Navigating Reproductive Care in Patients With Inflammatory Bowel Disease: A Comprehensive Review.

Paula Sousa, Javier P Gisbert, Mette Julsgaard, Christian Philipp Selinger, María Chaparro
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Abstract

Inflammatory bowel disease [IBD] is often diagnosed in patients during their reproductive years. It is crucial that both healthcare providers and patients are adequately informed to avoid misguided decisions regarding family planning. One of the most important aspects during conception and pregnancy is to maintain disease remission, as disease activity is associated with adverse pregnancy outcomes. Apart from methotrexate, most conventional drugs used in IBD are considered low risk during conception and pregnancy. For newer agents, evidence is still limited. If needed, surgery must not be postponed and should ideally be performed in specialized centres. In most patients, delivery should be vaginal except for patients with complex perianal disease, with an ileoanal pouch anastomosis, or if there is an obstetric contraindication. In children exposed to biological treatments during pregnancy, the risk of infections appears to be low, and psychomotor development is probably not affected. Regarding immunizations, the standard vaccination schedule for inactivated vaccines should be followed for children exposed to biologics in utero. In the case of live vaccines, such as rotavirus, decisions should be individualized and take into consideration the risk-benefit ratio, particularly in developing countries. In this review, we provide a comprehensive and updated overview of aspects related to fertility, pregnancy, breastfeeding, and the impact on the care of children born to mothers with IBD. Both the available evidence and areas of uncertainty are discussed, with the goal of assisting healthcare professionals caring for IBD patients during this important stage of their lives.

炎症性肠病患者的生殖护理导航:全面回顾。
炎症性肠病 [IBD] 患者通常在育龄期被诊断出来。医护人员和患者都必须充分了解相关信息,以避免在计划生育方面做出错误的决定。在受孕和怀孕期间,最重要的一点是保持疾病缓解,因为疾病活动与不良妊娠结局有关。除甲氨蝶呤外,大多数用于治疗 IBD 的常规药物被认为在受孕和妊娠期间风险较低。至于较新的药物,证据仍然有限。如果需要,手术不能推迟,最好在专业中心进行。大多数患者应经阴道分娩,除非患者患有复杂的肛周疾病、进行了回肠肛门吻合术或有产科禁忌症。在孕期接受生物治疗的儿童,感染的风险似乎很低,精神运动发育可能也不会受到影响。在免疫接种方面,宫内暴露于生物制剂的儿童应遵循灭活疫苗的标准接种计划。对于轮状病毒等活疫苗,应根据个体情况并考虑风险收益比来决定是否接种,尤其是在发展中国家。在这篇综述中,我们对生育、妊娠、母乳喂养以及对患有 IBD 的母亲所生婴儿的护理的影响等相关方面进行了全面的最新概述。我们讨论了现有的证据和不确定的领域,旨在帮助医护人员在 IBD 患者生命的这一重要阶段为其提供护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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