Introduction

In a significant move for the healthcare community, the American Gastroenterological Association (AGA) has released an important clinical practice update focused on the management of gastrointestinal (GI) and liver diseases in pregnant patients. This new update comes at a crucial time, as conditions like inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, are often diagnosed in young adults—typically between the ages of 15 and 30. With many individuals affected by IBD being of reproductive age, effective disease management during pregnancy has never been more vital.

Guidelines Overview

The comprehensive update is featured in the October 2024 issue of Gastroenterology, with lead author Dr. Shivangi Kothari from the University of Rochester spearheading the effort alongside her team. They have compiled 13 Best Practice Advice statements aimed at equipping healthcare professionals with practical recommendations for treating pregnant patients suffering from GI and liver diseases.

Preconception Counseling

A cornerstone of the guidelines is the emphasis on preconception counseling conducted by a multidisciplinary team for individuals wishing to conceive. Contrary to outdated practices, the AGA advises against the blanket withholding of medications solely based on pregnancy status. Instead, individualized patient care should be prioritized, with a careful assessment of the risks and benefits associated with any treatment or procedure.

Impact of IBD on Pregnancy Outcomes

Research indicates that active IBD can raise the likelihood of adverse pregnancy outcomes, including preterm birth, fetal growth restrictions, and cesarean deliveries. Interestingly, conception during periods of disease remission shows comparable relapse rates to those of non-pregnant individuals with IBD. Therefore, achieving and maintaining clinical remission before conception and throughout pregnancy and the postpartum phase is crucial, according to the AGA's panel of experts.

Medication Recommendations

The AGA recommends that pregnant patients continue biologic treatments, such as tumor necrosis factor (TNF) inhibitors, throughout their pregnancy and during the postpartum period. However, special care must be taken with newborns—live vaccines should not be administered during the first six months of life for infants exposed to TNF inhibitors in utero after the 20-week mark.

Management of Flare-Ups

Management of IBD flare-ups during pregnancy should align with treatments provided to non-pregnant individuals. Safe medications during this period include mesalamine, 6-mercaptopurine, and azathioprine, while others such as methotrexate and thalidomide are strictly contraindicated.

Endoscopy Recommendations

Regarding endoscopies, the guidelines recommend postponing non-essential elective procedures until after delivery, but advise that urgent, necessary interventions may proceed during the second trimester to minimize risks.

Conclusion

Dr. Kothari and her colleagues underscore their commitment to ensuring the safety and well-being of both the patient and the fetus throughout the pregnancy journey. The new guidelines represent a comprehensive resource for healthcare teams tasked with navigating the complexities of managing GI and liver diseases in pregnant patients.

Call to Action

As awareness of these important guidelines grows, healthcare providers are urged to integrate these recommendations into their practice to enhance outcomes for mothers and their babies. The AGA's update will undoubtedly serve as a critical tool for improving pregnancy care in the context of GI and liver disease management.