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  • Review Article
  • Published:

IBD medications during pregnancy and lactation

Nature Reviews Gastroenterology & Hepatology volume 11, pages 116–127 (2014)Cite this article

Subjects

Abstract

IBD often affects patients during their peak reproductive years. Several drugs are available for the treatment of IBD and new drugs are continuously in the pipeline. As long-term administration of medications is often necessary, the safety of drug therapy during pregnancy and breast-feeding needs to be considered in daily clinical practice. The aim of this Review is to summarize the latest information concerning the safety of medications used to treat IBD during pregnancy and lactation, as well as their effect on fertility. Although only thalidomide and methotrexate are absolutely contraindicated during pregnancy and breast-feeding, alternatives to ciprofloxacin, natalizumab and sodium phosphate should also be considered for pregnant women. Breast-feeding is also discouraged while on treatment with ciclosporin, metronidazole and ciprofloxacin. However, therapy with 5-aminosalicylic acid preparations, glucocorticoids, thiopurines and TNF inhibitors are acceptable during pregnancy and lactation. Pregnant women who have symptomatic IBD or who require therapy should have the opportunity to discuss any associated risks to their pregnancy and infant with the appropriate consultants. By ensuring that the patient and her family are informed, the clinical outcome might be optimized.

Key Points

  • Multidisciplinary cooperation between a gastroenterologist, obstetrician and paediatrician in the care of pregnant women with IBD might optimize expectation, care and outcome for the mother and child

  • Although the maxim of 'first, do no harm' is still true, in many patients continuing relevant medication can be the lesser harm

  • Mesalazine, glucocorticoids and thiopurines do not affect female or male fertility and can be used safely prior to and during pregnancy, as well as during lactation

  • Methotraxate is abortifacient, teratogenic and excreted into breast milk; patients should wait 3–6 months from discontinuing methotrexate before becoming pregnant and the drug is contraindicated during pregnancy and breastfeeding

  • Biologic agents seem to be safe for use during pregnancy; biologic agents should only be discontinued before the third trimester in cases of quiescent disease, as with any other therapy for patients with IBD

  • When using biologic agents, inoculations with live vaccines to the infant should be avoided until the agent cannot be detected in the circulation; from a practical standpoint, the standard vaccine schedule is rarely altered

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Acknowledgements

The authors are greatly indebted to Rasmus Dahlin Bojesen for his initial help with data collection and preparing the manuscript.

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  1. Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, DK-2730, Denmark

    Ole Haagen Nielsen & Jakob Hendel

  2. Department of Obstetrics and Gynaecology, Maternal Fetal Medicine Division, Mount Sinai Hospital, University of Toronto, OPG-3, 600 University Avenue, Toronto, M5G 1X5, ON, Canada

    Cynthia Maxwell

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Nielsen, O., Maxwell, C. & Hendel, J. IBD medications during pregnancy and lactation. Nat Rev Gastroenterol Hepatol 11, 116–127 (2014). https://doi.org/10.1038/nrgastro.2013.135

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