Surgical Management of Inflammatory Bowel Disease in Pregnancy

Abstract

While the incidence of developing inflammatory bowel disease does not increase during pregnancy, exacerbations of existing IBD often occur in pregnant women. Treatment decisions must take into account not only the possible negative effects on the mother but also the implications for the pregnancy as well as adverse effects on the fetus. Over the last two decades, there have been significant advances in the medical management of IBD which includes both ulcerative colitis and Crohn’s disease. The most significant of these has been the use of tumor necrosis factor inhibitors and other monoclonal antibodies which have been used effectively and relatively safely during pregnancy. Despite these advances, complications of both ulcerative colitis and Crohn’s disease can develop which require surgical intervention. The nature of these complications often differs between ulcerative colitis and Crohn’s disease, and a thorough understanding of the surgical options is necessary to maximize clinical outcomes and preserve appropriate future treatment options. In this chapter we discuss appropriate medical management for IBD to try to avoid surgical intervention during pregnancy as well as the myriad of clinical presentations of IBD which require surgery and the appropriate surgical management to maximize outcomes for both the mother and fetus.