Table 1.
Pros and Cons of monitoring modalities.
| Monitoring Modality | Pros | Cons |
|---|---|---|
| Lower endoscopy | ||
| Colonoscopy | The gold standard of disease monitoring. Early studies show no difference in adverse events between pregnant patients with IBD who underwent colonoscopy and those who did not undergo colonoscopy. |
Limited studies Provider/patient hesitancy due to procedural and anesthetic concerns |
| Flexible sigmoidoscopy | It can be performed without sedation. No case reports of any procedure-related complications | Limited studies |
| Radiologic studies | ||
| IUS | The safest form of radiologic imaging | Sensitivity in pregnancy is not well-established |
| Contrast-enhanced ultrasound has been shown to have good results in IBD. | ||
| Magnetic resonance imaging | No use of damaging ionizing radiation | No well-controlled studies of the teratogenic effects of gadolinium contrast in pregnant women have been performed, and the fetal risk is unknown. |
| Can detect luminal and extraluminal abnormalities | ||
| Long-term safety after exposure to MRI during the trimester of pregnancy showed no increased risk of harm to the fetus or in early childhood. | ||
| Biomarkers | ||
| Albumin | Low albumin has been shown to be a predictor of poor outcomes in IBD | Limited utility in pregnancy due to pregnancy-induced hemodilution resulting in lower albumin values |
| ESR | Generally, it is a good marker of inflammation and reflects disease activity. | Limited utility in pregnancy due to physiologic increase in ESR (2–3× upper limit of normal) |
| CRP | Levels are only slightly raised in normal pregnancy and are still under the normal limits. CRP is higher in clinically active pregnant patients with IBD at preconception and first trimester compared to clinically inactive pregnant patients with IBD |
It may not accurately reflect disease activity in the second and third trimesters. Limited studies in pregnant IBD population. |
| FCP | Measure of GI mucosal inflammatory activity detected before signs of systemic inflammation. Multiple studies show a correlation between FCP levels and noninvasive disease activity scores in CD and UC. |
Conflicting evidence for the utility of FCP in IBD during pregnancy. Limited studies with actual endoscopic data to evaluate clinical activity |
IUS, Intestinal Ultrasound; ESR, Erythrocyte Sedimentation Rate; CRP, C-react protein; FCP, fecal calprotectin; UC, Ulcerative colitis; CD, Crohn’s’ disease; IBD, Inflammatory bowel disease.