Inflammatory bowel disease in pregnancy

- May first present during pregnancy 
- course no more severe than in women who develop disease outside pregnancy but diagnosis may be delayed

 - Active disease at conception is associated with a doubling of the risk of miscarriage
  
- Crohn's disease especially associated with increased risk of prematurity.
  
- Associated with folate malabsorption and megaloblastic anaemia

  - Risk of relapse not affected by pregnancy. 

 - Active disease in early pregnancy is more likely to be associated with relapse in later pregnancy or puerparium

- If relapse occurs, more likely in the first trimester or the puerparium 

  - Drug therapy during pregnancy (corticosteroids, sulfasalazine, azathioprine) is safe and treatment should be continued during pregnancy. 

- Methotrexate, cyclosporine, tacrolimus and mycophenolate-mofetil should be avoided in pregnancy
  
- Steroid enema not contraindicated