Table 1.
| Medical Treatment | Safety and Recommendations in Pregnancy | Safety and Recommendations in Breastfeeding |
|---|---|---|
| Aminosalicylates (mesalazine, sulfasalazine, balsalazide, olsalazide) | No increased obstetrical risk. Always recommended (formulation without dibutylphthalate are preferable and, if sulfasalazine is used, suggestion to supplement with folate) | Safe and must be discontinued only in case of neonatal severe bloody diarrhea. |
| Corticosteroids | Concerns about teratogenic effects, such as cleft lip or palate. Recommended only in case of active flares | Recommended to breastfeed babies 4 h after taking corticosteroids |
| Antibiotics (metronidazole and ciprofloxacin) | Concerns about teratogenic effects, such as cleft lip or plate.Recommended only after the first trimester of gestation. | Recommended to breastfeed babies 12–24 h after metronidazole and 48 h after ciprofloxacin intake. A short-term antibiotic regimen must be preferred |
| Thiopurines (azathioprine or 6-mercaptopurine) | Slight increase in preterm deliveries. Recommended as monotherapy | Advisable, no a higher risk of physical or developmental anomalies in newborns |
| Methotrexate | Strong teratogenicity and abortive effects. Never recommended in pregnancy | Contraindicated |
| Cyclosporine | No data on pregnant women available, only recommended as rescue therapy for acute severe steroid-refractory ulcerative colitis | Contraindicated |
| Antibiotics (metronidazole and ciprofloxacin) | Concerns about teratogenic effects, such as cleft lip or plate.Recommended only after the first trimester of gestation. | Recommended to breastfeed babies 12–24 h after metronidazole and 48 h after ciprofloxacin intake A short-term antibiotic regimen must be preferred |
| Thiopurines (azathioprine or 6-mercaptopurine) | Slight increase in preterm deliveries. Recommended as monotherapy. | Advisable, no a higher risk of physical or developmental anomalies in newborns. |
| Anti-TNFα agents (infliximab, adalimumab, golimumab and certolizumab) | Evidence of crossing the placenta, except of certolizumab Recommended stopping around the 24th week of gestation, if the case permits. | Safe due to their transmission in breast milk only in small amounts and deactivation by neonatal digestion enzymes |
| Vedolizumab and ustekinumab | Should be avoided due to their transmission across the placenta and partial lack of data in pregnancy. Can eventually be prescribed only as an ultimate alternative | Safety data are still missing, so their use is not recommended |
| Tofacitinib, filgotinib and upadacitinib | Contraindicated due to the complete lack of data in pregnancy. | Safety data are still missing, so their use is not recommended. |
Abbreviations: CRP, C-reactive protein; CT, computed tomography; ESR, erythrocyte sedimentation rate; MRI, magnetic resonance imaging, IBD, inflammatory bowel disease.