:
Drug therapy is justified in pregnant patients with active
inflammatory bowel disease. Selection of medical treatment depends on disease severity and the potential for fetal toxicity. Preferably, pregnancy should be planned to coincide with periods of disease quiescence, so that
drug requirements can be minimized.
Sulphasalazine and
prednisolone are clearly safe in pregnancy and lactation. Preliminary studies suggest that lowto-moderate-dose
mesalazine is well tolerated in pregnant and nursing mothers. Immunosuppressive therapy during pregnancy in transplant and nontransplant recipients may be associated with an increased risk of
fetal growth retardation and prematurity. The risk of congenital malformations from
azathioprine and
cyclosporin is not markedly increased, although exposure to
methotrexate during the first trimester may cause fetal loss and characteristic anomalies. Short-term
therapy with
metronidazole in the first trimester is not associated with an increased risk of teratogenicity, although the safety of this
drug in pregnancy as primary
therapy for
Crohn's disease using higher doses for prolonged periods has not been confirmed.