JLE

Hépato-Gastro & Oncologie Digestive

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Inflammatory bowel diseases and pregnancy Volume 20, issue 8, Octobre 2013

Authors
Groupe hospitalier Paris Sud, site de Bicêtre, service de gastroentérologie, 78 rue du Général Leclerc, 94240, Le Kremlin Bicêtre, France ; Université Paris Sud, Paris, France

<p>Principles of management of pregnancy in women with inflammatory bowel disease (IBD) are well established. Systematic folate supplementation should be prescribed in women who wish to become pregnant. IBD patients have a normal fertility rate, except women with active Crohn's disease and those with ulcerative colitis and ileal pouch anal anastomosis (IPAA). Nutritional deficiencies in folate, vitamin B12, iron, vitamin D should be searched for and corrected in pregnant women with IBD. It is recommended to be in remission at the time of conception and to maintain it during pregnancy. Indeed, active disease increases the risk of premature delivery and low birth weight. IBD drugs can be prescribed during pregnancy, except methotrexate. 6 thioguanines and anti-TNF cross the placental barrier during the third trimester. It is possible to stop anti-TNF therapies at the end of the second quarter when the disease is quiescent. Delivery mode is decided on an individual basis; cesarean section is generally recommended in women with active perineal lesions and IPAA.</p><p>There are several areas of uncertainties and many different situations are encountered in clinical practice. Therefore, close collaboration between the patient, the obstetrician and the gastroenterologist before and during pregnancy is essential for an optimal management of pregnancy in women with IBD.</p>