Myth-busting important for women with IBD

IBD

By Mardi Chapman

4 Oct 2017

Myths abound for women with IBD who want to start a family so it is important for gastroenterologists to be proactive and start discussions with their patients early, an expert advises.

Associate Professor Sally Bell, from St Vincent’s Hospital Melbourne, recommends talking to young women with IBD as early as their first or second visit.

“The first priority is to get them well but when you raise discussions about their future plans for a family, patients often say ‘I didn’t think I could get pregnant’.”

Professor Bell said the exception was women who have had a colonic resection and pouch surgery.

“Those patients need special assistance. It’s a mechanical problem – they’ve got adhesions in the pelvis stopping the egg getting into the fallopian tubes – and they often need assisted reproductive technology to get pregnant.”

She said as with the general population, IVF works better in younger women under 40 years.

Professor Bell said the focus for family planning purposes was to first get women into remission, ideally for about six months prior to conception.

All women should be advised it was safe to continue taking their medications, including methotrexate, during pregnancy. Early data on vedolizumab showed it was likely to be safe, she told the limbic in an interview.

There were some questions yet to be answered about ustekinumab in pregnancy as the Th17 pathway inhibitor was involved in implantation and induction of labour.

Strong advice about the benefits of continuing treatment was particularly important for women who were hard to get into remission.

Professor Bell said fecal calprotectin was a non-invasive method of monitoring IBD activity during pregnancy. Any disease flares during pregnancy should be treated aggressively.

“The evidence is that developmental outcomes are very good even in infants exposed to multitudinous drugs.”

Associate Professor Bell said it was useful to enlist the support of partners during pregnancy and to include them in at least one antenatal visit.

“Men have a different focus and are more likely to reinforce to the woman that she has to be well.”

She said parents might need some reassurance that the risk of their children also having IBD was quite low at about 6-8%.

“It is often assumed it is autosomal dominant but it is not. IBD is a polygenic disease and genetics contribute only about 15% of the risk.”

Postpartum care

For most women with IBD, advice regarding breastfeeding and maternal nutrition were the same as for other women.

Breastfeeding was important for mothers and their babies and it was safe for women to continue or recommence their IBD medications.

Professor Bell said women who had discontinued IBD treatment during pregnancy should recommence it as soon as possible – even having their first infliximab infusion while still in hospital.

“It reinforces the message that it is safe during breastfeeding and helps ensure it doesn’t get inadvertently deferred,” she said.

There was no need for ongoing vitamin supplementation in women who were normally nourished.

Associate Professor Bell said there was a slightly higher risk of mild childhood infections in infants of mothers taking a thiopurine and an anti-TNF. However the main advice regarding infections was to avoid the use of live vaccines.

“Rotavirus is a mild disease and there is good supportive care here in Australia.”

Professor Bell was addressing the AGW conference held earlier this year on the Gold Coast.

 

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