Jessica Allegretti, MD, on IBD and Pregnancy

When addressing the treatment of inflammatory bowel diseases (IBD) among pregnant patients, Jessica Allegretti, MD, stressed  the importance of following the best practices for IBD management in women with active disease because “increased disease activity can negatively affect a pregnancy more than most IBD medications,” during her presentation on April 26 at the Advances in Inflammatory Bowel Disease Regional meeting in Chapel Hill, North Carolina.

Dr Allegretti is an associate professor of medicine and section director for inflammatory bowel disease at the Brigham & Women's Hospital in Boston, Massachusetts..

The most crucial step, Dr Allegretti said, is to admit that pregnancy among women with IBD is an important topic. “Pregnant women with IBD are at risk for poor outcomes including miscarriage, premature delivery, complications such as preeclampsia, placental abruption, and increased C-section deliveries,” Dr Allegretti said.

Most patients with IBD are diagnosed between the ages of 20 and 40, and many health care providers are fearful or conservative about treatment of IBD during pregnancy. Because worsening IBD activity is the greatest predictor for poor pregnancy outcomes, Dr Allegretti said, multidisciplinary care is important for best outcomes among pregnant patients.

Preconception counseling is important in more ways than one. After assessing pregnancy and fertility plans, physicians are encouraged to evaluate the patient's IBD. The treatment evaluation stage includes a collaborated effort to review the current medications for IBD, discontinue any contraindicated therapies, to taper off steroids, and completely stop opioids. Maintaining health includes screening for any vitamin deficiency, being up to date on vaccinations, and cancer screening for the cervix, colon, and skin. Nutrition screening for those at risk for malnutrition is also essential.

Together with reproductive endocrinologists, colorectal surgeons, nutritionists, and lactation consultants, gastroenterologists can provide quality preconception care, to reduce the risk of disease relapse during pregnancy.

The goal, Dr Allegretti said, “is to achieve and maintain remission for at least 3 to 6 months before conception for greater likelihood of successful and healthy pregnancy.”

For IBD medications throughout pregnancy, ‘safe’ medications to continue include mesalamine, sulfasalazine, anti-TNFs, vedolizumab, ustekinumab, and antibiotics such as amoxicillin. However, she added, “avoid metronidazole in first trimester.” Medications that are contraindicated include methotrexate, tofacitinib, upadacitinib, ozanimod, etrasimod, and tacrolimus.

“Medications that have been cleared to use during pregnancy are also considered safe to continue while breastfeeding,” Dr Allegretti said.

“The risks of IBD among pregnant women are significant and manifold with complications,” Dr Allegretti concluded. “The most important message is that disease management during pregnancy requires a multidisciplinary approach for best outcomes.”

Reference:
Allegretti J. Pregnancy in IBD. Presented at: Advances in Inflammatory Bowel Disease Regional Meeting. April 5, 2024. Boston, Massachusetts.