Are IBD Drugs Safe During Pregnancy?

Drugs might be safe for pregnant women with Crohn's and ulcerative colitis

(RxWiki News) When you're pregnant, you try to avoid putting any unnecessary chemicals into your body. But what if you're an expectant mom with inflammatory bowel disease – is it safe to take your meds?

A new study has good news for hopeful moms with inflammatory bowel disease (IBD).

Continuing medical treatment for IBD during pregnancy does not increase your baby's chances of having a birth defect, or congenital abnormality.

"Consult your doctor about healthy pregnancy strategies."

The study was led by Dr. Uma Mahadevan, an associate professor of clinical medicine at the University of California, San Francisco, and the Center for Colitis and Crohn’s Disease. The research team set out to learn whether fears about IBD treatments causing birth defects were justified.

IBD is an umbrella term for a group of diseases that are characterized by inflammation of the intestines. The most common forms are ulcerative colitis and Crohn's disease.

As many as one million Americans have some form of IBD. It's a chronic, or lifelong disease, and those who suffer from it go through periods of active flare-ups and remissions.

According to Crohn's and Colitis UK, a charity based in England, pregnancies can be safe and normal if the mother's disease is under control – in remission – throughout the pregnancy. But there is a debate about what types of drugs are safe for mothers to take if she experiences a painful flare-up period while pregnant.

Dr. Mahadevan's study looked at azathioprine and biologic therapy. Azathioprine, brand name Imuran, is a common immunosuppressant that fights to subdue the intestine's wayward immune response and calm the inflammation that occurs during flare-ups.

Biologic therapy is medication that targets the root of the disease at the body's immune response. It's used in cases where patients have moderate to severe symptoms, and haven't responded to conventional therapies.

The study was the largest to follow pregnant patients with IBD. Nearly 900 were separated into four groups, categorizing women by the drugs they had taken, along with women who had taken no drugs.

They found that children of women who had medical therapy for IBD were no more likely to have birth defects than women who hadn't taken drugs at all. The rate of abnormalities overall for women with IBD was 6 percent compared with a national rate of 3 percent.

For women with Crohn's disease, there was no notable increase in adverse events during pregnancy or birth, but there was some concern for women who had ulcerative colitis and were on biologic therapy. This group had 4.85 times more spontaneous miscarriages.

Ulcerative colitis patients on combination therapy had three times as many complications, four times as many preterm births, three times as many babies with low birth weights and the babies were four times as likely to stay in a neonatal intensive care unit. 

At a press briefing, Dr. Mahadevan said that patients with IBD are expected to have more complications than women without IBD, even if their disease is in remission during the pregnancy. That is especially true for women who are treated with a combination of biologic therapies, because it is likely that their disease is more severe than women who are taking the first-line medications.

Her recommendation is that IBD patients who are in remission on Imuran or a biologic therapy should remain on that drug during pregnancy. But if Imuran is prescribed only to prevent antibody formation, it should be discontinued.

For IBD patients who want to become pregnant but have not begun treatment yet, she recommends certolizumab.

If you have IBD and plan to become pregnant, consult your gastroenterologist about what you can do to increase your chances of having a healthy baby.

The research was presented at the 2012 Digestive Disease Week meeting. Dr. Mahadevan has ties to several pharmaceutical companies, including SmithGlaxoKline which produces Imuran.

Review Date: 
July 28, 2012