Pregnancy and medications for inflammatory bowel disease: An updated narrative review

Inflammatory bowel disease (IBD) is often diagnosed during the peak reproductive years of young women. Women with active IBD around conception are at a significantly increased risk of disease relapse during pregnancy, which is associated with poor pregnancy and neonatal outcomes. Given these substantial risks, it is prudent that disease remission should ideally be achieved before conception. Unfortunately, some patients may experience a disease flare-up even if they are in a state of remission before pregnancy. Patients must continue their IBD medications to reduce the risk of disease flare and subsequent poor outcomes during the gestational and postpartum periods. When treating IBD flare-ups during pregnancy, the management is quite similar to the therapeutic approach for non-pregnant patients with IBD, including 5-aminosalicylate, steroids, calcineurin inhibitors (CNIs), and biologic therapies. While the data regarding the safety of CNIs in pregnant women with IBD is limited, the findings in our recent meta-analysis suggest that CNIs may be safer to use in those with IBD than in solid organ transplant recipients. There are several types of biologics and small-molecule therapies currently approved for IBD, and physicians should thoroughly understand their clinical benefits and safety profiles when utilizing these treatments in the context of pregnancy. This review highlights recent studies, including our systematic review and meta-analysis, and discusses the clinical advantages and safety considerations of biologics and small molecules for pregnant women with IBD.

Automated summary

Inflammatory bowel disease (IBD) is more common in young women during their peak reproductive years. Women with active IBD during pregnancy have a higher risk of disease relapse, leading to poor outcomes for both mother and baby. Achieving disease remission before conception is ideal, but some patients may experience flare-ups during pregnancy. Medication for IBD should be continued to reduce the risk of flare-ups and poor outcomes. Treatment for IBD flare-ups during pregnancy is similar to non-pregnant patients, including the use of 5-aminosalicylates, steroids, calcineurin inhibitors, and biologic therapies. The safety of calcineurin inhibitors in pregnant women with IBD is limited, but recent findings suggest they may be safer than in solid organ transplant recipients. Physicians should have a thorough understanding of the benefits and safety profiles of biologics and small molecules for pregnant women with IBD.