Drug Safety

Controlling your IBD with medications during pregnancy

If you've been diagnosed with IBD and are considering pregnancy, or are currently pregnant or breastfeeding, you might be thinking about the safety of your medications for your baby. Rest assured, we're here to help you understand how IBD drugs may impact your pregnancy so you can have the information you need as you prepare for the future.

Remember, talking with a doctor who specializes in the treatment of IBD during pregnancy is the best way to find out what's right for you.

IBD medications and safety considerations

5-ASA agents

5-ASA agents (mesalamine, balsalazide, sulfasalazine) are commonly used for mild to moderate ulcerative colitis and do not affect the immune system. They are safe to continue during pregnancy — as well as during breastfeeding — to treat symptoms and maintain remission. The one exception may be Asacol HD, which specifically contains a chemical in the coating of the tablet, not the drug itself, that has been linked to birth defects in rabbits. If you are taking Asacol HD and are planning a pregnancy or are pregnant, talk to your doctor about switching to another form.

Antibiotics

Many doctors use antibiotics to treat infections, pouchitis and some fistulas. We recommend avoiding ciprofloxacin, but instead using short courses of metronidazole (Flagyl) and Augmentin when necessary. For women who develop C. difficile infection, vancomycin is recommended.

Steroids

Budesonide is the generic for Entocort and UCERIS^®. This is used for less serious symptoms that require prednisone. It is unclear if these are safer than prednisone during pregnancy. During pregnancy, if your IBD is severe enough to use steroids, your doctor will generally prescribe prednisone as it’s stronger and controls active inflammation faster. Your doctor should try to use the least amount of steroids possible to control the disease, as active IBD is the main risk factor for complications, not the drug itself.

Immunomodulators

Common immunomodulators include azathioprine, or its similar 6-MP and methotrexate. In high doses, azathioprine/6-MP is used to treat cancer and is associated with a high risk for birth defects in women using these during pregnancy. However, this is not the case with the dosage used to treat IBD. In fact, their use is associated with better outcomes during pregnancy. Methotrexate is the exception. It should be stopped at least three months, and preferably six months, before conception.

Anti-TNF agents taken pre – and post – pregnancy

The biologics REMICADE^®, HUMIRA^®, CIMZIA^® and SIMPONI^® are all considered safe during pregnancy. In fact, many doctors may start a woman on an anti-TNF during pregnancy rather than use steroids. CIMZIA^® is unique in that it doesn't cross the placenta, so the infant isn't exposed to the therapy. However, if you're already on an anti-TNF that's working for you and isn't associated with complications, your doctor shouldn't switch you to CIMZIA.^® Research on infants exposed to anti-tnf therapies during pregnancy does not suggest any increased risk for birth defects or developmental abnormalities.

Anti-TNF drug levels in newborn infants take a few months to clear from the blood if a mother receives any medications after the beginning of the third trimester. Therefore, it's recommended that infants do not receive any vaccines that use live viruses like rotavirus. Use is also fine during breastfeeding as it does not appear any of these agents are secreted into milk.

Anti-integrins

ENTYVIO^® is a FDA approved therapy for IBD. It also crosses the placenta, but babies exposed do not appear to have any increased risk for complications. Additionally, breastfeeding is safe while taking this drug.

Anti-interleukins

Some women with Crohn's disease are treated with STERLARA^®. Studies are still in the early stages, but pregnant women with psoriasis who take this drug do not appear to have an increased risk for pregnancy complications.

JAK Kinase Inhibitors (Tofacitinib)

Limited human data. Consider other options, particularly in first trimester.