Managing IBD therapy during pregnancy demands a multidisciplinary approach

2021 ◽  
Vol 75 (2) ◽  
pp. 149-158
Author(s):  
Filip Marek ◽  
Radoslav Hrivnák ◽  
Ivo Rovný ◽  
Petr Jabandžiev ◽  
Karolína Poredská ◽  
...  
Keyword(s):  
Best Practice ◽  
Multidisciplinary Approach ◽  
Conservative Therapy ◽  
Perianal Abscess ◽  
Multidisciplinary Cooperation ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Acute Severe Colitis ◽  
Severe Colitis ◽  
Chronic Inflammatory Bowel

Crohn’s disease and ulcerative colitis are both chronic inflammatory bowel diseases (IBD). This article summarizes current best practice in treating pregnant patients with IBD, ranging from conservative therapy to endoscopy and imaging methods, including a description of surgical therapy indications. Female patients with IBD should ideally plan their pregnancies for when their disease is in remission. Patients in remission may also have complications during pregnancy, however the risk of complications is lower than in patients with active disease. Any chronic medications they were on before becoming pregnant (with the exception of teratogenic methotrexate) should remain unchanged. According to the current literature, pregnancy does not itself complicate the course of IBD. In cases of a severe relapse or an occurrence of complications in these patients, careful multidisciplinary cooperation is required, especially between the gastroenterologist, surgeon, radiologist, and gynaecologist. Surgical treatment is required only in cases of acute complications of IBD (such as acute severe colitis resistant to medical therapy, perianal abscess, and complications of IBD in the sense of such acute abdomen events as perforations, ileus due to a stenosis, or massive haemorrhage).

scholarly journals Pregnancy-Onset Acute Severe Colitis after in vitro Fertilization Embryo Transfer

2020 ◽  
Vol 14 (3) ◽  
pp. 477-482
Author(s):  
Dora Grgić ◽  
Silvija Čuković Čavka ◽  
Vesna Elveđi Gašparović ◽  
Nikša Turk ◽  
Marko Brinar ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Biologic Therapy ◽  
Late Pregnancy ◽  
Vitro Fertilization ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Acute Severe Colitis ◽  
Severe Colitis ◽  
In Pregnancy

Inflammatory bowel diseases (IBD) usually affect women in their fertile years and, therefore, have implications for their fertility and pregnancy. The presence of IBD during pregnancy has been shown to adversely affect pregnancy outcomes, and increased rates of preterm delivery and of spontaneous abortion have been reported. An onset of acute severe colitis in pregnancy has rarely been seen. We present the case of a 42-year-old woman who conceived after 9 attempts of in vitro fertilization and whose pregnancy was the result of a donated oocyte. Shortly after conception, she was diagnosed with severe active ulcerative colitis, and biologic therapy was introduced in the 28th week of pregnancy. Although therapy for IBD in pregnancy is considered safe for most drugs, this was not very well known in 2015. We also consider our case exceptional because we now have a 5-year follow-up of our patient and her child after having begun biologic therapy during late pregnancy.

scholarly journals Management of Acute Severe Colitis in the Era of Biologicals and Small Molecules

2019 ◽  
Vol 8 (12) ◽  
pp. 2169
Author(s):  
Christine Verdon ◽  
Talat Bessissow ◽  
Peter L. Lakatos
Keyword(s):  
Ulcerative Colitis ◽  
Small Molecules ◽  
Patient Monitoring ◽  
Treatment Options ◽  
Medical Emergency ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
New Treatment ◽  
Acute Severe Colitis ◽  
Severe Colitis

Acute severe ulcerative colitis (ASUC) is a medical emergency which occurs in about 20%–30% of patients with ulcerative colitis during their lifetime, and does carry a mortality risk of 1%. The management of inflammatory bowel diseases has evolved with changes in objective patient monitoring, as well as the availability of new treatment options with the development of new biological and small molecules; however, data is limited regarding their use in the context of ASUC. This review aims to discuss the emerging data regarding biologicals and small molecules therapies in the context of ASUC.

scholarly journals Inflammatory bowel disease and COVID-19: A review

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Rabin Hamal ◽  
◽  
Rahul Pathak ◽  
Brindeswari Kafle Bhandari ◽  
Anurag Jha ◽  
...  
Keyword(s):  
Immunosuppressive Drugs ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Severe Illness ◽  
Infectious Risk ◽  
The World ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Health Organization ◽  
Chronic Inflammatory Bowel

The World Health Organization officially declared infection with severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), leading to coronavirus disease 2019 (COVID-19) as a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 and then as a pandemic on March 11, 2020 with reports of infection from most of the countries of the world [1]. COVID-19 has severely disrupted prevention and treatment for noncommunicable diseases. Severe illness can occur in otherwise healthy individuals of any age, but it predominantly occurs in adults with advanced age or certain underlying medical comorbidities [2]. Since the beginning of the health emergency, particular attention has been paid to the management of patients with chronic Inflammatory Bowel Diseases (IBDs) because they frequently are treated with immunosuppressive drugs and therefore potentially are exposed to a greater infectious risk than the general population [3].

scholarly journals Optimization of antenatal monitoring approaches of women with chronic inflammatory bowel diseases

2021 ◽  
pp. 84-92
Author(s):  
O.V. Bulavenko Bulavenko ◽  
D.G. Konkov ◽  
N.V. Kuzminova ◽  
T.V. Lobastova ◽  
I.V. Oleksienko
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Inflammatory Bowel Diseases ◽  
Clinical Guidelines ◽  
Cochrane Library ◽  
Chronic Inflammatory Bowel Diseases ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Chronic Inflammatory Bowel

Chronic inflammatory bowel diseases (CIBD) affect patients at their peak of reproductive age. Clinical presentation of CIBD in pregnancy is associated with an increased risk of adverse effects in mother and fetus, including prematurity, low birth weight, increased indications for caesarean section. Thus optimizing of the CIBD diagnosis and treatment before and during pregnancy is essential to improve maternal and fetal outcomes.Research aim: to analyze the effectiveness of the CIBD clinical management at the stage of preconception and during pregnancy.Materials and methods. It was searched the Cochrane Library, WHO platform, clinical guidelines, and research reference database Medline. All potential studies have evaluated the clinical practice guidelines in women with CIBD for conception, pregnancy and breastfeeding. Recommendations related to the necessary laboratory and instrumental examination methods, therapeutic strategy, the safety of drugs for mother and fetus, the features of multidisciplinary antenatal observation, the timing and method of delivery of pregnant women with CIBD. Results. Treatment in the planning phase and pregnancy should be multidisciplinary, involving a gastroenterologist, obstetrician-gynecologist, primary care physician, pediatrician and a colorectal surgeon if necessary, as well as stakeholders from the association of patients with CIBD. Communication between these professionals is critical to avoid ambivalent or even conflicting counseling, which is an additional source of anxiety for patients, and also potentially dangerous for suboptimal prevention of clinical CIBD manifestation. Obtained results of the analysis will prevent laboratory and therapeutic polypharmacy and significantly improve the pregnancy outcome.Conclusions. Most women with CIBD had a physiological pregnancy and healthy children. However, some studies have linked CIBD to an increased risk of preterm birth and low birth weight infants. The development of national clinical guidelines will optimize and improve the quality of perinatal care to women with CIBD in the Ukraine, and will lead to a decrease in obstetric, fetal and neonatal complications.

Sign in / Sign up

Export Citation Format

Share Document