I. The role of IBD management during pregnancy.
1. Pre-pregnancy counseling is recommended for women of childbearing age with IBD to improve pregnancy outcome.
2. In women with IBD who are planning a pregnancy, an objective evaluation of the disease prior to pregnancy is recommended to optimize disease management.
3. In women with ulcerative colitis who are planning to become pregnant and are on a dibutyl phthalate (DBP)-containing 5-aminosalicylic acid (ASA) formulation, adjustment to a DBP-free 5-ASA drug is recommended.
4. In women with IBD on methotrexate and planning pregnancy, it is recommended that methotrexate be discontinued at least 3 months prior to conception to minimize teratogenic risk. If a woman becomes pregnant while on methotrexate, immediate discontinuation of methotrexate and referral to obstetrics and gynecology is recommended.
5. For women with active or complicated IBD pregnancies, consultation with an obstetrician and gynecologist is recommended, preferably one with experience in high-risk obstetrics.
For women with IBD, a gastroenterologist is recommended to manage IBD throughout the pregnancy.
7. For women with IBD requiring hospitalization, referral to a tertiary care hospital with access to gastroenterologists and obstetricians and gynecologists, preferably with a physician experienced in high-risk obstetrics, is recommended.
II. Pharmacological treatment of IBD during pregnancy
8. In women with IBD in pregnancy on oral and/or rectal 5-aminosalicylic acid (5-ASA) maintenance therapy, continuation of 5-ASA therapy throughout pregnancy is recommended.
In women with IBD who are on thiopurine maintenance therapy, it is recommended that thiopurine therapy be continued throughout pregnancy.
10. In pregnant women with IBD on maintenance anti-tumor necrosis factor (anti-TNF) therapy, continuation of anti-TNF therapy is recommended. In women with elective pregnancies with a low risk of IBD recurrence, a final anti-TNF treatment is recommended at 22-24 weeks of gestation when there is a clear reason to discontinue anti-TNF (to minimize fetal exposure).
11. In pregnant women with IBD treated with a combination of anti-TNF and thiopurines, it is recommended to develop an individualized strategy for switching to monotherapy.
12. Combined oral and rectal 5-ASA therapy is recommended to induce symptomatic remission in pregnant women with ulcerative colitis who experience a sudden exacerbation of mild to moderate disease during 5-ASA maintenance therapy.
13. Metronidazole and/or ciprofloxacin is recommended in pregnant women with Crohn’s disease requiring antibiotic therapy for perianal abscesses.
14. In pregnant women with IBD who experience a sudden exacerbation of disease during maintenance therapy with optimal 5-ASA or thiopurines, systemic glucocorticoid or anti-TNF therapy is recommended to induce symptomatic remission.
15. In pregnant women with IBD with sudden exacerbation of disease due to glucocorticoid resistance, anti-TNF therapy is recommended to induce symptomatic remission.
16. In pregnant women with IBD who have not been previously treated with thiopurines and have initiated anti-TNF therapy, anti-TNF monotherapy is recommended over the combination of anti-TNF and thiopurines.
17. In pregnant women hospitalized for IBD, anticoagulants are recommended for thromboprophylaxis during hospitalization.
III. Imaging, endoscopy and surgical treatment of patients with IBD during pregnancy.
18. Fiberoptic sigmoidoscopy or colonoscopy is recommended for pregnant women with suspected IBD or sudden exacerbation of IBD.
19. For pregnant women with suspected IBD or sudden exacerbation of IBD, the recommended imaging modality is limited to ultrasound or MRI.
20. In patients with IBD during pregnancy, emergency surgery is recommended for the treatment of IBD complications, and surgery should not be postponed simply because of pregnancy considerations.
IV. Issues related to delivery in women with IBD in pregnancy.
21. For women with IBD in pregnancy, it is recommended that the decision to deliver by cesarean section be based on obstetric considerations rather than the diagnosis of IBD alone.
22. For women with IBD in pregnancy undergoing ileal pouch-anal anastomosis (IPAA), it is recommended that cesarean section be considered in consultation with obstetricians and surgeons to reduce the risk of anal sphincter injury.
23. For pregnant women with Crohn’s disease with active perianal disease, cesarean delivery is recommended instead of vaginal delivery to reduce the risk of perianal injury.
24. For pregnant women with IBD who undergo cesarean delivery, anticoagulants are recommended to prevent thrombosis during hospitalization.
V. Neonatal breastfeeding and vaccination.
25. In women with IBD, the use of 5-ASA, glucocorticoids, thiopurines, or anti-TNF therapy should not influence breastfeeding decision making, and breastfeeding should not influence strategy development for the application of the above drugs.
26. In breastfeeding female patients with IBD, it is recommended to avoid methotrexate therapy.
27. For newborns delivered by women treated with anti-TNF during pregnancy, the application of live attenuated vaccination within 6 months after birth is opposed.