IBD and Pregnancy

  • Gianluca Colucci
  • Gian Gaetano Delaini
  • Filippo Nifosì


UC and CD are inflammatory diseases of the intestine, with a multifactor pathogenesis and the tendency to especially afflict young women of reproductive age, affecting their quality of life as well as their interpersonal relationships. In reference to this aspect, it is important to emphasise the psychological effect of the disease on patients’ sexual life, which can undermine the opportunity of having children despite the fact that IBD itself does not considerably affect fertility. Moreover, even if pregnant women suffering from IBD require strict monitoring, particularly concerning the nutritional aspect and the need for aggressive treatment of any disease relapses, risk to the foetus or the expectant mother are moderate in suitably controlled disease, and many concerns about pregnancy and its possible consequences are not justified.

Risks increase in insufficiently treated disease, as in this case, relapses are frequent and invariably influence foetal growth negatively, resulting in low birth weight, premature delivery and miscarriage. For this reason, it is necessary when treating young women with IBD to apply a multidisciplinary approach involving careful evaluation of patients’ psychosocial status and including discussion about medical, psychological and sexual problems, informing and educating them about the peculiar aspects of pregnancy and its management during IBD.

On the basis of the present trend, a patient with IBD that is kept in a quiescent stage thanks to increasingly effective medical therapies, most of which are well tolerated during pregnancy, may expect pregnancy course and outcome not too different from those expected in young healthy women.


Inflammatory Bowel Disease Ulcerative Colitis Pregnant Patient Ileal Pouch Anal Anastomosis Ileal Pouch 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Irvine EJ, Feagan B, Rochon J et al (1994) Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Gastroenterology 106:287–296PubMedGoogle Scholar
  2. 2.
    Alstead EM, Nelson-Piercy C (2003) Inflammatory bowel disease in pregnancy. Gut 52:159–161PubMedCrossRefGoogle Scholar
  3. 3.
    Moody G, Probert G, Srivasta E et al (1993) Sexual dysfunction amongst patients with Crohn’s disease, a hidden problem. Digestion 52:179–183Google Scholar
  4. 4.
    Moody G, Mayberry J (1993) Perceived sexual dysfunction amongst patients with inflammatory bowel disease. Digestion 52:256–260CrossRefGoogle Scholar
  5. 5.
    Mayberry JF, Weterman IT (1986) European survey of fertility and pregnancy in women with Crohn’s disease: a case control study by European collaborative group. Gut 27:821–825PubMedGoogle Scholar
  6. 6.
    Hudson M, Flett G, Sinclair TS, et al (1997) Fertility and pregnancy in inflammatory bowel disease. Int J Gynaecol Obstet 58:229–237PubMedCrossRefGoogle Scholar
  7. 7.
    Ravid A, Richard C, O’Connor BI et al (2001) Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis. Gastroenterology 120:2417CrossRefGoogle Scholar
  8. 8.
    Narendranathan M, Sandler RS, Suchindran M et al (1989) Male fertility in inflammatory bowel disease. J Clin Gastroenterol 11:403–406PubMedCrossRefGoogle Scholar
  9. 9.
    O’Morain C, Smethurst P, Dore CJ et al (1984) Reversible male infertility due to sulphasalazine: studies in man and rat. Gut 25:1078–1084PubMedGoogle Scholar
  10. 10.
    Moody GA, Probert C, Jayanthi V et al (1997) The effect of chronic ill health and treatment with sulphasalazine on fertility amongst men and women with inflammatory bowel disease in Leicester. Int J Colorectal Dis 12:220–224PubMedCrossRefGoogle Scholar
  11. 11.
    Trachter AB, Rogers AI, Leiblum SR (2002) Inflammatory bowel disease in women: impact on relationship and sexual health. Inflamm Bowel Dis 8(6):413–421PubMedCrossRefGoogle Scholar
  12. 12.
    Peeters M, Nevans H, Baert F et al (1996) Familial aggregation in Crohn’s disease. Increased age, adjusted risk and concordance in clinical characteristics. Gastroenterology 111:597–603PubMedCrossRefGoogle Scholar
  13. 13.
    Sartor RB (2003) Clinical applications of advances in the genetics of IBD. Rev Gastroenterol Disord 3(Suppl1)S9–S17PubMedGoogle Scholar
  14. 14.
    Fonager K, Sorensen HT, Olsen J et al (1998) Pregnancy outcomes in women with Crohn’s disease: a follow up study based on linkage between national registries. Am J Gastroenterol 93:2426–2430PubMedCrossRefGoogle Scholar
  15. 15.
    Norgard B, Fonager K, Sorensen HT et al (2000) Birth outcomes in women with ulcerative colitis: a nationwide Danish cohort study. Am J Gastroenterol 95:3165–3170PubMedGoogle Scholar
  16. 16.
    Dominitz JA, Young JC, Boyko EJ (2002) Outcomes of infants born to mothers with inflammatory bowel disease: a population based cohort study. Am J Gastroenterol 97:641–648PubMedCrossRefGoogle Scholar
  17. 17.
    Baird DD, Narendranathan M, Sandler RS (1990) Increased risk of pre-term birth for women with inflammatory bowel disease. Gastroenterology 99:987–994PubMedGoogle Scholar
  18. 18.
    Fedorkow DM, Persaud D, Nimrod CA (1989) Inflammatory bowel disease: a controlled study of late pregnancy outcome. Am J Obstet Gynaecol 160:998–1001Google Scholar
  19. 19.
    Cappell MS (1998) The safety and efficacy of gastrointestinal endoscopy during pregnancy. Gastroenterol Clin NA 27:37–71CrossRefGoogle Scholar
  20. 20.
    Mogadam M, Korelitz BI, Ahmed SW et al (1981) The course of inflammatory bowel disease during pregnancy and postpartum. Am J Gastroenterol 18:735–742Google Scholar
  21. 21.
    Christian Mottet, Pascal Juillerat et al (2005) Pregnancy and Crohn’s disease. Digestion 71:54–61CrossRefGoogle Scholar
  22. 22.
    Castiglione F, Pignata S, Morace F et al (1996) Effect on pregnancy on the clinical course of a cohort of women with inflammatory bowel disease. Ital J Gastroenterol 28:199–204PubMedGoogle Scholar
  23. 23.
    Connel W, Miller A (1999) Treating inflammatory bowel disease during pregnancy: risk and safety of therapy. Drug Saf 21:311–323CrossRefGoogle Scholar
  24. 24.
    Moskovitz DN, Carol Bodian et al (2004) The effect on the fetus of medications used to treat pregnant inflammatory bowel disease patients. Am J Gastroenterol 100(8)1897–1898Google Scholar
  25. 25.
    Habal FM, Hui G, Greenberg Gr (1993) Oral 5 aminosalicylic acid for inflammatory bowel disease in pregnancy: safety and clinical course. Gastroenterology 105:1057–60PubMedGoogle Scholar
  26. 26.
    Trallori G, d’Albasio G, Bardazzai G, et al (1994) 5-aminosalicylic acid in pregnancy: clinical report. Ital J Gastroenterol 26:75–78PubMedGoogle Scholar
  27. 27.
    Newman NM, Correy JF (1983) Possible teratogenicity of Sulphasalazine. Med J Aust 1(11):528–529PubMedGoogle Scholar
  28. 28.
    Reinisch SM, Simon NG, Karwo WG et al (1978) Prenatal exposure to prednisone in Humans and animals retards intrauterine growth. Science 202:436–438PubMedCrossRefGoogle Scholar
  29. 29.
    Scott JR (1977) Fetal growth retardation associated with maternal administration of immunosuppressive drugs. Am J Obstet Gynecol 128(6):668–676PubMedGoogle Scholar
  30. 30.
    Marion JF, Present DH (1996) 6-MP maintains cyclosporine induced response in patients with severe ulcerative colitis with inflammatory bowel disease. Am J Gastroenterol 91:A1975Google Scholar
  31. 31.
    Weinstein GD (1977) Methotrexate. Ann Intern Med 86:199–204PubMedGoogle Scholar
  32. 32.
    Srinivasan R (2001) Infliximab treatment and pregnancy outcome in active Crohn’s disease. Am J Gastroenterol 96:2274–2275PubMedCrossRefGoogle Scholar
  33. 33.
    Burtin P, Taddio A, Ariburnu O et al (1995) Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol 172:525–529PubMedCrossRefGoogle Scholar
  34. 34.
    Lewis JH, Weingold AB (1985) The use of the gastrointestinal drugs during pregnancy and lactation. Am J Gastroenterol 80:912–923PubMedGoogle Scholar
  35. 35.
    Modigliani R (1997) Drug therapy for ulcerative colitis in pregnancy. Eur J Gastroenterol Hepatol 9:854–857PubMedGoogle Scholar
  36. 36.
    Scott HJ, McLeod RS, Blair J et al (1996) Ileal pouchanal anastomosis: pregnancy, delivery and pouch function. Int J Colorectal Dis 11:84–87PubMedGoogle Scholar
  37. 37.
    Fazio VW, Ziv Y, Church JM et al (1995) Ileal pouchanal anastomoses complications and function in 1005 patients. Ann Surg 222:120–127PubMedCrossRefGoogle Scholar
  38. 38.
    Dayton MT, Larsen KP (1997) Outcome of pouch-related complications after ileal pouch-anal anastomosis. Am J Surg 174:728–731PubMedCrossRefGoogle Scholar
  39. 39.
    Meagher AP, Farouk R, Dozois RR et al (1998). Ileal pouch-anal anastomosis for chronic ulcerative colitis: complication and long-term outcome in 1310 patients. Br J Surg 85:800–803PubMedCrossRefGoogle Scholar
  40. 40.
    Metcalf AM, Dozois RR, Kelly KA (1986) Sexual function in women after proctocolectomy. Ann Surg 204:624–627PubMedCrossRefGoogle Scholar
  41. 41.
    Oresland T, Palmblad S, Ellstrom M et al (1994) Gynaecological and sexual function in women after proctocolectomy. Int J Colorectal Dis 9:77–81PubMedCrossRefGoogle Scholar
  42. 42.
    Damgaard B, Wettergren A, Kirkegaard P (1995) Social and sexual function following ileal pouch-anal anastomosis. Dis Colon Rectum 38:286–289PubMedCrossRefGoogle Scholar
  43. 43.
    Tainen J, Matikainen M, Hiltunen KM et al (1999) Ileal J pouch anal anastomosis, sexual dysfunction and fertility. Scand J Gastroenterol 34:185–188CrossRefGoogle Scholar
  44. 44.
    Diamond MP, Freeman ML (2001) Clinical implication of post-surgical adhesion. Hum Reprod Update 7:567–576PubMedCrossRefGoogle Scholar
  45. 45.
    Sjogren B, Poppen B (1995) Sexual life in women after colectomy-proctomusectomy with S-pouch. Acta Obstet Gynecol Scand 74:51–55PubMedGoogle Scholar
  46. 46.
    Bambrick M, Fazio VW, Hull T et al (1996). Sexual function following restorative proctocolectomy in women. Dis Colon Rectum 39:610–614PubMedCrossRefGoogle Scholar
  47. 47.
    Farouk R, Pemberton JH, Wolff BG et al (2000) Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 231:919–926PubMedCrossRefGoogle Scholar
  48. 48.
    Johnson P, Richard C, Ravid A et al (2004) Female infertility after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum 47:1119–1126PubMedCrossRefGoogle Scholar
  49. 49.
    Olsen KO, Joelsson M, Lauberg S et al (1999) Fertility after ileal pouch anal anastomosis in women with ulcerative colitis. Br J Surg 86:493–495PubMedCrossRefGoogle Scholar
  50. 50.
    Donnelly V, Fynes M, Campbell D et al (1998) Obstetric events leading to anal sphincter damage. Obstet Gynecol 92:955–961PubMedCrossRefGoogle Scholar
  51. 51.
    Pezim ME (1984) Successful childbirth after restorative proctocolectomy with pelvic ileal reservoir. Br J Surg 71:292PubMedGoogle Scholar
  52. 52.
    Juhasz ES, Fozard B, Dozois RR et al (1995) Ileal pouch-anal anastomosis function following childbirth. An extended evaluation. Dis Colon Rectum 38:159–165PubMedCrossRefGoogle Scholar
  53. 53.
    Scott HJ, McLeod RS, Blair J et al (1996) Ileal pouchanal anastomosis: pregnancy, delivery and pouch function. Int J Colorectal Dis 11:84–87PubMedGoogle Scholar
  54. 54.
    Remzi FH, Gorgun E, Bast J et al (2005) Vaginal delivery after ileal pouch-anal anastomosis: a word of caution. Dis Colon Rectum 48:1691–1699PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • Gianluca Colucci
    • 1
  • Gian Gaetano Delaini
    • 1
  • Filippo Nifosì
    • 1
  1. 1.Department of General Surgery and GastroenterologyUniversity of VeronaVeronaItaly

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