title: Maternal and fetal outcomes in pregnant Japanese women with inflammatory bowel disease: our experience with a series of 23 cases.
abstract: OBJECTIVE
  Our physicians work to expand the possibilities to treat female patients with inflammatory bowel disease (IBD) who wish to become pregnant. Although many drugs, including 5-aminosalicylate (5-ASA), corticosteroids, immunomodulators, and biologics, are used safely during pregnancy, few reports have described the therapeutic regimen throughout pregnancy and the management of patients who relapse during pregnancy precisely. The aim of this study was to assess the management of patients with IBD during pregnancy.
  
  
  METHODS
  We identified 19 patients (five with Crohn's disease and 14 with ulcerative colitis [UC]) who became pregnant with a total of 23 pregnancies between May 2005 and May 2015 by reviewing the medical records of Kyoto University Hospital. The following data were collected: the maternal variables, the IBD treatment type, the disease activity, the pregnancy outcome, and the mode of delivery.
  
  
  RESULTS
  Among the 19 patients, 18 had become pregnant after being diagnosed with IBD, while one had developed UC newly after pregnancy. Throughout the gestation, all patients were treated with probiotics, 5-ASA, prednisolone, cytapheresis, or infliximab. The relapse rate during pregnancy was 21.7% (5/23 cases). The five patients who experienced a relapse were able to pursue their pregnancy after intensification of their treatments. There were no adverse fetal or neonatal problems, except in one case that required an emergency Caesarean section because of placental dysfunction and in which a very low-birth-weight infant was born preterm.
  
  
  CONCLUSIONS
  Our present data confirmed that even if the disease flares up during pregnancy, good pregnancy outcomes can be achieved with an optimal intensification of the patient's treatment.
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine Kyoto University, Kyoto, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Minami
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine Kyoto University, Kyoto, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsuura
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine Kyoto University, Kyoto, Japan.
authors.forename: Yorimitsu
authors.initials: Y
authors.lastname: Koshikawa
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine Kyoto University, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine Kyoto University, Kyoto, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Honzawa
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine Kyoto University, Kyoto, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakase
keywords: Inflammatory bowel disease; Pregnancy; Therapeutic management