Optimization of antenatal monitoring approaches of women with chronic inflammatory bowel diseases

Authors

DOI:

https://doi.org/10.18370/2309-4117.2021.57.84-92

Keywords:

chronic inflammatory bowel diseases, ulcerative colitis, Crohn's disease, conception, pregnancy, breastfeeding

Abstract

Chronic inflammatory bowel diseases (CIBD) affect patients at their peak of reproductive age. Clinical presentation of CIBD in pregnancy is associated with an increased risk of adverse effects in mother and fetus, including prematurity, low birth weight, increased indications for caesarean section. Thus optimizing of the CIBD diagnosis and treatment before and during pregnancy is essential to improve maternal and fetal outcomes.
Research aim: to analyze the effectiveness of the CIBD clinical management at the stage of preconception and during pregnancy.
Materials and methods. It was searched the Cochrane Library, WHO platform, clinical guidelines, and research reference database Medline. All potential studies have evaluated the clinical practice guidelines in women with CIBD for conception, pregnancy and breastfeeding. Recommendations related to the necessary laboratory and instrumental examination methods, therapeutic strategy, the safety of drugs for mother and fetus, the features of multidisciplinary antenatal observation, the timing and method of delivery of pregnant women with CIBD.
Results. Treatment in the planning phase and pregnancy should be multidisciplinary, involving a gastroenterologist, obstetrician-gynecologist, primary care physician, pediatrician and a colorectal surgeon if necessary, as well as stakeholders from the association of patients with CIBD. Communication between these professionals is critical to avoid ambivalent or even conflicting counseling, which is an additional source of anxiety for patients, and also potentially dangerous for suboptimal prevention of clinical CIBD manifestation. Obtained results of the analysis will prevent laboratory and therapeutic polypharmacy and significantly improve the pregnancy outcome.
Conclusions. Most women with CIBD had a physiological pregnancy and healthy children. However, some studies have linked CIBD to an increased risk of preterm birth and low birth weight infants.
The development of national clinical guidelines will optimize and improve the quality of perinatal care to women with CIBD in the Ukraine, and will lead to a decrease in obstetric, fetal and neonatal complications.

Author Biographies

O.V. Bulavenko, Vinnytsya National Pirogov Memorial Medical University

MD, professor, head of Obstetrics and Gynecology Department number 2

D.G. Konkov, National Pirogov Memorial Medical University

MD, professor, Obstetrics and Gynecology Department No. 1

N.V. Kuzminova, National Pirogov Memorial Medical University

MD, professor, Internal Medicine Department No. 1

T.V. Lobastova, National Pirogov Memorial Medical University

PhD, assistant, Obstetrics and Gynecology Department No. 1

I.V. Oleksienko, National Pirogov Memorial Medical University

Graduate student, Obstetrics and Gynecology Department No. 2

References

Abdul Sultan, A., West, J., Ban, L., et al. “Adverse pregnancy outcomes among women with inflammatory bowel disease: a population-based study from England.” Inflamm Bowel Dis 22.7 (2016): 1621–30.

Abhyankar, A., Ham, M., Moss, A.C. “Meta-analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease.” Aliment Pharmacol Ther 38.5 (2013): 460–6.

Arsenescu, R., Arsenescu, V., de Villiers, W.J. “TNF-α and the development of the neonatal immune system: implications for inhibitor use in pregnancy.” Am J Gastroenterol 106.4 (2011): 559–62.

Ban, L., Tata, L.J., Humes, D.J., et al. “Decreased fertility rates in 9639 women diagnosed with inflammatory bowel disease: a United Kingdom population-based cohort study.” Aliment Pharmacol Ther 42.7 (2015): 855–66.

Bashmakova, N.V., Volkova, N.Y., Gnatko, E.P., et al. “Probiotics for prophylaxis of vulvovaginal candidiasis relapses (Results of the international multicenter open-label revolact study).” Akusherstvo i Ginekologiya 6 (2017): 135–42.

Beyer-Berjot, L., Maggiori, L., Birnbaum, D., et al. “A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study.” Ann Surg 258.2 (2013): 275–82.

Blumenstein, I., Herrmann, E., Filmann, N., et al. “Female patients suffering from inflammatory bowel diseases are treated less frequently with immunosuppressive medication and have a higher disease activity: a subgroup analysis of a large multi-centre, prospective, internet-based study.” J Crohns Colitis 5.3 (2011): 203–10.

Bressler, B., Marshall, J.K., Bernstein, C.N., et al. “Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus.” Gastroenterology 148.5 (2015):1035–58.e3.

Carroll, M.W., Kuenzig, M.E., Mack, D.R., et al. “The Impact of Inflammatory Bowel Disease in Canada 2018: Children and Adolescents with IBD.” J Can Assoc Gastroenterol 2 Suppl 1 (2019): S49–S67.

Casanova, M.J., Chaparro, M., Domènech, E., et al. “Safety of thiopurines and anti-TNF-α drugs during pregnancy in patients with inflammatory bowel disease.” Am J Gastroenterol 108.3 (2013): 433–40.

Cury, D.B., Moss, A.C. “Treatment of Crohn’s disease in pregnant women: drug and multidisciplinary approaches.” World J Gastroenterol 20.27 (2014): 8790–5.

de Lima, A., Zelinkova, Z., Mulders, A.G., van der Woude, C.J. “Preconception care reduces relapse of inflammatory bowel disease during pregnancy.” Clin Gastroenterol Hepatol 14.9 (2016): 1285–92.e1.

Dignass, A., Lindsay, J.O., Sturm, A., et al. “Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management.” J Crohn’s Colitis 6.10 (2012): 991–1030.

Flanagan, E., Gibson, P., Ross, A., et al. “Stability of serum concentrations of infliximab and adalimumab across pregnancy in IBD.” J Crohn’s Colitis 3 Suppl 1 (2019): S449–50.

Gallinger, Z.R., Nguyen, G.C. “Presence of phthalates in gastrointestinal medications: is there a hidden danger?” World J Gastroenterol 19.41 (2013): 7042–7.

Gallinger, Z.R., Rumman, A., Nguyen, G.C. “Perceptions and attitudes towards medication adherence during pregnancy in inflammatory bowel disease.” J Crohns Colitis 10.8 (2016): 892–7.

Gisbert, J.P., Chaparro, M. “Safety of anti-TNF agents during pregnancy and breastfeeding in women with inflammatory bowel disease.” Am J Gastroenterol 108.9 (2013): 1426–38.

Clavulanic acid. Description (Ukrainian). [Electronic resource]. Available from: [http://utis.in.ua/clavulanic-acid], last accessed Mar 23, 2021.

Huang, H., Wang, H., He, M. “Early oral feeding compared with delayed oral feeding after cesarean section: a meta-analysis.” J Matern Fetal Neonatal Med 29.3 (2016): 423–9.

Huang, V., Leung, Y., Nguyen, G.C., Seow, C.H. “Management of inflammatory bowel disease in pregnancy: a practical approach to new guidelines.” Can J Gastroenterol Hepatol 2016 (2016): 9513742.

Huang, V., Kroeker, K.I., Goodman, K., et al. “Physician knowledge of reproductive issues in inflammatory bowel disease is highly variable.” Journal of Crohn's and Colitis 7 Suppl 1 (2013): S173–S174.

Hviid, A., Mølgaard-Nielsen, D. “Corticosteroid use during pregnancy and risk of orofacial clefts.” CMAJ 183.7 (2011): 796–804.

Jharap, B., de Boer, N.K., Stokkers, P., et al. “Dutch Initiative on Crohn and Colitis. Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease.” Gut 63.3 (2014): 451–7.

Julsgaard, M., Nørgaard, M., Hvas, C.L., et al. “Self-reported adherence to medical treatment prior to and during pregnancy among women with ulcerative colitis.” Inflamm Bowel Dis 17.7 (2011): 1573–80.

Jürgens, M., Brand, S., Filik, L., et al. “Safety of adalimumab in Crohn’s disease during pregnancy: case report and review of the literature.” Inflamm Bowel Dis 16.10 (2010): 1634–6.

Kammerlander, H., Nielsen, J., Kjeldsen, J., et al. “The effect of disease activity on birth outcomes in a nationwide cohort of women with moderate to severe inflammatory bowel disease.” Inflamm Bowel Dis 23.6 (2017): 1011–8.

Kammerlander, H., Nielsen, J., Kjeldsen, J., et al. “Fecal calprotectin during pregnancy in women with moderate-severe inflammatory bowel disease.” Inflamm Bowel Dis 24.4 (2018): 839–48.

Kanis, S.L., de Lima-Karagiannis, A., van der Ent, C., et al. “Anti-TNF levels in cord blood at birth are associated with anti-TNF type.” J Crohn’s Colitis 12.8 (2018): 939–47.

Kaplan, G.G., Bernstein, C.N., Coward, S., et al. “The impact of inflammatory bowel disease in Canada 2018: Epidemiology.” J Can Assoc Gastroenterol 2 Suppl 1 (2019): S6-S16.

Lichtenstein, G.R., Feagan, B.G., Cohen, R.D., et al. “Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREATTM registry.” Am J Gastroenterol 107.9 (2012): 1409–22.

Lin, K., Martin, C., Dassopoulos, T., et al. “Pregnancy outcomes amongst mothers with inflammatory bowel disease exposed to systemic corticosteroids: results of the PIANO registry [abstract].” Gastroenterology 146.5 (2014): 146.

Mahadevan, U., Martin, C., Sandler, R., et al. “PIANO: a 1000 patient prospective registry of pregnancy outcomes in women with IBD exposed to immunomodulators and biologic therapy [abstract].” Gastroenterology 142.5 (2012): 142.

Mahadevan, U., McConnell, R.A., Chambers, C.D. “Drug safety and risk of adverse outcomes for pregnant patients with inflammatory bowel disease.” Gastroenterology 152.2 (2017): 451–62.e2.

Mahadevan, U., Robinson, C., Bernasko, N., et al. “Inflammatory bowel disease in pregnancy clinical care pathway: a report from the American Gastroenterological Association IBD Parenthood Project Working Group.” Inflamm Bowel Dis 25.4 (2019): 627–41.

Mahadevan, U., Vermeire, S., Lasch, K., et al. “Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease.” Aliment Pharmacol Ther 45.7 (2017): 941–50.

Mahadevan, U., Vermeire, S., Wolf, D., et al. “Pregnancy outcomes after exposure to certolizumab pegol: updated results from safety surveillance [abstract].” Gastroenterology 148.4 (2015): 148.

Matro, R., Martin, C., Wolf, D., et al. “Detection of biologic agents in breast milk and implication for infection, growth and development in infants born to women with inflammatory bowel disease: results from the PIANO registry [abstract].” Gastroenterology 148.4 (2015): 148.

Matro, R., Martin, C.F., Wolf, D., et al. “Exposure concentrations of infants breastfed by women receiving biologic therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development.” Gastroenterology 155.3 (2018): 696–704.

McConnell, R.A., Mahadevan, U. “Pregnancy and the patient with inflammatory bowel disease: fertility, treatment, delivery, and complications.” Gastroenterol Clin North Am 45.2 (2016): 285–301.

Moens, A., van Hoeve, K., Humblet, E., et al. “Belgian IBD Research and Development group (BIRD). Outcome of pregnancies in female patients with inflammatory bowel diseases treated with vedolizumab.” J Crohns Colitis 13.1 (2019): 12–8.

Narula, N., Al-Dabbagh, R., Dhillon, A., et al. “Anti-TNFα therapies are safe during pregnancy in women with inflammatory bowel disease: a systematic review and meta-analysis.” Inflamm Bowel Dis 20.10 (2014): 1862–9.

Ng, S.C., Shi, H.Y., Hamidi, N., et al. “Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies.” Lancet 390.10114 (2018): 2769–78.

Nguyen, G.C., Seow, C.H., Maxwell, C., et al. “IBD in pregnancy consensus group; canadian association of gastroenterology. The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy.” Gastroenterology 150.3 (2016): 734–57.e1.

Nielsen, O.H., Loftus, E.V. Jr, Jess, T. “Safety of TNF-α inhibitors during IBD pregnancy: a systematic review.” BMC Med 11.1 (2013): 174.

Nielsen, O.H., Maxwell, C., Hendel, J. “IBD medications during pregnancy and lactation.” Nat Rev Gastroenterol Hepatol 11.2 (2014): 116–27.

Pabby, V., Oza, S.S., Dodge, L.E., et al. “In vitro fertilization is successful in women with ulcerative colitis and ileal pouch anal anastomosis.” Am J Gastroenterol 110.6 (2015): 792–7.

Palomba, S., Sereni, G., Falbo, A., et al. “Inflammatory bowel diseases and human reproduction: a comprehensive evidence-based review.” World J Gastroenterol 20.23 (2014): 7123–36.

Practice Committee of American Society for Reproductive Medicine. “Diagnostic evaluation of the infertile female: a committee opinion.” Fertil Steril 98.2 (2012): 302–7.

Rajaratnam, S.G., Eglinton, T.W., Hider, P., Fearnhead, N.S. “Impact of ileal pouch-anal anastomosis on female fertility: meta-analysis and systematic review.” Int J Colorectal Dis 26.11 (2011): 1365–74.

Reid, G., Kumar, H., Khan, A.I., et al. “The case in favour of probiotics before, during and after pregnancy: insights from the first 1,500 days.” Benef Microbes 7.3 (2016): 353–62.

Restellini, S., Biedermann, L., Hruz, P., et al. “Update on the management of inflammatory bowel disease during pregnancy and breastfeeding.” Digestion 101 Suppl 1 (2020): 27–42.

Salgado, V.C.L., Luiz, R.R., Boéchat, N.L.F., et al. “Risk factors associated with inflammatory bowel disease: A multicenter case-control study in Brazil.” World J Gastroenterol 26.25 (2020): 3611–24.

Schulze, H., Esters, P., Dignass, A. “Review article: the management of Crohn’s disease and ulcerative colitis during pregnancy and lactation.” Aliment Pharmacol Ther 40.9 (2014): 991–1008.

Seirafi, M., de Vroey, B., Amiot, A., et al. “Factors associated with pregnancy outcome in anti-TNF treated women with inflammatory bowel disease.” Aliment Pharmacol Ther 40.4 (2014): 363–73.

Selinger, C.P., Eaden, J., Selby, W., et al. “Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views.” J Crohns Colitis 7.6 (2013): e206–13.

Selinger, C.P., Leong, R.W., Lal, S. “Pregnancy related issues in inflammatory bowel disease: evidence base and patients’ perspective.” World J Gastroenterol 18.21 (2012): 2600–8.

Selvaratnam, S., Gullino, S., Shim, L., et al. “Epidemiology of inflammatory bowel disease in South America: A systematic review.” World J Gastroenterol 25.47 (2019): 6866–75.

Seow, C.H., Leung, Y., Vande Casteele, N., et al. “The effects of pregnancy on the pharmacokinetics of infliximab and adalimumab in inflammatory bowel disease.” Aliment Pharmacol Ther 45.10 (2017): 1329–38.

Sheehy, O., Santos, F., Ferreira, E., Berard, A. “The use of metronidazole during pregnancy: a review of evidence.” Curr Drug Saf 10.2 (2015): 170–9.

Tatarchuk, T.F., Kalugina, L.V., Petrova, G.A., et al. “Vaginal discharge syndrome. Problem with many unknowns.” Reproductive Endocrinology 53 (2020): 94–100.

Toomey, D., Waldron, B.“Family planning and inflammatory bowel disease: the patient and the practitioner. Family Practice. 2013;30(1):64–68.

Torres, J., Boyapati, R.K., Kennedy, N.A., et al. “Systematic review of effects of withdrawal of immunomodulators or biologic agents from patients with inflammatory bowel disease.” Gastroenterology 149.7 (2015): 1716–1730.

Van der Woude, C.J., Ardizzone, S., Bengtson, M.B., et al. “The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease.” Journal of Crohn's & Colitis 9.2 (2015): 107–24.

Vermeire, S., Carbonnel, F., Coulie, P.G., et al. “Management of inflammatory bowel disease in pregnancy.” J Crohn’s Colitis 6.8 (2012): 811–23.

Weber-Schoendorfer, C., Chambers, C., Wacker, E., et al. “Network of French Pharmacovigilance Centers. Pregnancy outcome after methotrexate treatment for rheumatic disease prior to or during early pregnancy: a prospective multicenter cohort study.” Arthritis Rheumatol 66.55 (2014): 1101–10.

Whiteley, I., Gullick, J. “The embodied experience of pregnancy with an ileostomy.” J Clin Nurs 27.21–22 (2018): 3931–44.

Published

2021-03-31

Issue

Section

Interdisciplinary consilium