Wednesday, 26 August 2009

Ulcerative Colitis in pregnancy

Inflammatory bowel disease in pregnancy

Effects of disease on pregnancy

Fertility-fertility isn't affected in quiescent disease.
Ulcerative colitis- Fertility is little affected in active disease except for severe disease
Crohn's - infertility correlates with disease activity.

Fetal outcome:
First trimester-rates of abortion in patient with pre-existing IBD is similar to general population.

Fetal outcome is generally good (80%) in quiescent disease but increased risk of preterm labour & small for gestational birth could occur, especially in active disease.

Drug Therapy on fertility

Female-no effect
Male-Sulphasalazine reversible azoospermia

Effect of pregnancy on IBD

Pregnancy has little effect on the course of IBD.

Risk of flare up minimized if disease is quiescent at the time of pregnancy.

Clinical features of exacerbation are:abdominal pain/diarrhoea/passage of rectal mucus & blood.

Risk of exacerbation similar to non pregnant patients(50%).

Exacerbation occur in the first two trimesters & mostly mild.

Crohn's-remains quiescent in 75%.Most exacerbations in first trimester & postpartum.


1.advise to embark on pregnancy when disease is quiescent.
2.Folic acid supplementation. Sulphasalazine is a dihydrofolate reductase inhibitor.


Multidisciplinary team-Obstetrician,Surgeon,Gastroenterologist

1.Management of acute episodes & chronic disease is similar to non pregnant patients.

Drugs-Oral or rectal sulphasalazine, mesalazine and other 5-aminosalicylic acid drugs can be safely used in pregnancy & breast feeding.

Folic acid given for the reasons explained above.

Oral or Rectal steroids can be used to induce remission.

Azathioprine,6-mercaptopurine & ciclosporine may be needed to maintain remission.There is no evidence of excess congenital abnormalities but refractory disease as well as treatment are associated with IUGR & preterm birth.

2.if surgery is indicated (obstruction/haemorrhage/
perforation),it shouldn't be delayed because of pregnancy.

Vit B12 is essential for ileal Chron's disease or following ileal resection.

Antimotility agents & stool thickeners usage should be avoided because they contain anticholinergic component which is associated with congenital anomalies.

Patients with previous surgery for Inflammatory bowel disease

They do well if there disease has been quiescent preconceptionally.
Intestinal obstruction is a complication in patients with ileostomy.
Patients with ileal pouch-anal anastomosis can go for vaginal delivery unless there is cephalopelvic disproportion or marginal anal incontinence.

Mode of Delivery

Vaginal delivery is aimed unless there is perianal Crohn's disease as this may make the perineum inelastic & also there is delaying in healing of episiotomy.

If caesarean section is considered in patients with previous surgery for Crohn's disease,It is important to liaise with the surgeon.

Intrapartum hydrocortisone is considered if Steroids have been used antenatally.


Inflammatory bowel disease is an additional risk factor for deep vein thrombosis.
Mother can breastfeed.Risk of kernicterus due sulphapyridine is minimal.

Prednisolone doses upto 30 mg/day hasn't been shown to cause fetal adrenal suppression.

Azathioprine and breast feeding

Sources :

Swiet MD. Medical disorders in obstetric practice. Wiley-Blackwell; 2002.

Nelson-Piercy C. Handbook of obstetric medicine. Taylor & Francis; 2002.

Parangi S, Levine D, Henry A, Isakovich N, Pories S. Surgical gastrointestinal disorders during pregnancy. Am J Surg. 2007 Feb;193(2):223-32. Review. PubMed PMID: 17236852.