Douglas K. Rex, MD reviewing Mahadevan U et al. Gastroenterology 2016 Oct 18.

The state of our knowledge on known risks associated with different drug classes

This article summarizes current knowledge on safety of medications for inflammatory bowel disease (IBD) during pregnancy. Highlights are as follows:

• Ciprofloxacin and amoxicillin–clavulanic acid are safe. Metronidazole use is controversial but should probably be avoided in the first trimester. Rifaximin should be avoided.
• The 5-aminosalicylates are safe.
• Steroids should be avoided as planned maintenance therapy during pregnancy.
• Methotrexate should be absolutely avoided.
• Thiopurines are safe but should generally not be initiated during pregnancy.
• Cyclosporine is probably safe for acute severe ulcerative colitis, but might cause increased rates of gestational diabetes, maternal hypertension, preeclampsia, preterm birth, small for gestational age, and low birth weight. It should only be used when the need is critical.
• For tacrolimus, data are limited. It is probably best to advise patients that there is some increased risk for congenital malformations.
• Tofacitinib has been insufficiently studied.
• Anti–tumor necrosis factor agents are safe.
• Vedolizumab and ustekinumab require additional study.

CITATION(S):

Mahadevan U et al. Drug safety and risk of adverse outcomes for pregnant patients with inflammatory bowel diseases. Gastroenterology 2016 Oct 18; [e-pub]. 

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