Inflammatory bowel disease in pregnancy clinical care pathway: A report from the american gastroenterological association ibd parenthood project working group

In the United States, approximately 0.5% of the population, or 1.6 million people, have inflammatory bowel disease (IBD) Crohn's disease (CD) and ulcerative colitis (UC).1,2 Of those, roughly half are women, and most will carry the diagnosis during their reproductive years.3 Caring for this complex population is a challenge for the multidisciplinary group of providers involved, compounded by misinformation and differences in priorities. There is fear surrounding the impact of IBD and its therapies on pregnancy and infant outcomes, as well as fear surrounding the impact of pregnancy on IBD and maternal health.4-6 Oftentimes, the default is to stop all therapies through pregnancy and lactation, despite the significant risk of worsening disease activity, which is the greatest known risk to pregnancy outcome.7 By looking at only one part of the puzzle, the greater picture of maternal and infant health is missed. The challenge of improving care to the woman with IBD is best met with the power of information, collaboration, and shared decision-making. The goal of the IBD in Pregnancy Clinical Care Pathway is to provide guidance on the continuum of care and best practices for managing patients with IBD who are either pregnant or have a desire to become pregnant. The Pathway outlines the entire care process-from preconception counseling through the postpartum phase. The Pathway was developed by a multidisciplinary working group, encompassing the full spectrum of providers that a pregnant female with IBD may seek treatment from before, during, and after pregnancy. The working group included representatives from the fields of gastroenterology, maternal-fetal medicine (MFM), teratology, and lactation, as well as patient stakeholders, and is backed by a multisociety team. The Pathway provides a practical resource for clinicians and health systems to guide the treatment for these patients and ensure a consistent and high level of care. (Figure 1 outlines the scope of the IBD in Pregnancy Clinical Care Pathway.)