Safety of IBD Medication During Pregnancy and Conception for Men and Women with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) has an increasing prevalence worldwide, including young adults. Fertility and pregnancy safety are common topics of concern in this patient population. Maintaining fertility and achieving healthy maternal and fetal outcomes are dependent on disease severity. Steroid free remission for at least three months prior to conception increases the likelihood of sustained remission throughout pregnancy and decreases the risk of pregnancy related complications for both the mother and child. Data from large registries, including PIANO (Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes), has demonstrated that biologics and thiopurines are low risk during pre-conception, pregnancy, delivery, and lactation. Children with in utero or breastmilk exposure to these medications are not at increased risk of infection during their first year of life and achieve developmental milestones at a rate consistent with that of the general population. Methotrexate must be avoided due to the risk of teratogenicity. Data to support use of small molecule therapies during pregnancy and breastfeeding is lacking at this time.