categories, offering 34 GRADE recommendations and 35 consensus statements, published by the American Journal of Gastroenterology on Aug. 27 and Gut on Aug. 28.
The statement offers points for preconception counseling, including that children with first-degree relatives with IBD have an increased risk of the disease and that women with IBD may have decreased fertility, particularly if they have active disease. However, it also noted that results of assisted reproductive technology may be comparable for patients with IBD and those without, including those who have undergone pelvic surgery with IBD undergoing in vitro fertilization.
Recommendations on care during pregnancy include a suggestion that pregnant patients with IBD take low-dose aspirin by 12 to 16 weeks gestation to prevent preterm preeclampsia. The guidance also recommends that patients who are pregnant or attempting conception continue maintenance 5-aminosalicylic acid therapy but discontinue maintenance methotrexate therapy. The experts also suggested continuing maintenance sulfasalazine, thiopurine, anti-tumor necrosis factor, vedolizumab, and ustekinumab therapy.
“A standardized approach utilizing these recommendations in clinical practice will enhance the care of patients through improved counseling, fertility considerations, therapeutic management of IBD during preconception and pregnancy, breastfeeding considerations, and vaccination of infants post-delivery,” the authors concluded. “This process demonstrated understudied areas, particularly in understanding why pregnant women with IBD have more complications (impact of inflammation, diet, placental changes, etc.) as well as the need for more formal safety monitoring, ideally before a drug is approved.”