Hecker Martin, Heihoff-Klose Anne, Mehdorn Matthias
Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology), University of Leipzig Medical Center, Leipzig, Germany.
Department of Obstetrics and Gynecology, University of Leipzig Medical Center, Leipzig, Germany.
Visc Med. 2025 Apr;41(2):53-63. doi: 10.1159/000539158. Epub 2024 Jun 10.
The incidence of inflammatory bowel diseases (IBDs) peaks in the fertile age of both women and men. There is a significant lack of knowledge regarding disease-specific aspects of guiding IBD patients through conception, pregnancy, and delivery in clinical routine.
Patients with IBD often remain voluntarily childless, primarily due to a lack of knowledge. Fertility is generally unaffected in IBD patients, except in those with high disease activity or who have undergone specific abdominal surgeries that may lead to changes in the abdominal cavity, such as inflammatory or postoperative adhesions. Immunosuppressive and immunomodulatory medications are generally considered safe during pregnancy and should be continued to reduce the likelihood of relapses. If flares occur, close monitoring of the mother and the fetus is mandatory, and therapeutic options (conservative, interventional, surgical) have to be weighed thoroughly. Despite advances in treatment, IBD patients remain at increased risk of preterm labor, small-for-gestational-age newborns and are at risk of C-sections, although the current literature suggests vaginal delivery is possible for most patients. C-sections are recommended in patients with active perianal disease.
Patients with IBD wishing to conceive should receive comprehensive preconception counseling about pregnancy-specific aspects of IBD management from an interdisciplinary team of specialists, including IBD gastroenterologists, obstetricians, and colorectal surgeons.
炎症性肠病（IBD）的发病率在男性和女性的育龄期达到峰值。在临床实践中，对于指导IBD患者度过受孕、妊娠和分娩等特定疾病方面的知识严重匮乏。
IBD患者通常自愿选择不育，主要原因是缺乏相关知识。一般而言，IBD患者的生育能力不受影响，但疾病活动度高或接受过可能导致腹腔改变（如炎症或术后粘连）的特定腹部手术的患者除外。免疫抑制和免疫调节药物在孕期通常被认为是安全的，应继续使用以降低复发的可能性。如果病情发作，必须密切监测母亲和胎儿的情况，并且必须全面权衡治疗方案（保守治疗、介入治疗、手术治疗）。尽管治疗取得了进展，但IBD患者早产、小于胎龄新生儿的风险仍然增加，且有剖宫产的风险，不过目前的文献表明大多数患者可以经阴道分娩。对于有活动性肛周疾病的患者，建议进行剖宫产。
希望受孕的IBD患者应从包括IBD胃肠病学家、产科医生和结直肠外科医生在内的跨学科专家团队那里获得关于IBD管理中与妊娠相关方面的全面孕前咨询。
