Abstract
Although it is known that women with inflammatory bowel disease have an increased risk of adverse outcome of pregnancy, the relationship between disease activity during pregnancy and the adverse outcome is not well known. A 29-year-old woman with Crohn’s disease presented with flare-up at the end of the first trimester. Although the disease had been rendered inactive by maintenance infusion of infliximab, the drug was discontinued at the time of conception because of the patient’s fear of the adverse effects of infliximab. Because retardation of fetal growth was observed at the flare-up, we re-started infliximab therapy. As disease activity reduced with therapy, the retardation of fetal growth subsequently improved. The patient finally delivered a newborn of 2550 g in weight and no adverse outcome was noted. The case supports the notion that disease activity is a risk factor for adverse outcome in pregnancy and that infliximab may be safely used in pregnancy.
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Dominitz JA, Young JC, Boyko EJ. Outcomes infants born to mothers with inflammatory bowel disease: a population based cohort study. Am J Gastroenterol. 2002;97:641–8.
Mahadevan U, Sandborn WJ, Li DK, Hakimian S, Kane S, Corley DA. Pregnancy outcome in women with inflammatory bowel disease: a large community-based study from northern California. Gastroenterology. 2007;133:1106–12.
Fonager K, Sorensen HT, Olson J, Dahlerup JF, Rasmussen SN. Pregnancy outcome for women with Crohn’s disease: a follow-up study based on linkage between national registries. Am J Gasteroenterol. 1998;93:2426–30.
Cornish J, Tan E, Teare J, Teoh TG, Rai R, Clark SK, et al. A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut. 2007;56:830–7.
Kornfeld D, Cnattingius S, Ekbom A. Pregnancy outcome for women with inflammatory bowel disease—a population-based cohort study. Am J Obstet Gynecol. 1997;177:942–6.
Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut. 2006;55(Suppl 1):i36–58.
Norgard B, Hundborg HH, Jacobsen BA, Nielsen GL, Fonager K. Disease activity in pregnant women with Crohn’s disease and birth outcomes: a regional Danish cohort study. Am J Gastroenterol. 2007;102:1947–54.
Tartakovsky B, Ben-Yair E. Cytokines modulate preimplantation development and pregnancy. Dev Biol. 1991;146:343–52.
Nielsen OH, Andreasson B, Bondesen S, Jacobsen O, Jarnum S. Pregnancy in Crohn’s disease. Scand J Gastroenterol. 1984;19:724–32.
Morales M, Berney T, Jenny A, Morel P, Extermann P. Crohn’s disease as a risk factor for the outcome of pregnancy. Hepatogastroenterology. 2000;47:1595–8.
Rogers RG, Katz VL. Course of Crohn’s disease during pregnancy and its effect on pregnancy outcome: a retrospective review. Am J Perinatol. 1995;12:262–4.
Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359:1541–9.
Lichtenstein GR, Feagan BG, Cohen RD, Salzberg BA, Diamond RH, Chen DM, et al. Serious infections and mortality in association with therapies for Crohn’s disease: TREAT registry. Clin Gastroenterol Hepatol. 2006;4:621–30.
Katz JA, Antoni C, Keenan GF, Smith DE, Jacobs SJ, Lichtenstein GR. Outcome of pregnancy in women receiving infliximab for treatment of Crohn’s disease and rheumatoid arthritis. Am J Gastroenterol. 2004;99:2385–92.
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Arai, K., Takeuchi, Y., Oishi, C. et al. The impact of disease activity of Crohn’s disease during pregnancy on fetal growth. Clin J Gastroenterol 3, 179–181 (2010). https://doi.org/10.1007/s12328-010-0158-9
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DOI: https://doi.org/10.1007/s12328-010-0158-9