Multidisciplinary perinatal care in IBD
Lihi Godny, D-ECCO Chair
Inflammatory Bowel Disease (IBD) can affect women during their reproductive years. Prenatal, perinatal and postnatal factors may be associated with adverse pregnancy outcomes and can also affect the long-term health of the infant. The perinatal period raises many concerns for the patient with IBD beyond medical therapy that can be addressed by the IBD multidisciplinary team (MDT). However, there is a lack of robust evidence on perinatal holistic management in IBD, and guidelines usually do not address non-medical and nutritional management. Therefore, D-ECCO initiated a collaborative Topical Review with the aim of assessing the scientific evidence and providing expert opinion on nutritional, psychological and supportive care for women with IBD and their infants throughout the perinatal period .
ECCO Members with diverse expertise were divided into four working groups, each including a gastroenterologist, IBD Nurse and dietitian. The working groups covered epigenetics and microbiome development, preconception, pregnancy and early-life development.
Although there is a lack of prospective IBD-specific perinatal evidence, increasing evidence in non-IBD populations suggests that the perinatal nutritional status and lifestyle of both parents are associated with perinatal outcomes. As poor nutritional status is common in patients with IBD, optimising nutritional status, with correction and prevention of nutritional deficiencies, prior to conception may improve pregnancy outcomes.
Pregnant women with IBD require MDT care. They often report high levels of pregnancy-related concerns and need non-judgmental psychosocial support to reduce anxiety and improve adherence to therapy. Dedicated IBD-obstetric antenatal clinics are associated with better outcomes. Pregnant women with IBD should follow local dietary guidelines for a healthy and diverse diet, which is inversely associated with adverse pregnancy outcomes. As they are at risk for micronutrient deficiencies, pregnant women should be screened for folate, iron, vitamin D and vitamin B12 deficiencies, with supplementation and monitoring as required. Suboptimal dietary patterns and restrictive diets may cause nutritional inadequacies and deficiencies, and referral to an IBD dietitian is recommended in these cases. Inadequate gestational weight gain should be considered an independent risk factor for adverse neonatal outcomes, and patients should receive counseling and support from a dietitian to promote adequate weight gain. Exclusive enteral nutrition can be considered for induction of remission in pregnant women with Crohn’s Disease. On the other hand, most complementary and alternative therapies (CAM) during preconception, pregnancy, and lactation have not been studied, so safety data for CAM therapies should be assessed by the MDT and initiation of new CAM therapies is not recommended.
Perinatal counseling should include education on early-life exposures that are associated with the risk of IBD. Epigenetics and the development of gut microbial composition may mediate the potential effects of environmental factors like antibiotics, smoking, breastfeeding and diet on IBD risk. Breastfeeding and healthy lifestyle habits are beneficial and should be promoted. Perinatal MDT that includes a dedicated gastroenterologist, obstetrician, IBD Nurse, dietitian and psychologist with IBD expertise is suggested for optimal care, education and support of prospective and current parents with IBD and their infants.
I would like to thank D-ECCO and all authors who contributed to this work, specifically Catherine Wall, who coordinated it with me. Applying for D-ECCO will give you the opportunity to be part of such initiatives and to contribute to the field of dietary management in IBD.
In order to read the Topical Review please log in to the ECCO Portal.
Link to D-ECCO application:
- Godny L, Svolos V, Williams A-J, et al. Multidisciplinary perinatal care in IBD. J Crohns Colitis. Published online December 20, 2022. doi:10.1093/ECCO-JCC/JJAC189