Table 1.
Drug safety and recommendations in pregnancy and breastfeeding.
| 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 palate. 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 teratogenic 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. |
| 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. |