Case 5: Treatment Options
Cindy Law, MD, a gastroenterologist at Massachusetts General Hospital, discusses the treatment options available in this case of ulcerative colitis in a pregnant patient:
Editor’s note: The following is an automatically generated transcript of the above video.
“This chart summarizes the safety of common IBD medications during pregnancy. Corticosteroids can be used if necessary, small studies have reported an association between corticosteroid use in the first trimester and oral facial clefts in infants. Amino salicylates are considered safe in pregnancy. If a patient is on sulfasalazine, increased folate supplementation is recommended. Thiopurines have not been found to increase risk of congenital malformations or developmental issues. In patients in remission on combination therapy, consider deescalating to monotherapy. Thiopurines can be continued, but avoid initiating them in pregnancy due to risk of side effects such as acute pancreatitis.
Methotrexate, is a well-known teratogen, it should be stopped at least three months before conception and should not be taken at any time during the pregnancy. Biologics can cross the placental barrier at around 27 weeks, with the exception of certolizumab (Cimzia, UCB). It is recommended to continue biologics in pregnancy as interruption could risk a disease flare, adverse outcomes appear comparable with that of the general population. And lastly, small molecules should be avoided in pregnancy. There's limited human data, but animal studies have demonstrated fetal anomalies.”