Last update April 18, 2022

Maternal Inflammatory bowel disease (IBD)

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

In disorders grouped under the term "inflammatory bowel disease" (IBD) there is a chronic inflammation of the digestive tract which is considered of autoimmune origin, in which the immune system mistakenly attacks cells of the digestive tract. Risk factors are family history, smoking, consumption of nonsteroidal anti-inflammatory drugs such as ibuprofen, diclofenac or naproxen, or a high-fat diet.

Not having been breastfed increases the risk of IBD. (Piovani 2019, Xu 2017, Huang 2014, Ponder 2013, Barclay 2009)

IBD mainly comprises two diseases:

  1. Ulcerative colitis. There is inflammation and ulcers in the large intestine (colon) and rectum.
  2. Crohn's disease or regional ileitis. The inflammation and ulcers are at the end of the small intestine, the ileum.

The symptoms of both can be severe, watery and bloody diarrhea, abdominal pain, loss of appetite, weight loss, fatigue and fever. There may be periods of active disease and periods of remission. IBD without surgical interventions in the pelvis does not affect the reproductive capacity of women. (Mahadevan 2015, van der Woude 2015, Hendy 2015, Schulze 2014)

There is no greater frequency of relapse during breastfeeding, which could have a protective effect during the first year after delivery. (Julsgaard 2016, Hendy 2015, Huang 2014)

Most treatments used in IBD are compatible with breastfeeding (Selinger 2020, Lamb 2019,Buchner 2019, Paizis 2019, Bell 2019, Buchner 2019, Matro 2018, Bermejo 2018, Lahat 2018, Mottet 2016, Huang 2016, Nguyen 2016, van der Woude 2015, Hosseini 2015, Mahadevan 2015, Damas 2015, Hendy 2015, Chaparro 2014, Nielsen 2014, Huang 2014, Schulze 2014, Cury 2014, Yarur 2013):

  • Anti-inflammatories: corticosteroids, sulfasalazine, mesalazine, balsalazide and olsalazine
  • Immunosuppressants: azathioprine, mercaptopurine, cyclosporine and low doses of methotrexate
  • "Biological" medications such as tumor necrosis factor alpha inhibitors: infliximab, adalimumab, certolizumab and golimumab
  • Other biological treatments: natalizumab, vedolizumab and ustekinumab 
  • Antibiotics: ciprofloxacin and metronidazole
  • Antidiarrheals and fibre: plantago or ispaghula, methylcellulose and loperamide
  • Analgesics: paracetamol
  • Iron, calcium and vitamin D supplements

Breastfeeding in women with IBD is possible and recommended (Selinger​​​​​​​ 2020, Lamb 2019, Schulze 2014, de Meij 2013). Serious complications such as malnutrition, surgical resections and the need for parenteral nutrition require multidisciplinary support for breastfeeding. (Borbolla 2016)


See below the information of these related products:

  • (Corticosteroids) (Safe substance and/or breastfeeding is the best option.)
  • Adalimumab (Safe substance and/or breastfeeding is the best option.)
  • Azathioprine (Safe substance and/or breastfeeding is the best option.)
  • Balsalazide (Safe substance and/or breastfeeding is the best option.)
  • Calcium salts (Safe substance and/or breastfeeding is the best option.)
  • Certolizumab (Safe substance and/or breastfeeding is the best option.)
  • Cholecalciferol (Vit. D3) (Safe substance and/or breastfeeding is the best option.)
  • Ciclosporin (Safe substance and/or breastfeeding is the best option.)
  • Ciprofloxacin (Safe substance and/or breastfeeding is the best option.)
  • Golimumab (Safe substance and/or breastfeeding is the best option.)
  • Infliximab (Safe substance and/or breastfeeding is the best option.)
  • Iron Salts (Safe substance and/or breastfeeding is the best option.)
  • Isphagula (Safe substance and/or breastfeeding is the best option.)
  • Loperamide Hydrochloride (Safe substance and/or breastfeeding is the best option.)
  • Mercaptopurine (Safe substance and/or breastfeeding is the best option.)
  • Mesalazine (5-ASA) (Safe substance and/or breastfeeding is the best option.)
  • Methotrexate (obstetric and immunosuppressive use) (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Methylcellulose (Safe substance and/or breastfeeding is the best option.)
  • Metronidazole (Safe substance and/or breastfeeding is the best option.)
  • Natalizumab (Safe substance and/or breastfeeding is the best option.)
  • Olsalazine (Safe substance and/or breastfeeding is the best option.)
  • Paracetamol (Safe substance and/or breastfeeding is the best option.)
  • Sulfasalazine (Safe substance and/or breastfeeding is the best option.)
  • Ustekinumab (Safe substance and/or breastfeeding is the best option.)
  • Vedolizumab (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Other names

Maternal Inflammatory bowel disease (IBD) is also known as


Group

Maternal Inflammatory bowel disease (IBD) belongs to this group or family:

References

  1. Selinger CP, Nelson-Piercy C, Fraser A, Hall V, Limdi J, Smith L, Smith M, Nasur R, Gunn M, King A, Mohan A, Mulgabal K, Kent A, Kok KB, Glanville T. IBD in pregnancy: recent advances, practical management. Frontline Gastroenterol. 2020 May 19;12(3):214-224. Abstract
  2. Paizis K. Immunomodulatory drugs in pregnancy and lactation. Aust Prescr. 2019 Jun;42(3):97-101. Abstract
  3. Piovani D, Danese S, Peyrin-Biroulet L, Nikolopoulos GK, Lytras T, Bonovas S. Environmental Risk Factors for Inflammatory Bowel Diseases: An Umbrella Review of Meta-analyses. Gastroenterology. 2019 Apr 20. pii: S0016-5085(19)36709-5. Abstract
  4. Bell SJ, Flanagan EK. Updates in the management of inflammatory bowel disease during pregnancy. Med J Aust. 2019 Apr;210(6):276-280. Abstract
  5. Puchner A, Gröchenig HP, Sautner J, Helmy-Bader Y, Juch H, Reinisch S, Högenauer C, Koch R, Hermann J, Studnicka-Benke A, Weger W, Puchner R, Dejaco C. Immunosuppressives and biologics during pregnancy and lactation : A consensus report issued by the Austrian Societies of Gastroenterology and Hepatology and Rheumatology and Rehabilitation. Wien Klin Wochenschr. 2019 Jan;131(1-2):29-44. Abstract Full text (link to original source)
  6. Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H; et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019 Dec;68(Suppl 3):s1-s106. Abstract Full text (link to original source)
  7. Matro R, Martin CF, Wolf D, Shah SA, Mahadevan U. Exposure Concentrations of Infants Breastfed by Women Receiving Biologic Therapies for Inflammatory Bowel Diseases and Effects of Breastfeeding on Infections and Development. Gastroenterology. 2018 Sep;155(3):696-704. Abstract Full text (link to original source) Full text (in our servers)
  8. Bermejo F, Aguas M, Chaparro M, Domènech E, Echarri A, García-Planella E, Guerra I, Gisbert JP, López-Sanromán A; en representación de GETECCU.. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the use of thiopurines in inflammatory bowel disease. Gastroenterol Hepatol. 2018 Mar;41(3):205-221. Abstract Full text (link to original source)
  9. Lahat A, Shitrit AB, Naftali T, Milgrom Y, Elyakim R, Goldin E, Levhar N, Selinger L, Zuker T, Fudim E, Picard O, Yavzori M, Ben-Horin S. Vedolizumab Levels in Breast Milk of Nursing Mothers With Inflammatory Bowel Disease. J Crohns Colitis. 2018 Jan 5;12(1):120-123. Abstract
  10. Xu L, Lochhead P, Ko Y, Claggett B, Leong RW, Ananthakrishnan AN. Systematic review with meta-analysis: breastfeeding and the risk of Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther. 2017 Nov;46(9):780-789. Abstract
  11. Mottet C, Schoepfer AM, Juillerat P, Cosnes J, Froehlich F, Kessler-Brondolo V, Seibold F, Rogler G, Vavricka SR, Michetti P. Experts Opinion on the Practical Use of Azathioprine and 6-Mercaptopurine in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2016 Nov;22(11):2733-2747. Abstract Full text (link to original source) Full text (in our servers)
  12. Borbolla Foster A, Dixon S, Tyrrell-Price J, Trinder J. Pregnancy and lactation during long-term total parenteral nutrition: A case report and literature review. Obstet Med. 2016 Dec;9(4):181-184. Epub 2016 Oct 9. Abstract
  13. Julsgaard M. Adherence to medical treatment in relation to pregnancy, birth outcome & breastfeeding behavior among women with Crohn's disease. Dan Med J. 2016 Jul;63(7). pii: B5263. Abstract
  14. Huang VW, Chang HJ, Kroeker KI, Goodman KJ, Hegadoren KM, Dieleman LA, Fedorak RN. Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding Varies Widely: A Need for Further Education. Can J Gastroenterol Hepatol. 2016;2016:6193275. Epub 2016 Sep 20. Abstract Full text (link to original source) Full text (in our servers)
  15. Nguyen GC, Seow CH, Maxwell C, Huang V, Leung Y, Jones J, Leontiadis GI, Tse F, Mahadevan U, van der Woude CJ; IBD in Pregnancy Consensus Group. The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy. Gastroenterology. 2016 Mar;150(3):734-757.e1. Abstract Full text (link to original source) Full text (in our servers)
  16. Mahadevan U, Matro R. Care of the Pregnant Patient With Inflammatory Bowel Disease. Obstet Gynecol. 2015 Aug;126(2):401-12. Abstract
  17. van der Woude CJ, Ardizzone S, Bengtson MB, Fiorino G, Fraser G, Katsanos K, Kolacek S, Juillerat P, Mulders AG, Pedersen N, Selinger C, Sebastian S, Sturm A, Zelinkova Z, Magro F; European Crohn’s and Colitis Organization. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis. 2015 Feb;9(2):107-24. Review. Abstract Full text (link to original source) Full text (in our servers)
  18. Damas OM, Deshpande AR, Avalos DJ, Abreu MT. Treating Inflammatory Bowel Disease in Pregnancy: The Issues We Face Today. J Crohns Colitis. 2015 Oct;9(10):928-36. Abstract Full text (link to original source) Full text (in our servers)
  19. Chaparro M. [Natural history, complications, safety and pregnancy in inflammatory bowel disease]. Gastroenterol Hepatol. 2015 Sep;38 Suppl 1:20-31. Abstract
  20. Hendy P, Chadwick G, Hart A. IBD: reproductive health, pregnancy and lactation. Frontline Gastroenterol. 2015 Jan;6(1):38-43. Abstract
  21. Hosseini-Carroll P, Mutyala M, Seth A, Nageeb S, Soliman D, Boktor M, Sheth A, Chapman J, Morris J, Jordan P, Manas K, Becker F, Alexander JS. Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management. World J Gastrointest Pharmacol Ther. 2015 Nov 6;6(4):156-71. Abstract
  22. Chaparro M, Gisbert JP. How safe is infliximab therapy during pregnancy and lactation in inflammatory bowel disease? Expert Opin Drug Saf. 2014 Dec;13(12):1749-62. Abstract
  23. Cury DB, Moss AC. Treatment of Crohn's disease in pregnant women: drug and multidisciplinary approaches. World J Gastroenterol. 2014 Jul 21;20(27):8790-5. Abstract
  24. Huang VW, Habal FM. From conception to delivery: managing the pregnant inflammatory bowel disease patient. World J Gastroenterol. 2014 Abstract Full text (link to original source) Full text (in our servers)
  25. Schulze H, Esters P, Dignass A. Review article: the management of Crohn's disease and ulcerative colitis during pregnancy and lactation. Aliment Pharmacol Ther. 2014 Nov;40(9):991-1008. Abstract Full text (link to original source) Full text (in our servers)
  26. Nielsen OH, Maxwell C, Hendel J. IBD medications during pregnancy and lactation. Nat Rev Gastroenterol Hepatol. 2014 Feb;11(2):116-27. Abstract
  27. Ponder A, Long MD. A clinical review of recent findings in the epidemiology of inflammatory bowel disease. Clin Epidemiol. 2013 Jul 25;5:237-47. Abstract
  28. Yarur A, Kane SV. Update on pregnancy and breastfeeding in the era of biologics. Dig Liver Dis. 2013 Oct;45(10):787-94. Abstract Full text (link to original source) Full text (in our servers)
  29. de Meij TG, Jharap B, Kneepkens CM, van Bodegraven AA, de Boer NK; Dutch Initiative on Crohn and Colitis.. Long-term follow-up of children exposed intrauterine to maternal thiopurine therapy during pregnancy in females with inflammatory bowel disease. Aliment Pharmacol Ther. 2013 Jul;38(1):38-43. Abstract Full text (link to original source) Full text (in our servers)
  30. Lawrence RM. Circumstances when breastfeeding is contraindicated. Pediatr Clin North Am. 2013 Feb;60(1):295-318. Abstract
  31. Habal FM, Huang VW. Review article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient. Aliment Pharmacol Ther. 2012 Abstract Full text (link to original source) Full text (in our servers)
  32. Selinger CP, Leong RW, Lal S. Pregnancy related issues in inflammatory bowel disease: evidence base and patients' perspective. World J Gastroenterol. 2012 Abstract Full text (link to original source) Full text (in our servers)
  33. Lahiff C, Moss AC. Cyclosporine in the management of severe ulcerative colitis while breast-feeding. Inflamm Bowel Dis. 2011 Abstract
  34. Mahadevan U, Cucchiara S, Hyams JS, Steinwurz F, Nuti F, Travis SP, Sandborn WJ, Colombel JF. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organisation: pregnancy and pediatrics. Am J Gastroenterol. 2011 Feb;106(2):214-23; quiz 224. Abstract
  35. Raj LS, Hawthorne AB. Optimising use of thiopurines in inflammatory bowel disease. Frontline Gastroenterol. 2010 Abstract Full text (link to original source) Full text (in our servers)
  36. van der Woude CJ, Kolacek S, Dotan I, Oresland T, Vermeire S, Munkholm P, Mahadevan U, Mackillop L, Dignass A; European Crohn's Colitis Organisation (ECCO). European evidenced-based consensus on reproduction in inflammatory bowel disease. J Crohns Colitis. 2010 Abstract Full text (link to original source) Full text (in our servers)
  37. Van Assche G, Dignass A, Reinisch W, van der Woude CJ, Sturm A, De Vos M, Guslandi M, Oldenburg B, Dotan I, Marteau P, Ardizzone A, Baumgart DC, D'Haens G, Gionchetti P, Portela F, Vucelic B, Söderholm J, Escher J, Koletzko S, Kolho KL, Lukas M, Mottet C, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations. J Crohns Colitis. 2010 Abstract Full text (in our servers)
  38. Gisbert JP. Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding. Inflamm Bowel Dis. 2010 May;16(5):881-95. Abstract
  39. van der Woude CJ, Kolacek S, Dotan I, Oresland T, Vermeire S, Munkholm P, Mahadevan U, Mackillop L, Dignass A; European Crohn's Colitis Organisation (ECCO).. European evidenced-based consensus on reproduction in inflammatory bowel disease. J Crohns Colitis. 2010 Nov;4(5):493-510. Abstract
  40. Correia LM, Bonilha DQ, Ramos JD, Ambrogini O, Miszputen SJ. Inflammatory bowel disease and pregnancy: report of two cases treated with infliximab and a review of the literature. Eur J Gastroenterol Hepatol. 2010 Abstract
  41. Barclay AR, Russell RK, Wilson ML, Gilmour WH, Satsangi J, Wilson DC. Systematic review: the role of breastfeeding in the development of pediatric inflammatory bowel disease. J Pediatr. 2009 Sep;155(3):421-6. Abstract
  42. Mottet C, Vader JP, Felley C, Froehlich F, Gonvers JJ, Juillerat P, Stockbrügger R, Angelucci E, Seibold F, Michetti P, Pittet V; EPACT II Study Group. Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): Results of a multidisciplinary international expert panel-EPACT II. J Crohns Colitis. 2009 Abstract Full text (link to original source) Full text (in our servers)
  43. Heetun ZS, Byrnes C, Neary P, O'Morain C. Review article: Reproduction in the patient with inflammatory bowel disease. Aliment Pharmacol Ther. 2007 Abstract Full text (link to original source) Full text (in our servers)
  44. Mottet C, Juillerat P, Pittet V, Gonvers JJ, Froehlich F, Vader JP, Michetti P, Felley C. Pregnancy and breastfeeding in patients with Crohn's disease. Digestion. 2007 Abstract
  45. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  46. Kanenguiser P, Goyheneche B, Filinger E. Aminosalicilatos: Características de las Formulaciones Orales Utilizadas en el Tratamiento de la Enfermedad Inflamatoria Intestinal. Lat. Am. J. Pharm. 22 (3): 255-60 2003 Full text (link to original source) Full text (in our servers)
  47. Moretti Myla Emily. Prospective follow-up of infants exposed to 5-aminosalicylic acid containing drugs through maternal milk. Thesis. Department of Pharmacology \ University of Toronto 1998 Full text (link to original source) Full text (in our servers)
  48. Connell WR. Safety of drug therapy for inflammatory bowel disease in pregnant and nursing women. Inflamm Bowel Dis. 1996 Abstract

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