Management of Pregnancy in Women with Inflammatory Bowel Disease: Positioning Janus Kinase Inhibitors Within Current Evidence.

Abstract

Inflammatory bowel diseases (IBD) frequently affect women of reproductive age. Disease activity may arise during pregnancy, at times in severe forms, thereby generating complex clinical scenarios. Adequate control of disease activity throughout pregnancy and the achievement of a safe delivery with a healthy newborn, therefore, represent vital objectives in therapeutic management. In recent years, the therapeutic armamentarium for moderate to severe IBD has expanded exponentially, with the introduction of biological agents and small molecules. However, although these therapies have largely superseded conventional treatment in complex settings, they do not share the same safety profile in pregnancy. Concerns persist regarding potential transplacental transfer and possible teratogenic effects, which justify mandatory caution in their use during pregnancy. Nonetheless, clinicians may readily encounter scenarios of active IBD during pregnancy in patients who have previously experienced failure of the biological agents most extensively studied in this context, thus necessitating an evaluation of the safety of more novel therapeutic options. This review examines the available evidence on Janus kinase inhibitors. Current data, which are highly heterogeneous and of low quality, preclude any recommendation for the use of these small molecules during pregnancy. Prospective registries and large-scale observational studies are mandatory, pending the feasibility of dedicated trials, to better characterise these inhibitors, which could prove valuable, should the evidence ultimately support their use, in women with biologic multi-failure active IBD during pregnancy.