Drug Safety in IBD During Pregnancy

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, …