Therapy of inflammatory bowel disease in pregnant women
Gaus O.V., Zhabrova T.S.
Omsk State Medical University
Drug therapy for ulcerative colitis and Crohn’s disease during pregnancy is a very actual problem, because the peak of their development falls on the period of childbearing. Despite the fact that the number of studies on the efficacy and safety of the drug therapy in pregnant women with inflammatory bowel diseases is increasing, most of these studies are uncontrolled and performed on a small clinical material. It is not always possible to analyze the results of such studies. Many drugs easily penetrate through the blood placenta barrier and affect the developing fetus. However, the refusal of treatment can be associated with a greater risk of adverse pregnancy outcomes for both the mother and the fetus. This article presents current data on the possible use of drugs for the treatment and maintaining a remission of inflammatory bowel diseases in pregnant women.
Key words: inflammatory bowel diseases, Crohn’s disease, ulcerative colitis, pregnancy, anti-inflammatory therapy, immunosuppressants, biological therapy.
For citation: Gaus O.V., Zhabrova T.S. Therapy of inflammatory bowel disease in pregnant women // RMJ. Medical Review. 2018. № 3. P. 30–35.
References
1. Клинические рекомендации Российской гастроэнтерологической ассоциации и Ассоциации колопроктологов России по диагностике и лечению язвенного колита [Электронный ресурс] [Klinicheskie recommendacii Rossiiskoi gastroenterologicheskoi associacii i Associacii koloproctologov Rossii po diagnostike i lecheniyu yazvennogo kolita in Russian)]. URL: http://www.gastro.ru/userfiles/R_YAZVKOLIT_2017.pdf (Дата обращения: 01.11.2017).
2. Клинические рекомендации Российской гастроэнтерологической ассоциации и Ассоциации колопроктологов России по диагностике и лечению болезни Крона [Электронный ресурс] [Klinicheskie recommendacii Rossiiskoi gastroenterologicheskoi associacii i Associacii koloproctologov Rossii po diagnostike i lecheniyu bolezni Krona (in Russian)]. URL: http://www.gastro.ru/userfiles/R_Krona_2017.pdf (Дата обращения: 01.11.2017).
3. Stein D.J., Shaker R. Inflammatory Bowel Disease. A Point of Care Clinical Guide // Springer International Publishing Switzerland. 2015. 244 р.
4. Kanis S.L., van der Woude C.J. Endoscopy for Inflammatory Bowel Disease During Pregnancy: Only When There Is a Strong Indication // Gastroenterology. 2017. Vol. 153(1). P. 330–331.
5. Циммерман Я.С., Михалева Е.Н. Возможности фармакотерапии при лечении гастроэнтерологических заболеваний в период беременности // Клиническая медицина. 2015. Т. 93(8). С. 8–18 [Cimmerman Y.S., Mihaleva E.N. Vozmozhnosti farmakoterapii pri lechenii gastroenterologicheskih zabolevanii v period beremennosti // Klinicheskaya medicina. 2015. Т. 93(8). S. 8–18 (in Russian)].
6. Gaidos J.K.J., Kane S.V. Managing IBD Therapies in Pregnancy // Curr Treat Options Gastroenterol. 2017. Vol. 15 (1). Р. 71–83.
7. Van der Woude C.J., Ardizzone S., Bengtson M.B. et al. The Second European Evidenced-Based Consensus on Reproduction and Pregnancy in Inflammatory Bowel Disease // J Crohns Colitis. 2015. Vol. 9 (2). Р. 107–124.
8. Gaidos J.K.J., Kane S.V. Sexuality, Fertility, and Pregnancy in Crohn’s Disease // Gastroenterol. Clin. N. Am. 2017. Vol. 46 (3). Р. 531–546.
9. Maliszewska А.М., Warska A., Cendrowski K., Sawicki W. Inflammatory bowel disease and pregnancy // Ginecologia Polska. 2017. Vol. 88(7). Р. 398–403.
10. Hosseini-Carroll P., Mutyala M., Seth A. et al. Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management // World J Gastrointest Pharmacol Ther. 2015. Vol. 6(4). Р. 156–171.
11. Корниенко Е.А. Воспалительные заболевания кишечника у детей. М.: Прима Принт, 2014. 208 с. [Kornienko E.A. Vospalitel’nie zabolevaniya kishechnika u detei. M.: Prima Print, 2014. 208 s. (in Russian)].
12. Mogadam M., Dobbins 3rd W.O., Korelitz B.I., Ahmed S.W. Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome // Gastroenterology. 1981. Vol. 80(1). P. 72–76.
13. Norgard B., Czeizel A.E., Rockenbauer M. et al. Population-based case control study of the safety of sulfasalazine use during pregnancy // Aliment. Pharmacol. Ther. 2001. Vol. 15(4). P. 483–486.
14. Riley S.A., Lecarpentier J., Mani V. et al. Sulphasalazine induced seminal abnormalities in ulcerative colitis: results of mesalazine substitution // Gut. 1987. Vol. 28(8). P. 1008–1012.
15. Toovey S., Hudson E., Hendry W.F., Levi A.J. Sulphasalazine and male infertility: reversibility and possible mechanism // Gut. 1981. Vol. 22(6). P. 445–451.
16. Mahadevan U.C.D. Aminosalicylate (ASA) use during pregnancy is not associated with increased adverse events or congenital malformations (CM) in women with inflammatory bowel disease (IBD) // Gastroenterology. 2006. Vol.130 (Suppl 2). P. A40.
17. Colombel J.F., Brabant G., Gubler M.C. et al. Renal insufficiency in infant: side-effect of prenatal exposure to mesalazine? // Lancet. 1994. Vol. 344(8922). P. 620–621.
18. Rahimi R., Nikfar S., Rezaie A., Abdollahi M. Pregnancy outcome in women with inflammatory bowel disease following exposure to 5-aminosalicylic acid drugs: a meta-analysis. Reprod // Toxicol. 2008. Vol. 25(2). P. 271–275.
19. Borch J., Metzdorff S.B., Vinggaard A.M. et al. Mechanisms underlying the antiandrogenic effects of diethylhexyl phthalate in fetal rat testis // Toxicology. 2006. Vol. 223(1–2). P. 144–155.
20. Hernandez-Diaz S., Su Y.C., Mitchell A.A. et al. Medications as a potential source of exposure to phthalates among women of childbearing age // Reprod. Toxicol. 2013. Vol. 37. P. 1–5.
21. Armenti V.T., Daller J.A., Constantinescu S. et al. Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation // Clin. Transpl. 2002. P. 121–130.
22. Habal F.M., Huang V.W. Review article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient // Aliment. Pharmacol. Ther. 2012. Vol. 35(5). P. 501–515.
23. Khan A.A., Rodriguez A., Kaakinen M. et al. Does in utero exposure to synthetic glucocorticoids influence birthweight, head circumference and birth length? A systematic review of current evidence in humans // Paediatr. Perinat. Epidemiol. 2011. Vol. 25(1). P. 20–36.
24. Beaulieu D.B., Ananthakrishnan A.N., Issa M. et al. Budesonide induction and maintenance therapy for Crohn’s disease during pregnancy // Inflamm. Bowel Dis. 2009. Vol. 15(1). P. 25–28.
25. Van Assche G., Dignass A., Reinisch W. et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Special situations // J. Crohns Colitis. 2010. Vol. 4(1). P. 63–101.
26. Cleary B.J., Kallen B. Early pregnancy azathioprine use and pregnancy outcomes. Birth Defects Res // A Clin. Mol. Teratol. 2009. Vol. 85(7). P. 647–654.
27. Jharap B., de Boer N.K., Stokkers P. et al. Dutch Initiative on Crohn and Colitis. Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease // Gut. 2014. Vol. 63(3). P. 451–457.
28. Polifka J.E., Friedman J.M. Teratogen update: azathioprine and 6-mercaptopurine // Teratology. 2002. Vol. 65(5). P. 240–261.
29. Bar Oz. B., Hackman R., Einarson T., Koren G. Pregnancy outcome after cyclosporine therapy during pregnancy: a meta-analysis // Transplantation. 2001. Vol. 71(8). P. 1051–1055.
30. Bertschinger P., Himmelmann A., Risti B., Follath F. Cyclosporine treatment of severe ulcerative colitis during pregnancy // Am. J. Gastroenterol. 1995. Vol. 90(2). P. 330.
31. Baumgart D.C., Sturm A., Wiedenmann B., Dignass A.U. Uneventful pregnancy and neonatal outcome with tacrolimus in refractory ulcerative colitis // Gut. 2005. Vol. 54(12). P. 1822–1823.
32. Mahadevan U., Wolf D.C., Dubinsky M. et al. PIANO: a 1000 patient prospective registry of pregnancy outcomes in women with IBD exposed to immunomodulators and biologic therapy // Gastroenterology. 2012. Vol. 142 (Suppl. 1). P. 149.
33. Shihab Z., Yeomans N.D., De Cruz P. Anti-Tumour Necrosis Factor α Therapies and Inflammatory Bowel Disease Pregnancy Outcomes: A Meta-analysis // J Crohns Colitis. 2016. Vol. 10(8). P. 979–988.
34. De Lima A., Zelinkova Z., van der Ent C. et al. Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety // Gut. 2016. Vol. 65 (8). P. 1261–1268.
35. Gisbert J.P., Chaparro M. Review Safety of anti-TNF agents during pregnancy and breastfeeding in women with inflammatory bowel disease // Am. J. Gastroenterol. 2013. Vol. 108 (90). P. 1426–1438.
36. Mahadevan U., Douglas C. W., Dubinsky M. et al. Placental transfer of anti-tumor necrosis factor agents in pregnant patients with inflammatory bowel disease // Clin. Gastroenterol. Hepatol. 2013. Vol. 11(3). P. 286–292.
37. Heller M.M., Wu J.J., Murase J.E. Fatal case of disseminated BCG infection after vaccination of an infant with in utero exposure to infliximab // J. Am. Acad. Dermatol. 2011. Vol. 65(4). P. 870.
38. Baker D.E. Adalimumab: human recombinant immunoglobulin g1 anti-tumor necrosis factor monoclonal antibody // Rev. Gastroenterol. Disord. 2004. Vol. 4(4). P. 196–210.
39. Yvette P.Y., Panaccione R., Ghosh S. et al. Management of the pregnant inflammatory bowel disease patient on antitumour necrosis factor therapy: State of the art and future directions // Can. J. Gastroenterol. Hepatol. 2014. Vol. 28(9). P. 505–509.
40. Lau A.G., Clark M., Harrison D.D. et al. Pregnancy outcomes in women exposed to golimumab // Arthritis Rheum. 2013. Vol. 65(10). P. 870–871.
41. Mariette X., Förger F., Abraham B. et al. Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacokinetic study // Ann. Rheum. Dis. 2017. Vol. 10. P. 1–6.
42. Friend S., Richman S., Bloomgren G. et al. Evaluation of pregnancy outcomes from the Tysabri® (natalizumab) pregnancy exposure registry: a global, observational, follow-up study // BMC Neurology. 2016. Vol. 16(1). P. 150.
43. Haghikia A., Langer-Gould A., Rellensmann G. et al. Natalizumab use during the third trimester of pregnancy // JAMA Neurol. 2014. Vol. 71(7). P. 891–895.
44. Mahadevan U., Vermeire S., Lasch K. et al. Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease. Alimantary Pharmocology and Therapeutics // 2017. Vol. 45(7). P. 941–950.

This work is licensed under a Creative Commons «Attribution» 4.0 License.
Previous article
Next article
















