Which treatments are considered safe for pregnant patients with inflammatory bowel disease (IBD)?

Updated: Oct 17, 2017
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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The aminosalicylates, including sulfasalazine, are safe during pregnancy. Folate supplements should be taken. Corticosteroids are also safe, but if high doses are needed near the end of the pregnancy, monitor the infant for signs of adrenal suppression. Continuation of immune modifiers (ie, 6-MP, azathioprine) appears to be safe in pregnancy, [105, 115] as well as metronidazole (Flagyl) and ciprofloxacin (Cipro).

It is considered safe to continue TNF-alpha inhibitors during pregnancy (FDA category B), but concerns have been raised about high levels of maternally administered anti-TNF agents being found in the fetal circulation. [116, 117, 118, 119] The manufacturers of infliximab and adalimumab recommend that these 2 agents be discontinued during the third trimester of pregnancy, although there is no documentation of fetal harm. Certolizumab does not cross the placenta. [116, 117, 118, 119]

In a retrospective, multicenter study, treatment of IBD with thiopurines and anti-TNF-alpha drugs did not increase the risk of complications during pregnancy or neonatal complications. [120] The rate of unfavorable Global Pregnancy Outcome and the rate of neonatal complications were lower in pregnant women treated with thiopurines alone than in those exposed to anti-TNF-alpha drugs or those not exposed to either group of agents.

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