Top News in Gastroenterology January 28 2019 (3 of 3) - MD Linx

Women with inflammatory bowel disease (IBD) can have healthy pregnancies with proper planning and care, according to a new initiative from a major medical society aimed at dispelling myths surrounding the disease.

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The IBD Parenthood Project from the American Gastroenterological Association (AGA) educates women with IBD about how to manage their condition to avert risks while conceiving, carrying a child, and giving birth.

Ulcerative colitis and Crohn's disease, the two forms of IBD, usually involve severe diarrhea, abdominal pain, fatigue, and weight loss. IBD, which affects more than 10 million people worldwide, can be debilitating and even life-threatening. Women with IBD are three times more likely to choose not to have children than women in the general population, in part due to misconceptions about the disease, the AGA notes.

Often, when a pregnant woman's IBD is not well controlled, her body's resources are directed toward the inflammation and away from nourishing a fetus. Complications can include miscarriages, pre-term births, and underweight newborns, said Dr. Uma Mahadevan of the University of California, San Francisco, who chaired the IBD Parenthood Project. But "with proper planning and care, women with IBD can have healthy pregnancies," the IBD Parenthood Project advises.

On the project's website, women who are pregnant or considering pregnancy can find a toolkit that includes fact sheets, a discussion guide, and a checklist of questions to go over with their physicians. The project seeks to address common worries, such as whether medications for IBD are harmful during pregnancy and fears about passing on the disease to a newborn.

"I personally feared that I may not be able to have children," Jessica Caron, who has Crohn's disease, told Reuters Health by phone. "You know, how do I manage this disease and also safely carry a pregnancy? Should I stop the medications that I was taking for my Crohn's in order to get pregnant?"

Caron, who successfully carried two pregnancies to term, faced a dearth of resources for women with IBD who were considering pregnancy. That's part of the reason, she says, she worked with the AGA to help develop content for the IBD Parenthood Project.

"A lot of women think they cannot get pregnant, that medications pose more risk than they actually do, or that they need a cesarean section," Dr. Edmund Funai of western Florida, a specialist in maternal-fetal medicine (MFM) who was not involved in the project, told Reuters Health by email.

"The toolkit is very comprehensive...My only suggestion would be to encourage women to see an MFM specialist before they are pregnant," Funai said. "Medications can then be evaluated for compatibility with pregnancy, and if changes need to be made, they can then be done in advance, so that disease is stable at the time of conception, thereby increasing the chance of a complication-free pregnancy."

Indeed, the IBD Parenthood Project advises women to talk with health-care providers "early in the process" of family planning and work with a team of specialists to develop an individualized treatment plan. Because inflammatory bowel diseases typically flare up and go into remission periodically, the goal is to avoid flares, considered risky during pregnancy.

"The rule of thumb is that you should be in a remission before you consider pregnancy," Mahadevan said. "One of the items outlined in the Parenthood Project is that you should be in remission for at least 3 months before considering conception so that your body has the time to recover from the flare and we know that your treatments are working."

The IBD Parenthood Project is also supported by the Society for Maternal-Fetal Medicine, the Crohn's & Colitis Foundation, and the patient support network, Girls With Guts. A clinical care pathway developed by the IBD Parenthood Project and published January 19, 2019, in the journal Gastroenterology provides doctors with information for treating pregnancies in women with IBD.

—Tamara Mathias

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