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Australian inflammatory bowel disease consensus statements for preconception, pregnancy and breast feeding
  1. Robyn Laube1,2,
  2. Christian P Selinger3,
  3. Cynthia H Seow4,
  4. Britt Christensen5,
  5. Emma Flanagan6,
  6. Debra Kennedy7,
  7. Reme Mountifield8,
  8. Sean Seeho9,
  9. Antonia Shand10,
  10. Astrid-Jane Williams11,
  11. Rupert W Leong1,2,12,13
  1. 1 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
  2. 2 Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia
  3. 3 Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4 Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  5. 5 Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  6. 6 Department of Gastroenterology, University of Melbourne, Melbourne, Victoria, Australia
  7. 7 MotherSafe, Royal Hospital for Women, Sydney, New South Wales, Australia
  8. 8 Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia
  9. 9 Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
  10. 10 Department of Maternal Foetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
  11. 11 Department of Gastroenterology, Liverpool Hospital, Liverpool, New South Wales, Australia
  12. 12 Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord, New South Wales, Australia
  13. 13 The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
  1. Correspondence to Professor Rupert W Leong, Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord, New South Wales, Australia; rupertleong{at}outlook.com

Abstract

Objective Because pregnancy outcomes tend to be worse in women with inflammatory bowel disease (IBD) than in those without, we aimed to update consensus statements that guide the clinical management of pregnancy in patients with IBD.

Design A multidisciplinary working group was established to formulate these consensus statements. A modified RAND/UCLA appropriateness method was used, consisting of a literature review, online voting, discussion meeting and a second round of voting. The overall agreement among the delegates and appropriateness of the statement are reported.

Results Agreement was reached for 38/39 statements which provide guidance on management of pregnancy in patients with IBD. Most medications can and should be continued throughout pregnancy, except for methotrexate, allopurinol and new small molecules, such as tofacitinib. Due to limited data, no conclusion was reached on the use of tioguanine during pregnancy. Achieving and maintaining IBD remission before conception and throughout pregnancy is crucial to optimise maternofetal outcomes. This requires a multidisciplinary approach to engage patients, allay anxieties and maximise adherence tomedication. Intestinal ultrasound can be used for disease monitoring during pregnancy, and flexible sigmoidoscopy or MRI where clinically necessary.

Conclusion These consensus statements provide up-to-date, comprehensive recommendations for the management of pregnancy in patients with IBD. This will enable a high standard of care for patients with IBD across all clinical settings.

  • INFLAMMATORY BOWEL DISEASE
  • BREAST FEEDING
  • IBD CLINICAL
  • CLINICAL DECISION MAKING

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Footnotes

  • Twitter @IBDmedicaldoc, @rupertleong

  • Contributors RL and RWL devised the study. RL did the literature review. All authors were involved in the data creation for the study. All authors contributed towards writing of the manuscript.

  • Funding This study was funded by: Janssen-Cilag Australia, Takeda Pharmaceutical Company and Dr Falk Pharma (nil grant numbers); Robyn Laube was partly funded by Royal Australasian College of Physician Fellowship.

  • Competing interests CPS: Advisory boards for AbbVie, MSD, Falk, Janssen, Pfizer, Arena, Galapagos, Takeda. CHS: Advisory boards: Janssen, Abbvie, Takeda, Ferring, Shire, Pfizer, Sandoz, Pharmascience. Speaker: Janssen, Abbvie, Takeda, Ferring, Shire, Pfizer, Pharmascience. RWL: advisory board fees: AbbVie, Aspen, BMS, Celgene, Celltrion, Chiesi, Ferring, Glutagen, Hospira, Janssen, Lilly, MSD, Novartis, Pfizer, Prometheus Biosciences, Takeda. Research grants from Celltrion, Shire, Janssen, Takeda, Joanna Tiddy grant from University of Sydney, Gastroenterological Society of Australia, NHMRC, Gutsy Group, Pfizer. RL: Speaker fees from Janssen.

  • Provenance and peer review Not commissioned; externally peer reviewed.