IBD should be controlled before pregnancy. (Ulcerative Colitis, Crohn's Disease).

SEATTLE -- A The most important advice regarding pregnancy for women with inflammatory bowel disease is to attempt conception only while in clinical remission, Dr. Daniel H. Present said at the annual meeting of the American College of Gastroenterology.

Large studies indicate that when women become pregnant while their ulcerative colitis or Crohn's disease is in remission, their relapse rate during the next 9 months is the same as in nonpregnant patients--25%-30%.

If they get pregnant while their inflammatory bowel disease (IBD) is active, however, their IBD will worsen in 45% of cases and continue to be active throughout pregnancy in another 25%, posing increased risk to both mother and fetus. If the patient's IBD becomes fulminant, fetal mortality approaches 50%, he said.

"You want to bring their disease under control before pregnancy--it increases their chances of a normal baby," emphasized Dr. Present of Mount Sinai School of Medicine, New York.

Indications for bowel surgery are the same as in nonpregnant IBD patients. But ileal pouch anal anastomosis, a procedure that's increasingly popular with IBD patients, is best delayed until patients are done having children. It's recently become apparent that this procedure, which entails extensive work in the pelvic cavity, reduces fertility by roughly 20-fold.

"If your patient wants to have children and is active with colitis, what we're recommending is a subtotal colectomy with the standard temporary ileostomy. Then after she has her children, she can have the ileal-anal anastomosis," Dr. Present said.

Relatively few medications used in the management of IBD are known to be teratogenic, and those that are increase the risk of congenital malformations only by ...