SAFETY OF DRUG-THERAPY FOR INFLAMMATORY BOWEL-DISEASE IN PREGNANT ANDNURSING WOMEN

Drug therapy is justified in pregnant patients with active inflammator y bowel disease. Selection of medical treatment depends on disease sev erity and the potential for fetal toxicity. Preferably, pregnancy shou ld be planned to coincide with periods of disease quiescence, so that drug requirements can be minimized. Sulphasalazine and prednisolone ar e clearly safe in pregnancy and lactation. Preliminary studies suggest that low-to-moderate-dose mesalazine is well tolerated in pregnant an d nursing mothers. Immunosuppressive therapy during pregnancy in trans plant and nontransplant recipients may be associated with an increased risk of fetal growth retardation and prematurity. The risk of congeni tal malformations from azathioprine and cyclosporin is not markedly in creased, 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 in creased risk of teratogenicity, although the safety of this drug in pr egnancy as primary therapy for Crohn's disease using higher doses for prolonged periods has not been confirmed.