Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
Department of Obstetrics and Gynaecology, Maternal Fetal Medicine Division, Mount Sinai Hospital, University of Toronto, OPG-3, 600 University Avenue, Toronto, ON M5G 1X5, Canada.
Nat Rev Gastroenterol Hepatol. 2014 Feb;11(2):116-27. doi: 10.1038/nrgastro.2013.135. Epub 2013 Jul 30.
IBD often affects patients during their peak reproductive years. Several drugs are available for the treatment of IBD and new drugs are continuously in the pipeline. As long-term administration of medications is often necessary, the safety of drug therapy during pregnancy and breast-feeding needs to be considered in daily clinical practice. The aim of this Review is to summarize the latest information concerning the safety of medications used to treat IBD during pregnancy and lactation, as well as their effect on fertility. Although only thalidomide and methotrexate are absolutely contraindicated during pregnancy and breast-feeding, alternatives to ciprofloxacin, natalizumab and sodium phosphate should also be considered for pregnant women. Breast-feeding is also discouraged while on treatment with ciclosporin, metronidazole and ciprofloxacin. However, therapy with 5-aminosalicylic acid preparations, glucocorticoids, thiopurines and TNF inhibitors are acceptable during pregnancy and lactation. Pregnant women who have symptomatic IBD or who require therapy should have the opportunity to discuss any associated risks to their pregnancy and infant with the appropriate consultants. By ensuring that the patient and her family are informed, the clinical outcome might be optimized.
IBD 常发生于患者的生育高峰期。有多种药物可用于治疗 IBD，且新的药物也在不断研发中。由于长期用药通常是必需的，因此在日常临床实践中需要考虑药物治疗在妊娠和哺乳期的安全性。本综述旨在总结用于治疗妊娠和哺乳期 IBD 的药物的最新安全性信息，以及它们对生育能力的影响。虽然只有沙利度胺和甲氨蝶呤在妊娠和哺乳期绝对禁忌使用，但环丙沙星、那他珠单抗和磷酸钠也应考虑用于孕妇。环孢素、甲硝唑和环丙沙星治疗期间也不鼓励母乳喂养。然而，5-氨基水杨酸制剂、糖皮质激素、硫嘌呤和 TNF 抑制剂在妊娠和哺乳期是可以接受的。有症状的 IBD 或需要治疗的孕妇应该有机会与适当的顾问讨论任何与妊娠和婴儿相关的风险。通过确保患者及其家属知情，临床结局可能会得到优化。
