TY - JOUR
T1 - Australian inflammatory bowel disease consensus statements for preconception, pregnancy and breast feeding
AU - Laube, Robyn
AU - Selinger, Christian P.
AU - Seow, Cynthia H.
AU - Christensen, Britt
AU - Flanagan, Emma
AU - Kennedy, Debra
AU - Mountifield, Reme
AU - Seeho, Sean
AU - Shand, Antonia
AU - Williams, Astrid Jane
AU - Leong, Rupert W.
PY - 2023/6
Y1 - 2023/6
N2 - Objective Because pregnancy outcomes tend to be worse in women with inflammatory bowel disease (IBD) than in those without, we aimed to update consensus statements that guide the clinical management of pregnancy in patients with IBD. Design A multidisciplinary working group was established to formulate these consensus statements. A modified RAND/UCLA appropriateness method was used, consisting of a literature review, online voting, discussion meeting and a second round of voting. The overall agreement among the delegates and appropriateness of the statement are reported. Results Agreement was reached for 38/39 statements which provide guidance on management of pregnancy in patients with IBD. Most medications can and should be continued throughout pregnancy, except for methotrexate, allopurinol and new small molecules, such as tofacitinib. Due to limited data, no conclusion was reached on the use of tioguanine during pregnancy. Achieving and maintaining IBD remission before conception and throughout pregnancy is crucial to optimise maternofetal outcomes. This requires a multidisciplinary approach to engage patients, allay anxieties and maximise adherence tomedication. Intestinal ultrasound can be used for disease monitoring during pregnancy, and flexible sigmoidoscopy or MRI where clinically necessary. Conclusion These consensus statements provide up-to-date, comprehensive recommendations for the management of pregnancy in patients with IBD. This will enable a high standard of care for patients with IBD across all clinical settings.
AB - Objective Because pregnancy outcomes tend to be worse in women with inflammatory bowel disease (IBD) than in those without, we aimed to update consensus statements that guide the clinical management of pregnancy in patients with IBD. Design A multidisciplinary working group was established to formulate these consensus statements. A modified RAND/UCLA appropriateness method was used, consisting of a literature review, online voting, discussion meeting and a second round of voting. The overall agreement among the delegates and appropriateness of the statement are reported. Results Agreement was reached for 38/39 statements which provide guidance on management of pregnancy in patients with IBD. Most medications can and should be continued throughout pregnancy, except for methotrexate, allopurinol and new small molecules, such as tofacitinib. Due to limited data, no conclusion was reached on the use of tioguanine during pregnancy. Achieving and maintaining IBD remission before conception and throughout pregnancy is crucial to optimise maternofetal outcomes. This requires a multidisciplinary approach to engage patients, allay anxieties and maximise adherence tomedication. Intestinal ultrasound can be used for disease monitoring during pregnancy, and flexible sigmoidoscopy or MRI where clinically necessary. Conclusion These consensus statements provide up-to-date, comprehensive recommendations for the management of pregnancy in patients with IBD. This will enable a high standard of care for patients with IBD across all clinical settings.
KW - Breast feeding
KW - Clinical decision making
KW - IBD Clinical
KW - Inflammatory bowel disease
UR - http://www.scopus.com/inward/record.url?scp=85152244914&partnerID=8YFLogxK
U2 - 10.1136/gutjnl-2022-329304
DO - 10.1136/gutjnl-2022-329304
M3 - Article
C2 - 36944479
AN - SCOPUS:85152244914
SN - 0017-5749
VL - 72
SP - 1040
EP - 1053
JO - Gut
JF - Gut
IS - 6
ER -