Ulcerative Colitis (UC) IN pregnancy: A Comprehensive Guide
- Ulcerative Colitis (UC) is a chronic inflammatory bowel disease.
- It primarily affects the mucosal layer of the colon and presents with relapsing and remitting episodes of inflammation.
- Typically develops in young adults, with many diagnosed before the age of 35.
Epidemiology 📊
- Annual incidence in Europe ranges between 0.6 and 24.3 per 100,000 people.
- More common in developed countries, influenced by genetic and environmental factors.
Pathogenesis: What Causes UC? 🧬
- Exact cause unknown, but results from a combination of:
- Genetics: Family history plays a major role.
- Gut Immune System: Abnormal immune response to intestinal contents.
- Gut Microbiota: Altered bacterial balance in the gut (not due to infection).
- Environmental Triggers: Smoking, diet, and stress.
Symptoms of Ulcerative Colitis 🚨
- Recurrent episodes of:
- Abdominal pain and cramping.
- Diarrhea, often mixed with blood or mucus.
- Rectal bleeding.
- Other signs may include:
- Urgency to defecate.
- Fatigue and weight loss.
- Fever during flare-ups.
Prepregnancy Counselling for UC 🤰
- Why It’s Important:
- Ensures optimal maternal and fetal outcomes.
- Highlights the importance of conceiving during disease remission.
- Key Topics:
- Impact of UC on pregnancy and vice versa.
- Safety of medications during pregnancy and breastfeeding.
- Substituting methotrexate and mycophenolate, contraindicated drugs, with safer alternatives.
- Importance of smoking cessation to reduce relapse risk.
Effects of Pregnancy on UC 🌼
- During Pregnancy:
- Women in remission at conception have a 30% relapse risk, similar to nonpregnant patients.
- Active disease at conception doubles the risk of flare-ups.
- Exacerbations often occur in early pregnancy, especially with discontinuation of maintenance therapy.
- Postpartum Period:
- Higher risk of flare-ups, particularly with untreated UC or treatment cessation.
- Close monitoring and timely treatment adjustments are essential.
- Episiotomy should be avoided where possible as it can trigger perianal disease.
- Planned caesarean section is indicated in women with active perianal or rectal diseas
Effect of UC on Pregnancy Outcomes 🤱
- Fertility Rates:
- Similar to the general population unless UC is active or surgery-related complications exist.
- Pregnancy Risks:
- Quiescent UC: Comparable outcomes to non-IBD pregnancies.
- Active UC: Increased risks of miscarriage, preterm birth, and low birth weight.
- Surgical History:
- Women with prior bowel surgeries may experience peristomal cracking or rare intestinal obstruction.
Diagnosis During Pregnancy 🩺
- Clinical Features: Abdominal pain, stool frequency, and rectal bleeding.
- Noninvasive Markers:
- C-reactive protein (CRP): Reliable indicator of inflammation during pregnancy.
- Faecal calprotectin: Differentiates UC from irritable bowel syndrome.
- Imaging:
- Ultrasound: Preferred for abdominal evaluation.
- MRI (without contrast): Used for complex cases.
- Endoscopy: Safe if necessary, under expert supervision.
Managing UC During Pregnancy 🤰
- General Management:
- UC does not significantly increase risks of miscarriage, birth defects, or preterm delivery.
- Avoid aminosalicylate doses >3 g/day to prevent fetal nephrotoxicity.
- High-dose folic acid (5 mg/day) is essential with sulfasalazine use.
- Steroids:
- Effective for rapid remission but associated with risks like maternal hypertension, gestational diabetes, and neonatal adrenal suppression at high doses.
- Preferred options: Prednisolone and hydrocortisone.
- Administer a stress dose during labor to prevent adrenal crisis.
- Thiopurines (Azathioprine/Mercaptopurine):
- Safe during pregnancy with no increased risk of congenital abnormalities or neonatal issues.
- Azathioprine is preferred to reduce fetal exposure.
- Calcineurin Inhibitors (Tacrolimus/Ciclosporin):
- Reserved for fulminant colitis or steroid-refractory cases.
- Biologics (Infliximab/Adalimumab):
- Safe with no significant link to adverse outcomes.
- Therapy is often stopped by the early third trimester to limit neonatal exposure.
- Avoid live vaccines for newborns until biologics are undetectable.
Medications to Avoid 🚫
- Mycophenolate Mofetil: Associated with multiple congenital abnormalities.
- Methotrexate:
- Contraindicated due to teratogenic effects.
- Women should delay pregnancy for 3 months post-treatment.
Surgery in Pregnancy 🔪
- Indications:
- Same as nonpregnant women: Obstruction, perforation, abscess, etc.
- Timing:
- Surgery should not be delayed if necessary.
- Fetal lung maturation may be supported with betamethasone or dexamethasone before preterm delivery.
Fetal Surveillance
- Growth Monitoring:
- Recommended for women with active disease or those on steroids/calcineurin inhibitors.
- Routine Scans:
- Offered for women on medical therapy to ensure fetal well-being.
Delivery Considerations 🚼
- Mode of Delivery:
- Vaginal delivery is safe for most women.
- Episiotomy should be avoided where possible as it can trigger perianal disease. Planned caesarean section is indicated in women with active perianal or rectal disease
- Intrapartum Care:
- Women on steroids need hydrocortisone supplementation during labor.
Postpartum Care 🌸
- Flare-Up Risks:
- Higher in the postpartum period, especially with treatment cessation.
- Breastfeeding:
- Safe with most UC medications; benefits outweigh risks.
- Pain Management:
- Avoid NSAIDs to prevent exacerbation.
- Use laxatives with opiates for constipation relief.
Conclusion 🌿
Ulcerative Colitis requires meticulous management, particularly during pregnancy. With prepregnancy counselling, safe medication practices, and a multidisciplinary approach, women with UC can achieve healthy pregnancies and postpartum periods. Stay informed and proactive to embrace parenthood with confidence and care! 💕✨
This blog combines medical accuracy with engaging visuals for better readability and impact.
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