Pregnancy and IBD: Timing Is Everything

Excerpt

Since the peak age of reproduction coincides with the peak incidence of inflammatory bowel disease (IBD), many female patients worry about the effect of pregnancy on disease activity, the effect of IBD on pregnancy and birth outcomes, and the effect of IBD medications on the developing fetus. As the study of pregnancy in IBD is complex, current research must attempt to separate the effects of confounders such as disease activity at conception and during pregnancy, medication use, comorbidities, gestational weight gain, and history of IBD surgery. Most pregnancy studies are performed in Europe or the USA with little data from Asia, an area in which IBD incidence is increasing rapidly. Since therapeutic monoclonal antibodies (biologics) are increasingly used to treat IBD in the USA and Europe, much of the recent research focuses on their safety during pregnancy. In India, where treatment with biologics is less common, Padhan et al. [1], writing in this issue of Digestive Diseases and Sciences, were able to measure the effect of IBD on pregnancy and vice versa in cohort of women, most of whom were not treated with biologic therapy. What makes this study unique is that for the first time the authors compare non-pregnant patients to patients whose pregnancy antedated disease onset, coincided with disease onset, or occurred after the onset of disease. The authors also examine the pregnancy outcomes of mode of delivery, abortion, stillbirth, preterm, full term, and postdated. …