Review article: Reproduction in the patient with inflammatory bowel disease.
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.


OBJECTIVE
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.


CONCLUSIONS
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.
Department of Gastroenterology, Adelaide and Meath Hospital, Trinity College, Tallaght, Dublin 24, Ireland. heetunz@gmail.com
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D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D001942:Breast Feeding; D005260:Female; D005298:Fertility / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012098:Reproduction; D012460:Sulfasalazine / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D012460:Sulfasalazine; D001379:Azathioprine