Inflammatory Bowel Disease: Peri- and Postpartum Care and Counseling
Sara Horst MD, MPH | Vanderbilt University Medical Center, Nashville, Tennessee
A 26-year-old woman who had ileal inflammatory Crohn disease presented to your clinic. She was on infliximab monotherapy (confirmed to be therapeutic drug levels); had a recent, normal endoscopic evaluation; and was doing well clinically. She was interested in getting pregnant. Data showed improved outcomes for patients who had pre-conception counseling regarding their disease.1 Therefore, you discussed the safety of anti-TNF continuation throughout pregnancy. You discussed recent data from the Pregnancy Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) registry,2 which reviewed more than 1000 patients with inflammatory bowel disease (IBD) going through pregnancy. The results of the study showed that biologic therapy, thiopurine therapy, or combination therapy did not increase the risk of adverse fetal outcomes. Increased disease activity did increase the risk of spontaneous abortion and pre-term birth, again solidifying the importance of disease control before and during pregnancy and continuing medications that work for the mother.2 Your patient agreed to continue infliximab throughout pregnancy. Your patient became pregnant and did well in pregnancy. She was in her third trimester when she saw you again in your clinic.
Your patient was feeling great and was in clinic at 36 weeks of pregnancy. She had questions about the peri- and postpartum periods.