Medical management of the pregnant patient with inflammatory bowel disease

The IBDs frequently affect women and men of childbearing age. Genetics seem to play a role in the development of these diseases (CD more than UC). IBD does not in and of itself seem to affect fertility; however, infertility rates do increase after surgery secondary to the effects of adhesions on tubal function. Medications used to treat IBD for the most part do not affect fertility except for the reversible effects of sulfasalazine on male fertility. If pregnancy occurs during disease activity, there is a greater chance that the disease will persist or worsen; every effort should be made to control the disease before conception. As the disease becomes more severe, the threat to the mother and fetus increases. Surgery in this population carries a high risk to the developing fetus. Furthermore, most medications used to treat active IBD have proved to be safe. It is recommended that active disease during pregnancy be treated aggressively. The risks of not treating are greater than the risks of treating.