TOG: IBD and Pregnancy

Question 1

what percentage of patients are diagnosed with IBD before age 35?

Answer 1

50%

Question 2

what percentage of women will conceive for the first time after diagnosis of IBD has been made?

Answer 2

25%

Question 3

what are the 2 key factors for successful pregnancy outcomes in women with IBD?

Answer 3

1. clinical remission at time of conception

2. optimal disease control during pregnancy

Question 4

what is the risk of relapse of IBD in women with stable disease at beginning of pregnancy?

Answer 4

30%

Question 5

what are the factors that increase likelihood of CROHNS DISEASE relapse in pregnancy?

Answer 5

1. longer disease duration

2. use of immunosuppressive therapy

Question 6

in pregnant women with ULCERATIVE COLITIS, when are exacerbations more likely to occur?

Answer 6

1. early pregnancy

2. if maintenance medication discontinued

Question 7

what are thought to be causes of subfertility in women with IBD?

Answer 7

1. fallopian tube occlusion 2ndry to pelvic adhesions
2. ovarian dysfunction secondary to nutrient deficiencies
3. chronic illness, dyspareunia in women with severe perianal/pelvic disease

Question 8

NICE recommends what test to differentiate IBD from other conditions with similar symptoms?

Answer 8

faecal calprotectin- non-invasive marker for intestinal inflammation

Question 9

how can faecal calprotectin be used in pregnancy?

Answer 9

can be used as non-invasive marker of disease activity in pregnancy

Question 10

what are the drawbacks of using faecal calprotectin in investigation ?

Answer 10

doesnt differentiate between infection and IBD flare. It indicates the amount of neutrophil breakdown product in stool

Question 11

which medications used to treat IBD should be stopped prior to conception? How long before conception should they be stopped?

Answer 11

mycophenolate
methotrexate
stop 3/12 before trying to conceive

Question 12

which aminosalicylates are commonly used in UC?

Answer 12

sulfasalazine, mesalazine

Question 13

up to what dose of sulfasalazine is safe in pregnancy? What are the risks if more than this is given?

Answer 13

up to 3g/day. risk of fetal nephrotoxicity if more given

Question 14

what are potential risks of sulfasalazine to newborn?

Answer 14

kernicterus

Question 15

what additional supplement should women take if on sulfasalazine in pregnancy?

Answer 15

high dose folic acid (5mg)

Question 16

when is metronidazole useful in CROHNS DISEASE?

Answer 16

useful for perianal CD and as initial treatment for flare of CD

Question 17

in what cases would women need hydrocortisone in labour & postpartum if they were taking steroids during the pregnancy?

Answer 17

if taking more than 5mg steroids / day for more than 4 weeks prior to delivery to lower risk of acute adrenal crisis

Question 18

why is azathioprine preferred over mercaptopurine for treatment of IBD in pregnancy?

Answer 18

fetus cannot convert it to mercaptopurine therefore less exposure to active metabolites

Question 19

what are the commonly used calcineurin inhibitors, and when are they used to treat IBD in pregnancy?

Answer 19

tacrolimus and ciclosporin.

used to treat fulminant colitis. high remission rate.

Question 20

what are the possible adverse effects of using tacrolimus/ ciclosporin in pregnancy?

Answer 20

link with pre-term birth, low birthwt, SGA

Question 21

which biologics are commonly used in IBD?

Answer 21

infliximab, adalimunab, certolizumab

Question 22

when should you advise women to stop taking biologics in pregnancy. Why?

Answer 22

discontinue biologics by 30-32/40.

Biologics are transferred across the placenta- highest level of transfer occurs in third trimester

Question 23

what advice is given wrt vaccinating newborn if biologics were used in 3rd trimester of pregnancy?

Answer 23

delay all live virus vaccines until after biologic molecules no longer detectable in blood- generally 6/12 after delivery.

Question 24

when would elective c/s be considered in women with IBD?

Answer 24

active peri-anal/ rectal disease,
after restorative proctocolectomy with ileo-anal pouch
obstetric reasons