Reproduction in the Patient With Inflammatory Bowel Disease

Z. S. Heetun; C. Byrnes; P. Neary; C. O'Morain

Disclosures

Aliment Pharmacol Ther. 2007;26(4):513-533. 

In This Article

Summary and Introduction

Background: Inflammatory bowel disease (IBD) affects mainly the young population. The effect of IBD and its treatment on fertility and pregnancy is therefore an important clinical consideration.
Aim: To review the best management of IBD in the reproductive and pregnant population.
Methods: A MEDLINE and an EMBASE search were performed using mainly the search phrases 'pregnancy AND IBD,' 'sulphasalazine AND male fertility,' 'abdominal surgery AND female fertility,' 'AZA AND placenta' and 'infliximab AND pregnancy.' No language or date restrictions were placed. References of review articles were examined.
Results: Overall male and female fertility are not affected by IBD. Sulphasalzine reduces male fertility. No other drugs used in IBD affect significantly fertility in humans. The risk of pregnancy-related complications and the disease behaviour during pregnancy depends mainly on disease activity at time of conception. Proactive treatment for maintenance of disease remission during gestation is recommended. Except for methotrexate, drugs used in IBD appear safe in pregnancy. Breast feeding should be encouraged.
Conclusion: The management of IBD in the young and pregnant population remains controversial because the literature comes mostly from retrospective studies. Further studies particularly large prospective trials are needed to guide clinicians in decision making.

Ulcerative Colitis (UC) and Crohn's Disease (CD) are two chronic idiopathic gastrointestinal conditions, commonly referred to as inflammatory bowel disease (IBD). Their incidence shows a bimodal distribution curve with the higher peak in the younger population. Fifty percent of patients are less than 35-years old at the time of diagnosis[1] and a quarter of them conceive for the first time after the diagnosis.[2] The impact of IBD and its treatment on fertility and pregnancy is therefore an important clinical consideration. The management of IBD in the fertile or pregnant patient is controversial because most of the evidence relating to fertility and pregnancy in IBD comes from opinions of experts and a few case-control trials rather than randomized control trials.[3] The aim of this review article is to summarize the current literature on fertility and pregnancy in the presence of IBD and provide a critical review as to best management of IBD in the reproductive and pregnant population.

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