Practice Pregnancy Plus

Inflammatory bowel disease in pregnancy

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.39566.681458.BE (Published 03 July 2008) Cite this as: BMJ 2008;337:a427
  1. Charles B Ferguson, specialist registrar in gastroenterology1,
  2. Samina Mahsud-Dornan, subspecialist trainee in materno-fetal medicine1,
  3. R Neil Patterson, consultant gastroenterologist2
  1. 1The Royal Hospitals, Belfast BT12 6BA
  2. 2Antrim Area Hospital, Antrim, County Antrim, BT41 2RL
  1. Correspondence to: C B Ferguson charlieferguson{at}doctors.org.uk
  • Accepted 1 April 2008

Active maternal inflammatory bowel disease during pregnancy carries a greater risk to the fetus than appropriate treatment. Careful management is essential to achieve good obstetric outcome

Inflammatory bowel disease is a collective term for chronic illnesses characterised by inflammation of the intestinal tract, the most common of which are ulcerative colitis and Crohn’s disease. The natural course of inflammatory bowel disease is marked by periods of relapse followed by periods of remission, and the aims of management are induction and maintenance of remission and avoidance of disease complications.

Scenario

A 32 year old woman (para 2) presented at week 14 of pregnancy with bleeding from the rectum (clots and overt bleeding mixed with stools) but no change in bowel habit. She did not have haemorrhoids, stool cultures were negative, and she had moderate proctitis on proctoscopy. She was given steroid enemas, but these had no effect, and at 29 weeks’ gestation she was started on a course of oral prednisolone under the close supervision of the obstetricians. She had a good clinical response, but on tapering the dose her symptoms recurred, and at 35 weeks the dose was increased again to control her symptoms. The obstetricians monitored the fetus weekly and she delivered at term. Her steroid dose was again tapered and mesalazine was started. Subsequent colonoscopy showed mild rectosigmoiditis. She remains on maintenance mesalazine, she is breast feeding, and mother and baby are well.

Diagnosis is often made early in life and 50% of patients are diagnosed before 35 years of age. The incidence of ulcerative colitis is estimated at 10.4 per 100 000 and that of Crohn’s disease at around 5.6/100 000 in Western populations.1 2 About a quarter of female patients with inflammatory bowel disease will conceive after the diagnosis is made, so an understanding of managing the disease …

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