Use of medications during pregnancy and breastfeeding for Crohn’s disease and ulcerative colitis

Robyn Laube, Sudarshan Paramsothy, Rupert W. Leong*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: The peak age of diagnosis of inflammatory bowel disease (IBD) occurs during childbearing years, therefore management of IBD during pregnancy is a frequent occurrence. Maintenance of disease remission is crucial to optimize pregnancy outcomes, and potential maternal or fetal toxicity from medications must be balanced against the risks of untreated IBD. Areas covered: This review summarizes the literature on safety and use of medications for IBD during pregnancy and lactation. Expert opinion: 5-aminosalicylates, corticosteroids and thiopurines are safe for use during pregnancy, while methotrexate and tofacitinib should only be used with extreme caution. Anti-TNF agents (except certolizumab), vedolizumab, ustekinumab and tofacitinib readily traverse the placenta via active transport, therefore theoretically may affect fetal development. Certolizumab only undergoes passive transfer across the placenta, thus has markedly lower cord blood levels making it likely the safest biologic agent for infants. There is reasonable evidence to support the safety of anti-TNF monotherapy and combination therapy during pregnancy and lactation. Vedolizumab and ustekinumab are also thought to be safe in pregnancy and lactation, while tofacitinib is generally avoided due to teratogenic effects in animal studies.

Original languageEnglish
Pages (from-to)275-291
Number of pages17
JournalExpert Opinion on Drug Safety
Volume20
Issue number3
Early online date5 Feb 2021
DOIs
Publication statusPublished - 4 Mar 2021

Keywords

  • biologic therapy
  • breastfeeding
  • immunosuppression
  • Inflammatory bowel disease
  • medication safety
  • pregnancy

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