In a recent article published in Reproductive Medicine, researchers presented information on scientific evidence-based inflammatory bowel disease (IBD) management methods while pregnant.
Study: The Management of Inflammatory Bowel Disease during Reproductive Years: An Updated Narrative Review. Image Credit: Blue Planet Studio/Shutterstock.com
IBD patients, especially those with energetic disease, are at an increased risk of lack of pregnancy, preterm delivery, and emergent cesarean (C-section) deliveries. Nevertheless, those with a quiescent one are prone to have fewer complications.
The height incidence of IBD is between 15 and 29 years when people are likely to bear children or are of their reproductive years. Thus, IBD patients anticipating pregnancy must pay attention to its adversarial effects before conception.
Dedicated specialized IBD–pregnancy clinics could assist in improving patient knowledge and attitudes toward pregnancy through individualized pre-conception counseling, education, and drugs adherence.
Nevertheless, since lower than 50% of patients could have access to such clinics, the risks of poor pregnancy outcomes can’t be completely averted but minimized. Nonetheless, receiving direct care from IBD gastroenterologists, obstetricians, dieticians, and psychologists could reduce voluntary childlessness and adversarial pregnancy outcomes.
Clinicians often use multiple modalities to measure disease activity while pregnant due to the lack of agreement on the advantages of 1 for effective therapeutic decision-making.
An observational study demonstrated that in comparison with fecal calprotectin (FCP), gastrointestinal ultrasonography (GIUS) provided higher visuals of the terminal ileum and colon in women gestating since 20 weeks with specificity, sensitivity, and negative predictive values of 83%, 74%, and 90%, respectively.
Moreover, a recent review by De Lima et al. systematically showed that lower gastrointestinal endoscopy or sigmoidoscopy was low risk through all three trimesters in nearly 80% of cases and helped within the medical management of IBD patients when appropriately indicated.
Many drugs have received approval to be used in pregnant and breastfeeding IBD patients. These are aminosalicylates, thiopurines, corticosteroids, ciprofloxacin, amoxicillin, calcineurin inhibitors, anti-tumor necrosis factor, anti-integrin, and a few anti-interleukin agents. Notably, most of those drugs are really helpful during energetic flares; nevertheless, non-adherence to medications while pregnant could have serious repercussions.
The gut microbiome fluctuates in IBD, and the maternal microbiome also changes on account of pregnancy, especially within the third trimester when the maternal gut harbors increased inflammatory changes and reduced gut diversity, which, in turn, impacts the developing neonatal microbiota.
Clinicians have used protein-rich formulas to revive healthy microbiota in IBD patients. Currently, Modulating Early Life Microbiome through Dietary Intervention in Pregnancy (MELODY) trial is assessing how effectively weight loss plan could normalize the gut microbiome in IBD patients and their offspring through the third trimester of pregnancy.
While dietary modifications alone may not control IBD symptoms, when used alongside medications, they might greatly profit the health of IBD patients.
In cases of energetic perianal disease and ileal pouch-anal anastomosis (IPAA), a C-section should be considered on account of raised concerns about adhesions and bowel obstructions, despite the fact that it doesn’t influence the delivery mode in patients with CD.
Overall, the gastroenterologist, obstetrician, and patient should (together) determine essentially the most optimal delivery mode for IBD.
Most pediatric societies recommend breastfeeding until the newborn is six months old. It appears feasible because studies have shown that breastfeeding doesn’t increase the chance of maternal disease flare and (conversely) may be protective against IBD flares.
Yet, most girls with IBD stop breastfeeding early on account of concerns about drug transfer through breast milk. Even the outcomes of studies done on this regard are conflicting. Recently, a study showed that moms with IBD have reduced IgA levels and lactose of their breast milk, which dampens its helpful effects. Other studies have pointed towards increased inflammatory cytokines and succinate concentrations within the breast milk of lactating females with IBD, which could harm an infant’s gut microbiome.
More large-scale prospective studies should investigate how different breast milk composition is in women with IBD and whether it predisposes infants to develop IBD or other similar inflammatory diseases.
Future directions
In the long run, with increased awareness and availability of novel therapies for successful conception and improved pregnancy outcomes, many patients might surrender on their presumptions of adversarial IBD effects on maternal and fetal health and never select voluntary childlessness.
In other words, the opportunity of attaining remission before conception could help optimize pregnancy outcomes even in energetic IBD cases.