Fertility, pregnancy and breastfeeding in patients with inflammatory bowel disease

Gastroenterological Society of Australia (GESA), 2018 Nguyen, 2016

Most people with inflammatory bowel disease have normal fertility and pregnancies. However, it is recommended that pregnancy be delayed, where possible, until disease is in remission, as active disease at the time of conception increases the risk of persistent disease activity during pregnancy and worsens fetal outcomes.

Active inflammatory bowel disease during pregnancy carries an increased risk of adverse outcomes for mother and fetus. This risk is greater than the risk of therapy, so active disease during pregnancy should be treated to control inflammation as quickly as possible.

Breastfeeding is considered safe in patients on 5-aminosalicylates, thiopurines or tumour necrosis factor (TNF) inhibitor therapy. Although small amounts of these medications may be found in breast milk, little of this is absorbed by the infant. The risks and benefits of breastfeeding should be discussed with patients using methotrexate. Small amounts of methotrexate are excreted into breast milk and may accumulate within the infant’s tissues.

Note: Seek gastroenterologist advice before changing or stopping therapy for inflammatory bowel disease during pregnancy or breastfeeding.

Seek gastroenterologist advice before changing or stopping therapy for inflammatory bowel disease during pregnancy or breastfeeding. The Australian Therapeutic Goods Administration (TGA) pregnancy category should not be the sole basis of decision-making in the use of a drug during pregnancy, in part because it does not provide information about the balance of harms and benefits in a particular patient. During pregnancy, people with inflammatory bowel disease should have regular reviews with a gastroenterologist.

The Gastroenterological Society of Australia website contains fact sheets on inflammatory bowel disease in pregnancy, including information about preconception planning and drug safety during pregnancy and breastfeeding.

The MotherToBaby website includes patient information leaflets about the use of specific drugs in pregnancy and breastfeeding.