Caballero-Mateos Antonio M, Quesada-Caballero Miguel, Cañadas-De la Fuente Guillermo A, Caballero-Vázquez Alberto, Contreras-Chova Francisco
Gastroenterology Unit, Internal Medicine Department, Hospital Santa Ana, 18600 Motril, Spain.
Albayda La Cruz Community Health Center, 18014 Granada, Spain.
J Clin Med. 2023 Sep 25;12(19):6192. doi: 10.3390/jcm12196192.
Inflammatory Bowel Disease (IBD) presents distinct challenges during pregnancy due to its influence on maternal health and pregnancy outcomes. This literature review aims to dissect the existing scientific evidence on pregnancy in women with IBD and provide evidence-based recommendations for clinical management. A comprehensive search was conducted across scientific databases, selecting clinical studies, systematic reviews, and other pertinent resources. Numerous studies have underscored an increased risk of complications during pregnancy for women with IBD, including preterm birth, low birth weight, neonates small for gestational age, and congenital malformations. Nevertheless, it's evident that proactive disease management before and throughout pregnancy can mitigate these risks. Continuation of IBD treatment during pregnancy and breastfeeding is deemed safe with agents like thiopurines, anti-TNF, vedolizumab, or ustekinumab. However, there's a call for caution when combining treatments due to the heightened risk of severe infections in the first year of life. For small molecules, their use is advised against in both scenarios. Effective disease management, minimizing disease activity, and interdisciplinary care are pivotal in attending to women with IBD. The emphasis is placed on the continual assessment of maternal and infant outcomes and an expressed need for further research to enhance the understanding of the ties between IBD and adverse pregnancy outcomes.
炎症性肠病（IBD）在孕期会带来独特的挑战，因为它会影响母亲健康和妊娠结局。这篇文献综述旨在剖析关于IBD女性妊娠的现有科学证据，并为临床管理提供基于证据的建议。我们在多个科学数据库中进行了全面检索，筛选出临床研究、系统评价及其他相关资源。众多研究强调，IBD女性在孕期出现并发症的风险增加，包括早产、低出生体重、小于胎龄儿和先天性畸形。然而，很明显在妊娠前及整个孕期积极管理疾病可以降低这些风险。孕期和哺乳期继续使用硫唑嘌呤、抗TNF药物、维多珠单抗或乌司奴单抗等药物治疗IBD被认为是安全的。然而，由于生命第一年严重感染风险增加，联合治疗时需谨慎。对于小分子药物，在这两种情况下均不建议使用。有效的疾病管理、尽量减少疾病活动以及多学科护理对于照顾IBD女性至关重要。重点是持续评估母婴结局，并明确表示需要进一步研究以加深对IBD与不良妊娠结局之间关系的理解。
