↑ Risk of cancer (see ”Long-term management” in “Treatment” for screening protocol)
Risk increases with duration and/or extent of disease (e.g., pancolitis).
Colorectal carcinoma risk is not significantly increased in patients with mild ulcerative colitis.
Fulminant colitis: severe bowel inflammation that typically causes > 10 stools per day, lower gastrointestinal bleeding, abdominal pain, and abdominal distention
Gastrointestinal bleeding (both acute and chronic)
Perforation → peritonitis (see “Gastrointestinal perforation”)
Describe inflammatory bowel disease in pregnancy.
Fertility and preconception counseling
Fertility is not affected in women with IBD in remission and no history of abdominal surgery.
Women with active disease have decreased fertility rates.
Pharmacological therapy for IBD does not impact fertility.
Active disease at conception increases the risk of persistently active disease during gestation.
Active disease is associated with an increased risk of preterm birth and low birth weight.
Patients who wish to conceive should be on appropriate pharmacological therapy to maintain disease remission.
With the exception of methotrexate, all other treatments can be continued at conception.
Disease management during pregnancy
Most medications used in the treatment of IBD are considered safe during pregnancy.
Corticosteroids are indicated for disease flares but should be avoided as maintenance therapy because of the increased risk of gestational diabetes, preterm birth, and low birth weight.
5-ASA, 5-ASA derivatives, immunomodulators, and biopharmaceuticals can be used during pregnancy.
Monotherapy is preferred for maintenance treatment to reduce the risk of adverse effects.