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. 1989 Aug;151(2):168–171.

Pregnancy and inflammatory bowel disease.

J B Zeldis
PMCID: PMC1026908  PMID: 2570494

Abstract

Conclusions about the relationship between the pathophysiology and treatment of inflammatory bowel disease and the physiology and management of pregnancy are based on the results of several large physician surveys and retrospective chart reviews. Patients with active disease fare worse than those with inactive disease. There is little evidence that pregnancy affects the course of inflammatory bowel disease or that inactive inflammatory bowel disease affects the course of pregnancy. Judicious medical therapy is effective in controlling inflammatory bowel disease during pregnancy. Sulfasalazine or steroid therapy should not be withdrawn in a patient who needs it to achieve or maintain a quiescent state of inflammatory bowel disease during the course of pregnancy. Immunosuppressive therapy should be avoided. Aggressive medical therapy with total parenteral nutrition in a team approach with a gastroenterologist, surgeon, and perinatologist usually avoids the need for surgical intervention during pregnancy with a good fetal outcome in a patient whose disease is active. Contraception against pregnancy need only be considered in those patients whose disease is so severe that operative therapy is imminent.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BANKS B. M., KORELITZ B. I., ZETZEL L. The course of nonspecific ulcerative colitis: review of twenty years' experience and late results. Gastroenterology. 1957 Jun;32(6):983–1012. [PubMed] [Google Scholar]
  2. Baiocco P. J., Korelitz B. I. The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome. J Clin Gastroenterol. 1984 Jun;6(3):211–216. [PubMed] [Google Scholar]
  3. Bauer J. J. Sexual dysfunction after colectomy. Mt Sinai J Med. 1983 Mar-Apr;50(2):187–189. [PubMed] [Google Scholar]
  4. Beitins I. Z., Bayard F., Ances I. G., Kowarski A., Migeon C. J. The transplacental passage of prednisone and prednisolone in pregnancy near term. J Pediatr. 1972 Nov;81(5):936–945. doi: 10.1016/s0022-3476(72)80547-x. [DOI] [PubMed] [Google Scholar]
  5. Bohe M. G., Ekelund G. R., Genell S. N., Gennser G. M., Jiborn H. A., Leandoer L. J., Lindström C. G., Svanberg L. K. Surgery for fulminating colitis during pregnancy. Dis Colon Rectum. 1983 Feb;26(2):119–122. doi: 10.1007/BF02562590. [DOI] [PubMed] [Google Scholar]
  6. De Dombal F. T., Burton I. L., Goligher J. C. Crohn's disease and pregnancy. Br Med J. 1972 Sep 2;3(5826):550–553. doi: 10.1136/bmj.3.5826.550. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. De Dombal F. T., Watts J. M., Watkinson G., Goligher J. C. Ulcerative colitis and pregnancy. Lancet. 1965 Sep 25;2(7413):599–602. doi: 10.1016/s0140-6736(65)90513-1. [DOI] [PubMed] [Google Scholar]
  8. Donaldson R. M., Jr Management of medical problems in pregnancy--inflammatory bowel disease. N Engl J Med. 1985 Jun 20;312(25):1616–1619. doi: 10.1056/NEJM198506203122506. [DOI] [PubMed] [Google Scholar]
  9. Esbjörner E., Järnerot G., Wranne L. Sulphasalazine and sulphapyridine serum levels in children to mothers treated with sulphasalazine during pregnancy and lactation. Acta Paediatr Scand. 1987 Jan;76(1):137–142. doi: 10.1111/j.1651-2227.1987.tb10430.x. [DOI] [PubMed] [Google Scholar]
  10. Fielding J. F., Cooke W. T. Pregnancy and Crohn's disease. Br Med J. 1970 Apr 11;2(5701):76–77. doi: 10.1136/bmj.2.5701.76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fielding J. F. Pregnancy and inflammatory bowel disease. Ir J Med Sci. 1982 Jun;151(6):194–202. doi: 10.1007/BF02940180. [DOI] [PubMed] [Google Scholar]
  12. Ganchrow M. I., Benjamin H. Inflammatory colorectal disease and pregnancy: report of a case. Dis Colon Rectum. 1975 Nov-Dec;18(8):706–709. doi: 10.1007/BF02604283. [DOI] [PubMed] [Google Scholar]
  13. Greenfield C., Pounder R. E., Craft I. L., Lewis A. A. Severe ulcerative colitis during successful pregnancy. Postgrad Med J. 1983 Jul;59(693):459–461. doi: 10.1136/pgmj.59.693.459. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hanan I. M., Kirsner J. B. Inflammatory bowel disease in the pregnant woman. Clin Perinatol. 1985 Oct;12(3):669–682. [PubMed] [Google Scholar]
  15. Hudson C. N. Ileostomy in pregnancy. Proc R Soc Med. 1972 Mar;65(3):281–283. doi: 10.1177/003591577206500325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Jacobson L. B., Clapp D. H. Total parenteral nutrition in pregnancy complicated by Crohn's disease. JPEN J Parenter Enteral Nutr. 1987 Jan-Feb;11(1):93–96. doi: 10.1177/014860718701100193. [DOI] [PubMed] [Google Scholar]
  17. Järnerot G., Andersen S., Esbjörner E., Sandström B., Brodersen R. Albumin reserve for binding of bilirubin in maternal and cord serum under treatment with sulphasalazine. Scand J Gastroenterol. 1981;16(8):1049–1055. doi: 10.3109/00365528109181027. [DOI] [PubMed] [Google Scholar]
  18. Järnerot G., Into-Malmberg M. B. Sulphasalazine treatment during breast feeding. Scand J Gastroenterol. 1979;14(7):869–871. doi: 10.3109/00365527909181418. [DOI] [PubMed] [Google Scholar]
  19. Khosla R., Willoughby C. P., Jewell D. P. Crohn's disease and pregnancy. Gut. 1984 Jan;25(1):52–56. doi: 10.1136/gut.25.1.52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Korelitz B. I. Pregnancy, fertility, and inflammatory bowel disease. Am J Gastroenterol. 1985 May;80(5):365–370. [PubMed] [Google Scholar]
  21. Levi A. J., Fisher A. M., Hughes L., Hendry W. F. Male infertility due to sulphasalazine. Lancet. 1979 Aug 11;2(8137):276–278. doi: 10.1016/s0140-6736(79)90292-7. [DOI] [PubMed] [Google Scholar]
  22. Martimbeau P. W., Welch J. S., Weiland L. H. Crohn's disease and pregnancy. Am J Obstet Gynecol. 1975 Jul 15;122(6):746–749. doi: 10.1016/0002-9378(75)90581-5. [DOI] [PubMed] [Google Scholar]
  23. Mayberry J. F., Weterman I. T. European survey of fertility and pregnancy in women with Crohn's disease: a case control study by European collaborative group. Gut. 1986 Jul;27(7):821–825. doi: 10.1136/gut.27.7.821. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. McEwan H. P. Ulcerative colitis in pregnancy. Proc R Soc Med. 1972 Mar;65(3):279–281. doi: 10.1177/003591577206500324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Metcalf A., Dozois R. R., Beart R. W., Jr, Wolff B. G. Pregnancy following ileal pouch-anal anastomosis. Dis Colon Rectum. 1985 Nov;28(11):859–861. doi: 10.1007/BF02555493. [DOI] [PubMed] [Google Scholar]
  26. Miller J. P. Inflammatory bowel disease in pregnancy: a review. J R Soc Med. 1986 Apr;79(4):221–225. doi: 10.1177/014107688607900410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Mogadam M., Dobbins W. O., 3rd, Korelitz B. I., Ahmed S. W. Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome. Gastroenterology. 1981 Jan;80(1):72–76. [PubMed] [Google Scholar]
  28. Mogadam M., Korelitz B. I., Ahmed S. W., Dobbins W. O., 3rd, Baiocco P. J. The course of inflammatory bowel disease during pregnancy and postpartum. Am J Gastroenterol. 1981 Apr;75(4):265–269. [PubMed] [Google Scholar]
  29. Nielsen O. H., Andreasson B., Bondesen S., Jacobsen O., Jarnum S. Pregnancy in Crohn's disease. Scand J Gastroenterol. 1984 Sep;19(6):724–732. [PubMed] [Google Scholar]
  30. Nielsen O. H., Andreasson B., Bondesen S., Jarnum S. Pregnancy in ulcerative colitis. Scand J Gastroenterol. 1983 Sep;18(6):735–742. doi: 10.3109/00365528309182088. [DOI] [PubMed] [Google Scholar]
  31. Nugent F. W., Rajala M., O'Shea R. A., Kolack P. F., Hobin M. A., Haimes M. K., Ingalls M. L. Total parenteral nutrition in pregnancy: conception to delivery. JPEN J Parenter Enteral Nutr. 1987 Jul-Aug;11(4):424–427. doi: 10.1177/0148607187011004424. [DOI] [PubMed] [Google Scholar]
  32. O'Moráin C., Smethurst P., Doré C. J., Levi A. J. Reversible male infertility due to sulphasalazine: studies in man and rat. Gut. 1984 Oct;25(10):1078–1084. doi: 10.1136/gut.25.10.1078. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Pezim M. E. Successful childbirth after restorative proctocolectomy with pelvic ileal reservoir. Br J Surg. 1984 Apr;71(4):292–292. doi: 10.1002/bjs.1800710415. [DOI] [PubMed] [Google Scholar]
  34. Reinisch J. M., Simon N. G., Karow W. G., Gandelman R. Prenatal exposure to prednisone in humans and animals retards intrauterine growth. Science. 1978 Oct 27;202(4366):436–438. doi: 10.1126/science.705336. [DOI] [PubMed] [Google Scholar]
  35. Rivera-Alsina M. E., Saldana L. R., Stringer C. A. Fetal growth sustained by parenteral nutrition in pregnancy. Obstet Gynecol. 1984 Jul;64(1):138–141. [PubMed] [Google Scholar]
  36. Schade R. R., Van Thiel D. H., Gavaler J. S. Chronic idiopathic ulcerative colitis. Pregnancy and fetal outcome. Dig Dis Sci. 1984 Jul;29(7):614–619. doi: 10.1007/BF01347293. [DOI] [PubMed] [Google Scholar]
  37. Sorokin J. J., Levine S. M. Pregnancy and inflammatory bowel disease: a review of the literature. Obstet Gynecol. 1983 Aug;62(2):247–252. [PubMed] [Google Scholar]
  38. Toovey S., Hudson E., Hendry W. F., Levi A. J. Sulphasalazine and male infertility: reversibility and possible mechanism. Gut. 1981 Jun;22(6):445–451. doi: 10.1136/gut.22.6.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Tresadern J. C., Falconer G. F., Turnberg L. A., Irving M. H. Successful completed pregnancy in a patient maintained on home parenteral nutrition. Br Med J (Clin Res Ed) 1983 Feb 19;286(6365):602–603. doi: 10.1136/bmj.286.6365.602. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Vender R. J., Spiro H. M. Inflammatory bowel disease and pregnancy. J Clin Gastroenterol. 1982 Jun;4(3):231–249. doi: 10.1097/00004836-198206000-00008. [DOI] [PubMed] [Google Scholar]
  41. Warsof S. L. Medical and surgical treatment of inflammatory bowel disease in pregnancy. Clin Obstet Gynecol. 1983 Dec;26(4):822–831. doi: 10.1097/00003081-198312000-00007. [DOI] [PubMed] [Google Scholar]
  42. Webb M. J., Sedlack R. E. Ulcerative colitis in pregnancy. Med Clin North Am. 1974 Jul;58(4):823–827. doi: 10.1016/s0025-7125(16)32125-3. [DOI] [PubMed] [Google Scholar]
  43. Willoughby C. P., Truelove S. C. Ulcerative colitis and pregnancy. Gut. 1980 Jun;21(6):469–474. doi: 10.1136/gut.21.6.469. [DOI] [PMC free article] [PubMed] [Google Scholar]

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