A special combination of pregnancy and inflammatory bowel disease: case report and literature review

Authors

  • Viviana Parra Izquierdo Hospital Universitario San Ignacio
  • Carolina Pavez Ovalle Pontificia Universidad Católica de Chile
  • Alan Felipe Ovalle Hernández PONTIFICIA UNIVERSIDAD JAVERIANA
  • Carlos Espinoza Hospital Universitario San Ignacio
  • Valeria Atenea Costa Barney Hospital Universitario San Ignacio
  • Gerardo Andrés Puentes Hospital Universitario San Ignacio
  • Albis Cecilia Hani de Ardila Hospital Universitario San Ignacio

DOI:

https://doi.org/10.22516/25007440.279

Keywords:

inflammatory bowel disease, Crohn's disease, ulcerative colitis, pregnancy

Abstract

Inflammatory bowel disease (IBD) comprises a spectrum of chronic immune-mediated diseases that affect the gastrointestinal tract. Onset typical occurs in adulthood. Its incidence is increasing everywhere, the highest incidence of Crohn's disease of 20.2 per 100,000 people/year is in North America while the incidence of ulcerative colitis is 24.3 per 100,000 people/year in Europe. Since it is not curable, the remission is the main objective of management. Many women are affected by IBD at different stages of their lives, including during reproductive life, pregnancy and menopause, so the way the disease is managed in reproductive age women can affect IBD’s course. Treatment and maintenance strategies are very relevant. For patients with a desire to have children, disease remission is very important from conception through pregnancy to birth to ensure adequate results for both mother and fetus. It is well known that active disease during conception and pregnancy is associated with adverse outcomes of pregnancy. In addition, active perianal disease is an indication for cesarean delivery which entails increased risk of bowel surgery and complications in the postoperative period. We present a case of IBD during pregnancy.

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Author Biographies

Viviana Parra Izquierdo, Hospital Universitario San Ignacio

Médica internista, reumatóloga, gastroenteróloga, UNiversidad Javeriana. Hospital Universitario San Ignacio. Bogotá, Colombia.

Carolina Pavez Ovalle, Pontificia Universidad Católica de Chile

Gastroenteróloga

Alan Felipe Ovalle Hernández, PONTIFICIA UNIVERSIDAD JAVERIANA

MEDICO INTERNISTA

FELLOW GASTROENTEROLOGIA HUSI/PUJ

Carlos Espinoza, Hospital Universitario San Ignacio

Médico internista, gastroenterólogo, Universidad Javeriana. Hospital Universitario San Ignacio, Bogotá

 

Valeria Atenea Costa Barney, Hospital Universitario San Ignacio

Gastroenteróloga, Uiversidad Javeriana, Hospital Universitario San Ignacio, Bogotá

Gerardo Andrés Puentes , Hospital Universitario San Ignacio

Gastroenterólogo, Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia

Albis Cecilia Hani de Ardila, Hospital Universitario San Ignacio

Gastroenteróloga, Universidad Javeriana. Hospital Universitario San Ignacio, Bogotá, Colombia

References

Lewis A. Why isn't the foetus rejected? A study of the changes that occur in the mammalian immune system to allow for a successful pregnancy, Faculty of Health and Biosciences. Stratford, London.

Kanellopoulos-Langevin C, Caucheteux S, Verbeke P, Ojcius DM. Tolerance of the fetus by the maternal immune system: role of inflammatory mediators at the feto-maternal interface. Reprod Biol Endocrinol. 2003;2;1:121. doi: https://doi.org/10.1186/1477-7827-1-121.

Dealtry G, O'Farrell MK, Fernandez N. The Th2 cytokine environment of the placenta. Int Arch Allergy Immunol. 2000;123(2):107-19. doi: 10.1159/000024441.

Hanna N, Hanna I, Hleb M, Wagner E, Dougherty J, Balkundi D, et al. Gestational age-dependent expression of IL-10 and its receptor in human placental tissues and isolated cytotrophoblasts. J Immunol. 2000;164(11):5721-8. doi: https://doi.org/10.4049/jimmunol.164.11.5721.

Ozenci C, Korgun ET, Demir R. Immunohistochemical detection of CD45+, CD56+, and CD14+ cells in human decidua during early pregnancy. Early Pregnancy. 2001;5(3):164-75.

Steinlauf A, Present D. Medical management of the pregnant patient with inflammatory bowel disease. Gastroenterol Clin North Am. 2004;33:361-85. doi: https://doi.org/10.1016/j.gtc.2004.02.013.

Gorgun E, Remzi F, Goldberg JM, Thornton J, Bast J, Hull T, et al. Fertility is reduced after restorative proctocolectomy with ileal pouch anastomosis: a study of 300 patients. Surgery. 2004;136:795-803. doi: https://doi.org/10.1016/j.surg.2004.06.018.

Subhani J, Hamilton M. El manejo de la enfermedad inflamatoria intestinal durante el embarazo. Aliment Pharmacol Ther. 1998;12:1039-533.

Bush M, Patel S, Lapinski R, Stone J. Resultados perinatales en la enfermedad inflamatoria intestinal. J Matern Fetal Neonatal Med. 2004;15:237-41. doi: https://doi.org/10.1080/14767050410001668662.

Mahadevan U, Sandborn W, Li D, Hakimian S, Kane S, Corley D. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology. 2007;133(4):1106-12. doi: https://doi.org/10.1053/j.gastro.2007.07.019.

Mogadam M, Korelitz B, Ahmed S, Dobbins W, Baiocco P. El curso de la enfermedad inflamatoria intestinal durante el embarazo y el posparto. Am J Gastroenterol. 1981;75(4):265-9.

Miller J. Enfermedad inflamatoria intestinal en el embarazo: una revisión. JR Soc Med. 1986;79(4):221-5. doi: https://doi.org/10.1177/014107688607900410.

Pedersen N, Bortoli A, Duricova D, D’Inca R, Panelli M, Gisbert J, et al. The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom study of 209 pregnant women. Aliment Pharmacol Ther. 2013;38(5):501-51. doi: https://doi.org/10.1111/apt.12412.

Levi A, Fisher A, Hughes L, Hendry W. Male infertility due to sulphasalazine. Lancet. 1979;314(8137):P276-8. doi: https://doi.org/10.1016/S0140-6736(79)90292-7.

Sussman A, Leonard J. Psoriasis, methotrexate, and oligopsermia. Arch Dermatol. 1980;116:215-7. doi: 10.1001/archderm.1980.01640260091025.

Mahadevan U, Terdiman J, Aron J, Jacobsohn S, Turek P. Infliximab and semen quality in men with inflammatory bowel disease. Inflamm Bowel Dis. 2005;11(4):395-9. doi: https://doi.org/10.1097/01.MIB.0000164023.10848.c4.

Dejaco C, Mittermaier C, Reinisch W, Gasche C, Waldhoer T, Strohmer H, et al. Azathioprine treatment and male fertility in inflammatory bowel disease. Gastroenterology. 2001;121(5):1048-53. doi: https://doi.org/10.1053/gast.2001.28692.

Nørgård B, Puho E, Pedersen L, Czeizel A, Sørensen HT. Risk of congenital abnormalities in children born to women with ulcerative colitis: a population-based, case-control study. Am J Gastroenterol. 2003;98:2006-10. doi: https://doi.org/10.1016/S0002-9270(03)00427-1.

Moskovitz D, Bodian C, Chapman M, Marion J, Rubin P, Scherl E, et al. The effect on the fetus of medications used to treat pregnant inflammatory bowel-disease patients. Am J Gastroenterol. 2004;99:656-61. doi: https://doi.org/10.1111/j.1572-0241.2004.04140.x.

Nielsen O, Maxwell C, Hendel J. IBD medications during pregnancy and lactation. Nat Rev Gastroenterol Hepatol. 2014;11:116-27. doi: https://doi.org/10.1038/nrgastro.2013.135.

Polifka J, Friedman J. Teratogen update: azathioprine and 6-mercaptopurine. Teratology. 2002;65(5):240-61. doi: https://doi.org/10.1002/tera.10043.

Carmichael S, Shaw G. Maternal corticosteroid use and risk of selected congenital anomalies. Am J Med Genet. 1999;86(3):242-4. doi: https://doi.org/10.1002/(SICI)1096-8628(19990917)86:3<242::AID-AJMG9>3.0.CO;2-U.

Koss C, Baras D, Lane S, Aubry R, Marcus M, Markowitz L, et al. Investigation of metronidazole use during pregnancy and adverse birth outcomes. Antimicrob Agents Chemother. 2012;56:4800-5. doi: https://doi.org/10.1128/AAC.06477-11.

Nahum G, Uhl K, Kennedy D. Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol. 2006;107:1120-38. doi: https://doi.org/10.1097/01.AOG.0000216197.26783.b5.

Paziana K, Del Monaco M, Cardonick E, Moritz M, Keller M, Smith B, et al. Ciclosporin use during pregnancy. Drug Saf. 2013;36:279-94. doi: https://doi.org/10.1007/s40264-013-0034-x.

Schnitzler F, Fidder H, Ferrante M, Ballet V, Noman M, van Assche G, et al. Outcome of pregnancy in women with inflammatory bowel disease treated with antitumor necrosis factor therapy. Inflamm Bowel Dis. 2011;17:1846-54. doi: https://doi.org/10.1002/ibd.21583.

Gisbert J, Chaparro M. Safety of anti-TNF agents during pregnancy and breastfeeding in women with inflammatory bowel disease. Am J Gastroenterol. 2013;108:1426-38. doi: https://doi.org/10.1038/ajg.2013.171.

Dubinsky M, Abraham B, Mahadevan U. Management of the pregnant IBD patient. Inflamm Bowel Dis. 2008;14(12):1736-50. doi: https://doi.org/10.1002/ibd.20532.

Djokanovic N, Klieger-Grossmann C, Pupco A, Koren G. Safety of infliximab use during pregnancy. Reprod Toxicol. 2011;32:93-7. doi: https://doi.org/10.1016/j.reprotox.2011.05.009.

Hellwig K, Haghikia A, Gold R. Pregnancy and natalizumab: results of an observational study in 35 accidental pregnancies during natalizumab treatment. Mult Scler. 2011;17(8):958-63. doi: https://doi.org/10.1177/1352458511401944.

Brandt L, Estabrook S, Reinus J. Results of a survey to evaluate whether vaginal delivery and episiotomy lead to perineal involvement in women with Crohn's disease. Am J Gastroenterol. 1995;90:1918-22.

Moffatt D, Ilnyckyj A, Bernstein C. A population-based study of breastfeeding in inflammatory bowel disease: initiation, duration, and effect on disease in the postpartum period. Am J Gastroenterol. 2009;104:2517-23. doi: 10.1038/ajg.2009.362.

Grosen A, Julsgaard M, Kelsen J, Christensen L. Infliximab concentrations in the milk of nursing mothers with inflammatory bowel disease. J Crohns Colitis. 2014;8:175-6. doi: https://doi.org/10.1016/j.crohns.2013.09.003.

Nguyen G, Seow C, Maxwell C, Huang V, Leung Y, Jones J, et al. The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy. Gastroenterology. 2016;150:734-57. doi: https://doi.org/10.1053/j.gastro.2015.12.003.

Published

2019-12-30

How to Cite

Parra Izquierdo, V., Pavez Ovalle, C., Ovalle Hernández, A. F., Espinoza, C., Costa Barney, V. A., Puentes , G. A., & Hani de Ardila, A. C. (2019). A special combination of pregnancy and inflammatory bowel disease: case report and literature review. Revista Colombiana De Gastroenterología, 34(4), 425–432. https://doi.org/10.22516/25007440.279

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