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     Volume 10, Issue 2

References continued...

Norgard B, Czeizel AE, Rockenbaur M, Olsen J, Sorensen HT (2001) Population-based Case control study of the safety of sulfasalazine use during pregnancy.  Alimentary Pharmcology & Therapeutics 15(4):483-486

Park-Wyllie L, Mazzotta P Pastuszak A, Moretti ME, Beique L, Hunnisett L, Friesen MH, Jacobson S, Kasapinovic S, Chang D, Diav-Citrin O, Chitayat D, Nulman I, Einarson TR, Koren G(2000) Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 62(6):385-92

Rampton DS (2001) Methotrexate in Crohn's disease. Gut 48(6):790-791

Reprotox, www.reprotox.org  #1359, 1253, 1459, 1980, 1129, 1036, 1965

Witter FR, King TM, Blake DA (1981) The Effects of Chronic Gastrointestinal Medication on the Fetus and Neonate. Obstet & Gyne 58(5):79S-84S

that the use of this medication should be limited to the second and third trimesters of pregnancy (Connell and Miller 1999).  However, two large meta-analysis showed no increased risk for   congenital malformations, miscarriage, intrauterine growth retardation or prematurity with      maternal metronidazole use (Connell and Miller 1999, Reprotox #1129).  A recent prospective cohort study followed 132 first trimester exposed pregnancies and did not find an increased     incidence of congenital malformations (Diav-Citrin et al 2001). Often metronidazole is used to treat bacterial vaginosis during pregnancy.

Ciprofloxacin

Ciprofloxacin is a quinolone.  It can be used as an alternative to metronidazole to treat Crohn's disease (Connell and Sandborn 1999).  Quinolones as a class have a high affinity for bone tissue, and juvenile animals may develop arthropathy following exposure in pregnancy (Reprotox #1965).  However, other animal studies did not find an increased risk of congenital                 malformations associated with maternal ciprofloxacin use.  Additionally, a prospective study on thirty-eight pregnant women receiving ciprofloxacin during pregnancy did not associate this medication with an increased risk of malformations, including musculoskeletal problems.  It should be noted, however, that there are no studies of ciprofloxacin use during pregnancy as the primary treatment for inflammatory bowel disease (Connell and Miller 1999 and Reprotox #1965).

New Therapies

There are no reproductive data available regarding newer treatments for Crohn's disease in    pregnancy.  These therapies may include: Tissue necrosis factor-A, mycophenolate mofetil,     interleukin-10, short chain fatty acids and Tacrolimus. Due to the lack of data, use of these medications in pregnancy is not recommended.

Summary

Pregnancy should be avoided when a patient has active Crohn's disease.  The complications of active disease regardless of medication use are poor maternal weight gain, vaginal bleeding, premature rupture of the membranes, low birth weight, and miscarriage.  It is recommended that pregnancy be undertaken only when the disease is in remission.  Treatment during pregnancy is recommended to control maternal disease and decrease the risk for disease related                 complications. Any alterations to dosage should be done prior to pregnancy and it is not        recommended that dosage be decreased during pregnancy. The majority of studies have found that decreasing dosage during pregnancy increases the rate of relapse and complications due to active or uncontrolled disease. (CONTINUE)