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  Česky / Czech version Čes. a Slov. Gastroent., 55, 2001, No. 5, p. 192-196
 
Ulcerative Colitis and Pregnancy 
Lukáš K.: 

Gastroenterologické centrum VFN a 1. LF UK Praha, IV. interní klinika
 


Summary:

       Patients with ulcerative colitis (UC) have normal healthy offspring in 76–97%, offspring with congenital abnormalities is recorded in 0–3%, spontaneous abortions in 1–13% and abortions in 0–3%. Women with UC have a normal fertility as compared with the general population. Pregnancy should start during remission. The patient should be followed up by a team of specialists (gastroenterologist, gynaecologist, neonatologist). If the disease is inactive at the time of conception, it is likely that it will remain inactive throughout pregnancy. Inactive UC has no effect on the course of pregnancy and its termination. The risk of exacerbation during pregnancy is not greater than in women of comparable age who are not pregnant (25–34%). If a relapse occurs, this happens most frequently during the first trimester. If the disease is active at the time of conception, it is difficult to predict the course. But the activity of the disease usually correlates with the activity at the time of conception and deterioration is uncommon. Pregnancy rarely causes relapse of inactive UC, in exceptional cases it induces remission of UC. If primary UC is manifested – this happens usually during the first two trimesters. If the attack starts during the puerperium – the clinical course is usually not severe. The majority of pregnancies terminates by the delivery of a healthy baby, but there is a slightly higher incidence of spontaneous abortions in women with ICZ (12.2%) as compared with the normal population of women(9.9%). Colectomy and ileostomy before pregnancy do not influence its course. The development of the disease during subsequent pregnancies need not be necessarily the same as during a previus pregnancy. Safe drugs which can be administered during pregnancy include: sulfasalazine, 5-ASA preparations and corticosteroids. The following are probably also safe: azathioprin, 6-mercaptopurin, cyclosporin and among antibiotics ciprofloxacin. Metronidazole is probably dangerous and the authors recommend to discontinue it during the first 16 weeks of pregnancy. Methotrexate is considered dangerous and should be discontinues. Sigmoideoscopy, gastroscopy and endoscopic biopsy are not contraindicated during pregnancy. Surgical intervention should by restricted to the same indications as in „non-pregnant women„. Surgery should be used only when essential.

        Key words: ulcerative colitis – pregnancy
       

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