IBD is a chronic disease that affects women in their reproductive years. In general, decreased disease activity increases fertility and improves pregnancy outcomes. At the same time, limiting medication during pregnancy is always desired but sometimes conflicts with the goal of controlling the disease.
Mesalamine and glucocorticoids are FDA category B drugs that are used frequently in pregnancy and generally are considered safe, whereas methotrexate is clearly contraindicated in pregnant patients. The use of thiopurine immunosuppressives is more controversial. Because these medications are given long term, both their initiation and discontinuation are major management decisions. Although there are no controlled trials of these medications in pregnancy, considerable experience has emerged over the last several years. There does not appear to be an increase in adverse outcomes in pregnant patients maintained on thiopurine-based immunosuppressives. Nonetheless, decisions regarding the use of these medications in patients contemplating pregnancy are complex and necessarily must involve consideration of the risks and benefits involved.
For a complete Bibliographical listing see Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11th ed., or Goodman & Gilman Online at www.accessmedicine.com.
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