Pregnant Inflammatory Bowel Disease Patient: Successful Outcome

from England the authors showed that there was a lack of knowledge and understanding in the women of reproductive age about their disease, medication and effects of these on pregnancy. It is important to discuss the issues related to pregnancy and conception either at diagnosis or when medication is initially prescribed. In our experience some pregnant women tend to stop their medication in fear of the side effect of the drugs on the developing foetus, with an inherent risk of disease flare up. A questionnaire study by Mountfield et al found that a large proportion of subjects (84%) reported concerns that IBD medications would harm their pregnancy, whereas only 19% women reported concerns about the effect of active IBD on pregnancy. The author reported that patients with active disease had higher risks of adverse outcome with a better outcome if they are in remission (Mountfield, 2010). It is estimated that more than 50% of pregnancies are not planned hence as soon as the diagnosis is made this issue should be brought up. See table 1, for general pre-pregnancy recommendations. Folic acid is an important vitamin that should be taken prior to conception since neural tube defect occurs as soon as conception is discovered. It is interesting in the British abstract only 43 women (65.15%) knew the beneficial effect of folic acid pre-conception and during the first trimester of pregnancy (Chakrabarty & Poullis, 2011). The patient, her partner and her physician should discuss the possibility of disease exacerbation during pregnancy while off treatment and the necessary courses of action in such an event. Treatment choices depend on individual preference, disease severity and potential for drug toxicity. Risks and benefits of maintenance therapies during pregnancy with the best available evidence should be addressed. In addition, breastfeeding should be presented as a favourable option since it confers numerous benefits to both mother and child. The likelihood of medication secretion in breast milk and impact on foetal wellbeing should be approached and encouraged. General advice pre pregnancy 1. Discuss potential pregnancy outcome, breast feeding, and drug therapy 2. Diet and nutrition 3. Folic acid supplementation 5 mg daily