Review article: reproduction in the patient with inflammatory bowel disease

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Alimentary Pharmacology & Therapeutics

OnlineAccepted Articles

To cite this article: Z.S. Heetun, C. Byrnes, P. Neary, C. O'Morain Review article: reproduction in the patient with inflammatory bowel disease Alimentary Pharmacology & Therapeutics (OnlineAccepted Articles). doi:10.1111/j.1365-2036.2007.03397.x

Review article: reproduction in the patient with inflammatory bowel disease

Z.S. Heetun11. Department of Gastroenterology, Adelaide and Meath Hospital, Trinity College, Tallaght, Dublin, Ireland., C. Byrnes22. Department of Surgery, Adelaide and Meath Hospital, Trinity College, Tallaght, Dublin, Ireland., P. Neary22. Department of Surgery, Adelaide and Meath Hospital, Trinity College, Tallaght, Dublin, Ireland. & C. O'Morain11. Department of Gastroenterology, Adelaide and Meath Hospital, Trinity College, Tallaght, Dublin, Ireland.

1. Department of Gastroenterology, Adelaide and Meath Hospital, Trinity College, Tallaght, Dublin, Ireland. 2. Department of Surgery, Adelaide and Meath Hospital, Trinity College, Tallaght, Dublin, Ireland.

Correspondance Author: Z.S. HEETUNAddress:Gastroenterology Research Office,Department of Gastroenterology,Adelaide and Meath Hospital,Including the National Children's Hospital,Tallaght,Dublin 24,Republic of Ireland.E-mail: heetunz@...Tel: 00353-879035434

Abstract

Background

Inflammatory bowel disease (IBD) affects mainly the young population. The effect of IBD and its treatment on fertility and pregnancy is therefore an important clinical consideration.

Aim

To provide a review as to best management of IBD in the reproductive and pregnant population.

Methods

A MEDLINE and an EMBASE search were performed using mainly the search phrases ‘pregnancy AND IBD’, ‘sulphasalazine AND male fertility’, ‘abdominal surgery AND female fertility’, ‘AZA AND placenta’ and ‘infliximab AND pregnancy’. No language nor date restrictions were placed. References of review articles were examined.

Results

Overall male and female fertility are not affected by IBD. Sulphasalzine reduces male fertility. No other drugs used in IBD affect significantly fertility in humans. The risk of pregnancy related complications and the disease behaviour during pregnancy depends mainly on disease activity at time of conception. Proactive treatment for maintenance of disease remission during gestation is recommended. Except for methotrexate, drugs used in IBD appear safe in pregnancy. Breast feeding should be encouraged.

Conclusion

The management of IBD in the young and pregnant population remains controversial because the literature comes mostly from retrospective studies. Further studies particularly large prospective trials are needed to guide clinicians in decision making.