Young Female with Crohn’s Disease
Crohn’s Disease, Pregnancy, Safety Profile of Biologics
Anti-TNF agents, Azathioprine, Methotrexate, Prednisone
IBD Horizon’s ACG “The Dialogue®
- 28 year old Female with Crohn’s enterocolitis and active symptoms
- Wants to get pregnant soon and apprehensive of starting biologic treatment
- Discuss safety profile of biologics and risk for placental transfer.
- What should be your pre-pregnancy work up for this patient? Evaluate disease activity with colonoscopy and cross sectional imaging. Inactive bowel disease and mucosal remission associated with best outcomes for mother and baby.
- What is the safety profile of non-biologics and biologics during pregnancy? FDA Pregnancy Categories: Corticosteroids class C; Azathioprine class D; Anti-TNFs class B; Methotrexate class X
- What can you do to evaluate a flare during pregnancy? Best to evaluate during 2nd trimester. Flexible sigmoidoscopy without sedation. MRI without gadolinium.
- Is there a preferred mode of delivery? This is shared decision made with patient, obstetrician and gastroenterologist. In general, vaginal delivery is recommended unless active perianal disease or prior surgery such as IPAA/J pouch.Consensus: Evaluate disease activity before family planning. Control disease prior to conception.
Certolizumab pegol/Cimzia does not have placental transfer and may be considered as first line biologic/anti TNF treatment. Anti-TNFs as a class is considered pregnancy category B and safe with pregnancy and compatible with breastfeeding.