염증성장질환과 임신

Abstract

Because peak age of onset for inflammatory bowel disease (IBD) coincides with the peak age for conception and pregnancy, female patients with IBD concern pregnancy-related problems including sexual health, inheritance of disease in the offspring, fertility, the effect of pregnancy on disease, and conversely, the effect of disease on the course of pregnancy, as well as the safety of drugs. The clinicians must be prepared to address these issues and to discuss with patients and their spouses. Generally fertility is normal, although may be decreased in women with active Crohn's disease and in patients who received operation for IBD in both Crohn's disease and ulcerative colitis. Women with inactive IBD do not have increased risk of complicated pregnancy. However, active disease is associated with 2-3 times higher risk of complications such as preterm delivery or low birth weight. Inadequate therapy for IBD may results in exacerbation of disease and consequently, cause many pregnancy-related problems, including infertility, miscarriage or pre-term delivery. Furthermore, evidences have suggested that both Crohn's disease and ulcerative colitis tend to worsen if the disease is active at conception. Therefore, the focus should be on inducing remission before conception and maintaining remission during pregnancy. Treatment strategies in pregnant patients with IBD need to be evaluated carefully, and possibility of medication side effects on both the patients and the fetus must be weighed against the risks of active disease. Although the data on the safety of medications in pregnancy are limited, a key principle of management is that active disease, not the medications used to treat it, poses the greatest danger to pregnancy.