© Springer International Publishing AG 2018 81
A.S. Cheifetz, J.D. Feuerstein (eds.), Treatment of Inflammatory
Bowel Disease with Biologics, https://doi.org/10.1007/978-3-319-60276-9_6
Chapter 6
Biologics in Pregnancy and Breastfeeding
Jill K.J. Gaidos and Sunanda V. Kane
Introduction
Inflammatory bowel diseases, including ulcerative colitis and Crohn’s disease, are
commonly first diagnosed in the second and third decades of life [ 1 ]. As these are
chronic inflammatory diseases, they typically require lifelong treatment, which
means continuing medications throughout the childbearing years. The potential
effect that medications will have on the developing fetus and the impact on preg-
nancy of the mother’s underlying inflammatory bowel disease (IBD) are among
some of the common concerns that female IBD patients have prior to conception. As
pregnancy is exclusion criteria for most clinical trials of new therapeutic agents,
determining the safety of a drug in pregnancy and with breastfeeding becomes
based on clinical experience, typically with unintentional use at first and then with
intentional use due to a lack of other effective therapies. In addition, this slow pro-
cess gets restarted with each new therapy that becomes available.
Having IBD, even quiescent disease, is a risk factor for pregnancy complications,
such as preterm premature rupture of membranes, preeclampsia, and venous throm-
boembolism [ 2 – 4 ], as well as for adverse pregnancy outcomes, such as preterm
birth, small for gestational age infants, and stillbirth [ 5 ]. Active disease at the time
of conception further increases the risk for preterm birth and spontaneous abortion
(SA) [ 6 , 7 ], while worsening disease activity during pregnancy leads to a higher risk
J.K.J. Gaidos
Virginia Commonwealth University and McGuire VA Medical Center,
GI/Hepatology Service (111-N), 1201 Broad Rock Boulevard, Richmond, VA 23249, USA
e-mail: [email protected]
S.V. Kane (*)
Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
e-mail: [email protected]