Care of Women with Chronic Inflammatory Bowel Disease (Chronic IBD) During PregnancyRecommendations of the Obstetrics and Prenatal Medicine Working Group of the DGGG Artikel in mehreren Sprachen: English | deutsch
The incidence of chronic inflammatory bowel disease (chronic IBD) in persons of reproductive age is high. Chronic IBD does not typically lead to impaired fertility. Nevertheless, the percentage of women suffering from chronic IBD who have children is lower than that of the general population, due to self-imposed childlessness. Providing women with open, unbiased information and, if necessary, helping them to overcome baseless fears should therefore be an essential part of preconception counseling. With the exception of methotrexate, most standard drugs can and should be continued during pregnancy. If the pregnancy occurs during an inactive phase of disease, the rate of complications in pregnancy should, in principle, not be higher than normal. Nevertheless, pregnant women with chronic IBD are classed as high-risk pregnancies. Organ screening in accordance with DEGUM II criteria should be carried out in every case, and women must be monitored for the potential development of placental insufficiency. Any flare-ups which occur during pregnancy should be treated in full. Vaginal delivery can be considered if there is no perianal manifestation of disease; however, the individual risk must be carefully weighed up.
Eingereicht: 28. Februar 2021
Angenommen nach Revision: 10. März 2021
Artikel online veröffentlicht:
08. Dezember 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Preiß JC, Bokemeyer B, Buhr HJ. et al. German Society of Gastroenterology. [Updated German clinical practice guideline on „Diagnosis and treatment of Crohnʼs disease“ 2014]. Z Gastroenterol 2014; 52: 1431-1484 DOI: 10.1055/s-0034-1385199.
- 2 Kucharzik T, Dignass AU, Atreya R. et al. Collaborators. Aktualisierte S3-Leitlinie Colitis ulcerosa – Living Guideline. Z Gastroenterol 2020; 58: e241-e326 DOI: 10.1005/a-1296-3444.
- 3 Hudson M, Flett G, Sinclair TS. et al. Fertility and pregnancy in inflammatory bowel disease. Int J Gynaecol Obstet 1997; 58: 229-237
- 4 Vermeire S, Carbonnel F, Coulie P. et al. Management of inflammatory bowel disease in pregnancy. J Crohns Colitis 2012; 6: 811-823
- 5 Mountifield R, Bampton P, Prosser R. et al. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis 2009; 15: 720-725
- 6 Schmidt M. Präkonzeptionelle Beratung. Frauenheilkunde up2date 2018; 12: 23-35
- 7 Riis L, Vind I, Politi P. et al. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease. Am J Gastroenterol 2006; 101: 1539-1545
- 8 Moser MA, Okun NB, Mayes DC. et al. Crohnʼs disease, pregnancy, and birth weight. Am J Gastroenterol 2000; 95: 1021-1026
- 9 Nørgård B, Hundborg HH, Jacobsen BA. et al. Disease activity in pregnant women with Crohnʼs disease and birth outcomes: a regional Danish cohort study. Am J Gastroenterol 2007; 102: 1947-1954
- 10 Kim MA, Kim YH, Chun J. et al. The influence of disease activity on pregnancy outcomes in women with inflammatory bowel disease: A systematic review and meta-analysis. J Crohns Colitis 2020; jjaa225 DOI: 10.1093/ecco-jcc/jjaa225.
- 11 Magro F, Gionchetti P, Eliakim R. et al. European Crohnʼs and Colitis Organisation [ECCO]. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis 2017; 11: 649-670
- 12 Embryotox. Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie; Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin. Accessed March 06, 2021 at: http://www.embryotox.de
- 13 van der Woude CJ, Kolacek S, Dotan I. et al. for the European Crohnʼs Colitis Organisation (ECCO). European evidenced-based consensus on reproduction in inflammatory bowel disease. J Crohns Colitis 2010; 4: 493-510
- 14 Laube R, Paramsothy S, Leong RW. Use of medications during pregnancy and breastfeeding for Crohnʼs disease and ulcerative colitis. Expert Opin Drug Saf 2021; DOI: 10.1080/14740338.2021.1873948.
- 15 Bush MC, Patel S, Lapinski RH. et al. Perinatal outcomes in inflammatory bowel disease. J Matern Fetal Neonatal Med 2004; 15: 237-241
- 16 Reddy D, Murphy SJ, Kane SV. et al. Relapses of inflammatory bowel disease during pregnancy: in-hospital management and birth outcomes. Am J Gastroenterol 2008; 103: 1203-1209
- 17 Cornish J, Tan E, Teare J. et al. A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut 2007; 56: 830-837
- 18 OʼToole A, Nwanne O, Tomlinson T. Inflammatory Bowel Disease Increases Risk of Adverse Pregnancy Outcomes: A Meta-Analysis. Dig Dis Sci 2015; 60: 2750-2761
- 19 Bortoli A, Pedersen N, Duricova D. et al. Pregnancy outvome in inflammatory bowel disease: prospective European case-control ECCO EpiCom study, 2003–3006. Aliment Pharmacol Ther 2011; 34: 724-734
- 20 Tandon P, Govardhanam V, Leung K. et al. Systematic review with meta-analysis: risk of adverse pregnancy-related outcomes in inflammatory bowel disease. Aliment Pharmacol Ther 2020; 51: 320-333 DOI: 10.1111/apt.15587.
- 21 Burke KE, Haviland MJ, Hacker MR. et al. Indications for mode of delivery in pregnant women with inflammatory bowel disease. Inflamm Bowel Dis 2017; 23: 721-726
- 22 Schmidt M. Betreuung von Frauen mit chronisch entzündlichen Darmerkrankungen (CED) – Was muß ich in der Schwangerschaft und bei der Geburt beachten?. Gyn Praxis 2019; 45: 417-424
- 23 Hatch Q, Champagne BJ, Maykel JA. et al. Crohnʼs disease and pregnancy: the impact of perianal disease on delivery methods and complications. Dis Colon Rectum 2014; 57: 174-178
- 24 Foulon A, Dupas JL, Sabbagh C. et al. Defining the Most Appropriate Delivery Mode in Women with Inflammatory Bowel Disease: A Systematic Review. Inflamm Bowel Dis 2017; 23: 712-720
- 25 Jiang H, Qian X, Carroli G. et al. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev 2017; (02) CD000081
- 26 Remzi FH, Gorgun E, Bast J. et al. Vaginal delivery after ileal pouch-anal anastomosis: a word of caution. Dis Colon Rectum 2005; 48: 1691-1699
- 27 Julsgaard M, Norgaard M, Hvas CL. et al. Self-reported adherence to medical treatment, breastfeeding behaviour, and disease activity during the postpartum period in women with Crohnʼs disease. Scand J Gastroenterol 2014; 49: 958-966
- 28 Mahadevan U, McConnell RA, Chambers CD. Drug Safety and Risk of Adverse Outcomes for Pregnant Patients With Inflammatory Bowel Disease. Gastroenterology 2017; 152: 451-462.e2