Inflammatory bowel disease in prengnancy TOG 2016 Flashcards
6Clinical features of IBD
Cramping mid or lower abdominal pain
Diarrhoea
Urgency of defaecation
Aphthous ulcers
Passage of blood and mucus per rectum (ulcerative colitis)
Weight loss (Crohn’s disease)
Complications of ulcerative colitis
Haemorrhage
Colonic dilatation/toxic megacolon
Malignancy
Complications of Crohns disease
Haemorrhage
Perforation
Strictures
Fistulae
Abscess
Perianal disease
Extraintestinal manifestations of IBD
Conjunctivitis, iridocyclitis, episcleritis
Gallstones
Sclerosing cholangitis
Arthritis (sacroiliitis, ankylosing spondylitis)
Skin disease (pyoderma, erythema nodosum)
Risk of relapse in UC and Crohns
UC: 30% risk relapse
Crohns - not more likely than non pregnant
Highest risk if active at time of conception or Dx in pregnancy (2/3rds)
Postpartum UC flare 6 x more likely
Effects IBD on pregnancy
Similar fertility rates unless extensive abdominal surgery
80-90% have full term normal pregnancies
Active disease at conception increased risk miscarriage/SGA
Diagnosis IBD in pregnancy
Bloods: CRP
Stool: Faecal calprotectin
Imaging: Abdo ISS, MRI in 2nd/3rd
Gasrtoscopy/sigmoidoscopy/colonoscopy safe with mucosal Bx
What can be used as a non-invasive marker of disease activity in pregnancy?
Fetal calprotectin
What medications are safe in pregnancy
PO or topical 5 amniosalicylates (sulfasalzine, mesalazine) - avoid doses >3g/day, given high dose folic acid
PO/rectal steroids
Metronidazole
Thiopurines - azathioprine/mercaptoputine
Calcineurin inhibitors: Tacrolimus, cyclosporin
Which medications should be amended during pregnancy?
Stop anti-TNF in 3rd trimester - infliximab and adalimumab
What SE effect should be monitored for in neonate is mother taking mesalazine?
Bloody diarrhoea
Possible SE for Calcineurin inhibitors: Tacrolimus, cyclosporin
Low birth weight, SGA
Limit use to fulminant colitis and rescue therapy in steroid refectory UC
Can mycopheolate mofetil be used in pregnancy>
No risk congenital abnormality and pregnancy loss
Can methotrexate be used in pregnancy
No should stop 3 month prior to conception
What analgesia to avoid
NSAIDS
Opiates can cause constipation/exacerbation in with perianal disease, give osmotic laxatives
