TOG: IBD and Pregnancy Flashcards
what percentage of patients are diagnosed with IBD before age 35?
50%
what percentage of women will conceive for the first time after diagnosis of IBD has been made?
25%
what are the 2 key factors for successful pregnancy outcomes in women with IBD?
- clinical remission at time of conception
2. optimal disease control during pregnancy
what is the risk of relapse of IBD in women with stable disease at beginning of pregnancy?
30%
what are the factors that increase likelihood of CROHNS DISEASE relapse in pregnancy?
- longer disease duration
2. use of immunosuppressive therapy
in pregnant women with ULCERATIVE COLITIS, when are exacerbations more likely to occur?
- early pregnancy
2. if maintenance medication discontinued
what are thought to be causes of subfertility in women with IBD?
- fallopian tube occlusion 2ndry to pelvic adhesions
- ovarian dysfunction secondary to nutrient deficiencies
- chronic illness, dyspareunia in women with severe perianal/pelvic disease
NICE recommends what test to differentiate IBD from other conditions with similar symptoms?
faecal calprotectin- non-invasive marker for intestinal inflammation
how can faecal calprotectin be used in pregnancy?
can be used as non-invasive marker of disease activity in pregnancy
what are the drawbacks of using faecal calprotectin in investigation ?
doesnt differentiate between infection and IBD flare. It indicates the amount of neutrophil breakdown product in stool
which medications used to treat IBD should be stopped prior to conception? How long before conception should they be stopped?
mycophenolate
methotrexate
stop 3/12 before trying to conceive
which aminosalicylates are commonly used in UC?
sulfasalazine, mesalazine
up to what dose of sulfasalazine is safe in pregnancy? What are the risks if more than this is given?
up to 3g/day. risk of fetal nephrotoxicity if more given
what are potential risks of sulfasalazine to newborn?
kernicterus
what additional supplement should women take if on sulfasalazine in pregnancy?
high dose folic acid (5mg)
when is metronidazole useful in CROHNS DISEASE?
useful for perianal CD and as initial treatment for flare of CD
in what cases would women need hydrocortisone in labour & postpartum if they were taking steroids during the pregnancy?
if taking more than 5mg steroids / day for more than 4 weeks prior to delivery to lower risk of acute adrenal crisis
why is azathioprine preferred over mercaptopurine for treatment of IBD in pregnancy?
fetus cannot convert it to mercaptopurine therefore less exposure to active metabolites
what are the commonly used calcineurin inhibitors, and when are they used to treat IBD in pregnancy?
tacrolimus and ciclosporin.
used to treat fulminant colitis. high remission rate.
what are the possible adverse effects of using tacrolimus/ ciclosporin in pregnancy?
link with pre-term birth, low birthwt, SGA
which biologics are commonly used in IBD?
infliximab, adalimunab, certolizumab
when should you advise women to stop taking biologics in pregnancy. Why?
discontinue biologics by 30-32/40.
Biologics are transferred across the placenta- highest level of transfer occurs in third trimester
what advice is given wrt vaccinating newborn if biologics were used in 3rd trimester of pregnancy?
delay all live virus vaccines until after biologic molecules no longer detectable in blood- generally 6/12 after delivery.
when would elective c/s be considered in women with IBD?
active peri-anal/ rectal disease,
after restorative proctocolectomy with ileo-anal pouch
obstetric reasons
