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Hépato-Gastro & Oncologie Digestive

Pregnancy and inflammatory bowel diseases Volume 16, issue 2, mars-avril 2009

  • Author(s): Jérôme Filippi, Xavier Hébuterne , Service de gastroentérologie et de nutrition, pôle digestif, hôpital de l’Archet-II, CHU de Nice, 06202 Nice cedex 03, France
  • Key words: pregnancy, inflammatory bowel diseases
  • Page(s) : 101-9
  • DOI : 10.1684/hpg.2009.0288
  • Published in: 2009

IBD affect mostly young patients. Their doctors are often confronted with questions dealing with fertility and pregnancy issues. Large prospective studies that could yield definitive answers are not yet available. We can however offer some advice. Pregnancy is clearly not contraindicated in women with IBD, even less since the risk of transmitting the disease is very low. It is crucial to obtain a remission of the digestive disease before conception. On the therapeutic side, only methotrexate must be withdrawn because of its teratogenicity. Patients treated with azathioprine and salazopyrine must systematically receive folic acid supplementation. During pregnancy, a disease recurrence can be treated with 5-ASA derivatives or steroid therapy. Severe cases can be treated with infliximab. Vaginal birth is possible in most cases. Cesarean section is necessary in patients with severe and active anoperineal lesions, previous ileo-anal anastomosis and for obstetrical motives. In the postpartum period, breast-feeding is to be preferred if there is no medical contraindication. It seems that AZA and 6-MP levels found in breast milk are not high.