Crohn’s disease and pregnancy

Abstract

The relevance of the problem in the management of women with inflammatory bowel diseases during pregnancy is beyond question due to the fact that almost all women suffering from ulcerative colitis or Crohn’s disease develop these diseases during their reproductive age. The question of whether the women with inflammatory bowel diseases can carry their pregnancy is still being ambiguously tackled. The fact that physicians are unaware of the features of the course of pregnancy and the safety of current treatments leads to the unfounded conclusions that pregnancy is unallowable in this category of patients. Most researchers deem that pregnancy worsens the course of Crohn’s disease in 80% of women. Its recurrences most commonly occur in the first trimester of pregnancy after abortion or childbirth. This is due to an increase in second and third trimester steroid hormone levels that drop sharply after childbirth. Obstetric complications occur more frequently if a woman has an exacerbation of the disease during pregnancy, even during remission, there are pregnancy complications, such as anemia, hypoproteinemia, electrolyte disorders, and hypovitaminosis. It is known that patients with inflammatory bowel diseases undergo cesarean delivery more often than the general population. The reasons for these interventions are ileostomy or active Crohn’s disease with perianal lesions and perineal cicatricial changes. The choice of the delivery method is determined by obstetric indications in women with inflammatory bowel diseases. The excep-tion is patients with perianal Crohn’s disease; it is advisable to perform a cesarean section in these cases. The question of whether the risk of perianal complications increases in these patients after episiotomy remains controversial. Recent data suggest that there is no considerable risk for perianal fistulas after episiotomy. The interest of the presented clinical observa-tion of delivery in the patient with Crohn’s disease is in per vias naturalis.