A global consensus group has published comprehensive best practice recommendations for managing inflammatory bowel disease (IBD) in pregnant women, addressing a clinical area where knowledge gaps and unwarranted fears have contributed to suboptimal care.
Published in Clinical Gastroenterology and Hepatology, the guidance highlights that approximately half of patients with IBD have a limited understanding of how the condition affects pregnancy. Notably, 18% of patients with IBD are voluntarily childless, three times the rate seen in the general population, a trend the authors attribute to fear rather than biological necessity.
The recommendations emphasise that discontinuing IBD medications during pregnancy carries greater risks to the foetus than most IBD therapies themselves. Disease flares resulting from treatment withdrawal are considered more dangerous than continuing established therapy. Preconception care outlined in the guidance includes achieving disease remission three to six months before conception, nutritional assessment, prenatal vitamin supplementation with folic acid, and ensuring vaccinations are up to date.
On breastfeeding safety, the consensus finds that most modern IBD biologics and traditional therapies transfer minimally into breast milk and that breastfeeding does not increase the risk of IBD flares. Postpartum flares are most commonly linked to medication discontinuation driven by concerns about breastfeeding transfer. The guidance specifies which treatments are considered compatible with breastfeeding, including 5-ASAs, thiopurines, corticosteroids, anti-TNFs, and anti-integrins, and identifies JAK inhibitors and S1P receptor modulators as drugs to avoid during lactation.
Clinicians are advised not to discontinue maintenance therapy postpartum without specialist gastroenterological consultation.
Published in: Clinical Gastroenterology and Hepatology
