Inflammatory bowel disease and pregnancy.

Despite the lack of prospective studies on the relationship between inflammatory bowel disease (IBD) and pregnancy, the evidence strongly supports the conclusions that fertility is compromised in active Crohn's disease; heredity plays an important role in type and location of disease; fetal outcome is essentially no different than in the general population, except in the presence of active Crohn's disease during pregnancy; and the course of IBD during pregnancy is influenced by disease activity or lack of it before pregnancy. The major influence on outcome of pregnancy, fetal outcome, and course of IBD is the favorable effect of drug therapy on the disease. Most drugs, including sulfasalazine, 5ASA products, corticosteroids, and immunosuppressives, are safe, certainly safer than permitting the disease to be active and allowing for the possibility of surgical intervention during pregnancy. Episiotomy is contraindicated in women with Crohn's disease and perirectal complications. Cesarean section probably is indicated in most patients with Crohn's disease with colonic involvement.