Gastroenterology training and education

Discuss the impact of IBD on fertility?

IBD per se do not affect fertility. However, impotence is an unusual complication after proctocolectomy. Decreased fertility may occur in women with IBD who have undergone surgery.

Discuss pregnancy and IBD?

Pregnancy does not have an adverse effect on IBD. UC does not have an adverse impact on pregnancy. However, women with Crohn’s disease are at an increased risk of low birth weight baby and premature delivery. So careful monitoring of foetal growth is advisable.

Discuss safety of endoscopy during pregnancy?

Flexible sigmoidoscopy can be safely done during pregnancy. Colonoscopy should be avoided, if possible.

Discuss safety of drugs for IBD during pregnancy and lactation?

• Sulphasalazine – is safe during pregnancy and lactation.
• 5-ASA drugs – oral and topical 5-ASA are safe during pregnancy.
• Corticosteroids – The risk of steroids in pregnancy is small and hence they should not be withheld during pregnancy when clinically indicated.
• Cleft palate and low birth weight have been rarely reported in humans with the use of steroids in pregnancy. This potential risk is limited to use of steroid during the first trimester.   Prednisolone is safe during lactation.
• 6-Mercaptopurine and azathioprine –  these drugs can be continued during pregnancy.
• There are reports of teratogenicity with these drugs with exposure from either the mother or father. Males on 6-MP should probably stop the agent three months before conception to lessen the risks of spontaneous abortion and foetal abnormalities.
• Azathioprine and 6-MP are detectable at low levels in breast milk. Mothers taking these drugs should avoid breast feeding, although no good data are available regarding risks to the nursing infant.
• Ciclosporine – Ciclosporine can be used during pregnancy. Teratogenicity appears to be low.
• Methotrexate – absolutely contraindicated as it is a potent abortifacient and is associated with congenital anomalies. Women and men taking methotrexate should stop this drug and use contraception for at least three months prior to conception.
• Infliximab – Experience with infliximab during pregnancy is limited. However animal models do not show any teratogenicity. The manufacturer advises that infliximab should be given to a pregnant woman only if clearly needed.
• Whether infliximab is excreted in human milk is unknown. As a result, continued use of infliximab should be based on the clinical condition of the mother.
• Antidiarrheal drugs – Loperamide can be used during pregnancy.  There is little information about the risks to nursing infants during lactation.

Discuss IBD surgery and pregnancy?

Surgery for fulminant colitis during pregnancy may be associated with premature labour or spontaneous abortion, possibly related to inadvertent uterine manipulation.

Mode of delivery- The mode of delivery should be carefully considered.

Women who have a pouch for ulcerative colitis can have normal pregnancies and deliveries with minimal effects on pouch function.

Patients with active perianal Crohn’s disease at the time of delivery should undergo caesarean section. Patients with inactive perianal disease can undergo vaginal delivery.