Cao Rena H, Grimm Michael C
St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia.
Obstet Med. 2021 Mar;14(1):4-11. doi: 10.1177/1753495X20919214. Epub 2020 May 11.
Inflammatory bowel disease (IBD) affects patients at a significant time in their lives, often coinciding with family planning or pregnancy. While advances in IBD therapies have afforded women greater opportunities for successful conception and pregnancy outcomes, there still remains considerable maternal fear surrounding continuation of treatment in pregnancy. With the exception of methotrexate, most IBD drugs are safe and well tolerated during pregnancy and are not associated with significant risk of adverse fetal or pregnancy outcomes. Furthermore, the current evidence overwhelmingly suggests that good control of disease activity and clinical remission at time of conception are the greatest prognostic factors for an uncomplicated pregnancy and maintenance of quiescent disease. Management of pregnant women with IBD should involve discussions with the mother and family about fears or concerns surrounding the impact of IBD on pregnancy. Mothers should be supported and counselled carefully on the safety and importance of adherence to therapy in maintaining remission. Optimal management of these women requires an inter-disciplinary team effort, involving the general practitioner, in close consultation with both gastroenterologists and obstetricians.
炎症性肠病（IBD）在患者生命中的重要时期对其产生影响，通常与计划生育或怀孕同时发生。虽然IBD治疗方法的进步为女性提供了更多成功受孕和获得良好妊娠结局的机会，但孕妇对孕期继续治疗仍存在相当大的恐惧。除甲氨蝶呤外，大多数IBD药物在孕期是安全且耐受性良好的，与胎儿不良或妊娠不良结局的重大风险无关。此外，目前的证据压倒性地表明，受孕时疾病活动的良好控制和临床缓解是妊娠顺利及维持疾病静止的最大预后因素。IBD孕妇的管理应包括与母亲及其家人讨论IBD对妊娠影响的恐惧或担忧。应仔细支持并指导母亲了解坚持治疗对维持缓解的安全性和重要性。对这些女性的最佳管理需要跨学科团队的努力，包括全科医生，并与胃肠病学家和产科医生密切协商。
