Management for colitis for the most part mirrors that outside of pregnancy. Treatment of active colitis and maintenance therapy incorporate drugs that deliver 5-aminosalicyclic acid (5-ASA) or mesalamine. Suasalazine (Azuidine) is the prototype, and its 5-ASA moiety inhibits prostaglandin synthase in colonic mucosa. Others include olsalazine (Dipentum), balsalazide (Colazal), and delayed-release 5-ASA derivatives (Apriso, Asacol Pentasa, Lialda). Glucocorticoids are given orally, parenterally, or by enema for moderate or severe disease that does not respond to 5-ASA. However, these latter drugs are not given for maintenance therapy. Recalcitrant disease is managed with immunomodulating drugs, including azathioprine, 6-mercaptopurine, or cyclosporine, which appear relatively safe in pregnancy (Briggs, 2015; Mozafari, 2015). Importantly, methotrexate is contraindicated in pregnancy.
In the past, biological therapy was reserved for recalcitrant moderate to severe disease. Because of their considerable eicacy, these medications are now frequently given initialy for severe disease to prevent future complications. These agents are antibodies against tumor necrosis factor-alpha (TNF-alpha). Those approved for treatment of ulcerative colitis include inf liximab (Rem icade) , adalimumab (Hum ira), and golinumab (Simponi). These drugs are administered intravenously or subcutaneously. Several studies indicate that they are safe for use in pregnancy, although there are concerns that their discontinuance may prompt a relapse (Torres, 2015). Another worry is that they may cause immunosuppression in the neonate (Brams, 2016; Diav-Citrin, 2014; Gisbert, 20l3).
Colorectal endoscopy is performed as indicated (Katz, 2002).
During pregnancy, colectomy and ostomy creation for fulminant colitis may be needed as a lifesaving measure, and it has been described during each trimester. Dozois (2006) reviewed 42 such cases and found that, in general, outcomes have been good in recent reports. Most women underwent partial or complete colectomy, but Ooi and colleagues (2003) described decompression colostomy with ileostomy in a 10-and a 16-week pregnancy. Parenteral nutrition discussed on page 1043 is occasionally necessary for women with prolonged exacerbations.
For women with an ileal pouch and an anal anastomosis performed before pregnancy, sexual function and fertility are improved (Cornish, 2007). Disadvantages that temporarily worsen in pregnancy include frequent bowel movements, fecal incontinence, and pouchitis. he last is an inflammatory condition of the ileoanal pouch probably due to bacterial proliferation and stasis. Pouchitis usually responds to cephalosporins or metronidazole. In one rare case, adhesions to the growing uterus led to ileal pouch perforation (Aouthmany, 2004).
(Ravid, 2002). Hahnloser (2004) reviewed routes of delivery in women with 235 pregnancies before and 232 pregnancies after ileoanal pouch surgery. Functional outcomes were similar, for obstetrical indications. Postcesarean delivery ileoanal pouch obstruction has been described (Malecki, 2010).
To reiterate, ulcerative colitis likely has minimal adverse efects on pregnancy outcome. Modigliani (2000) reviewed to be not substantively diferent from those in the general obstetrical population. Speciically, the incidences of spontane ous abortion, preterm delivery, and stillbirth were remarkably low. In a population-based cohort study of 107 women from