title: Update on pregnancy and breastfeeding in the era of biologics.
abstract: Inflammatory bowel diseases are chronic conditions that frequently affect patients during their childbearing years. Considering the characteristics of disease and the medications used to treat it, several issues arise in the care of these patients when they attempt or achieve conception. We review the most current evidence concerning fertility and pregnancy outcomes in patients with inflammatory bowel diseases. With the exception of those women who undergo pelvic surgery, patients with inflammatory bowel diseases have no decreased fertility. Sulfasalazine decreases fertility in men. When looking at obstetrical outcomes, active disease at conception is associated with an increased risk of preterm delivery and low birth weight. While most medications used to treat inflammatory bowel diseases are low risk, some precautions need to be taken and the risk-to-benefit ratio needs to be considered on an individualized basis. In general, aminosalicylates and thiopurines should be continued, but methotrexate is contraindicated. Anti-tumour necrosis factor agents are considered safe to continue but full monoclonal antibodies do cross the placenta. As a general rule, the it is important to counsel women that conception is optimal when disease is in remission, as adverse obstetrical outcomes are directly associated with disease activity. Clinicians need to educate patients before, during and after conception, emphasizing treatment compliance.
authors.affiliation: Department of Medicine, University of Florida, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Yarur
authors.forename: Sunanda V
authors.initials: SV
authors.lastname: Kane
mesh_terms: D000068879:Adalimumab; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D001942:Breast Feeding; D000068582:Certolizumab Pegol; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D000075202:Contraindications; D003424:Crohn Disease / Q000188:drug therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005298:Fertility; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D015122:Mercaptopurine / Q000627:therapeutic use; D008727:Methotrexate; D000069442:Natalizumab; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000636:Aminosalicylic Acids; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007140:Immunoglobulin Fab Fragments; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D011092:Polyethylene Glycols; D016572:Cyclosporine; D000069285:Infliximab; D015122:Mercaptopurine; D000068879:Adalimumab; D001379:Azathioprine; D000068582:Certolizumab Pegol; D016559:Tacrolimus; D008727:Methotrexate
keywords: Crohn's disease; Fertility; Pregnancy; Ulcerative colitis