Pregnancy and Fertility in Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is a chronic relapsing and remitting disease that includes ulcerative colitis (UC) and Crohn’s disease (CD). It affects the population in a bimodal distribution with the higher peak in the younger population. Approximately fifty percent of patients are less than 35 years of age at the time of diagnosis and twenty five percent conceive for the first time after their diagnosis of inflammatory bowel disease [1]. As medical therapy for IBD advances, more patients are in a position to consider pregnancy. Because ethical considerations generally preclude conducting randomized controlled trials in pregnant patients, the majority of the available information has been gathered from retrospective studies. Most of the drugs used to treat IBD are safe to use during pregnancy. Traces of drugs have been reported in breast milk in women on drug therapy, but no major fetal or neonatal complications have been reported. With the increasing early use of immunosuppressant and biological therapy to treat active IBD, more studies are focusing on these issues. A multidisciplinary team that considers the individual patient wishes and concerns, and that manages them accordingly should care for inflammatory bowel disease patients who are contemplating conception or who are already pregnant. The aim of this review article is to summarize the current literature on fertility, pregnancy and IBD management during and after gestation.