Clinical Update
Preconception, Pregnancy, and Postpartum + IBD Clinic
People with inflammatory bowel disease (IBD) who are either contemplating or have already become pregnant face a host of uncertainties, as well as known risks. To assist these patients and their providers in navigating the many questions, dispelling misconceptions, and maximizing outcomes, the UCLA Department of Obstetrics and Gynecology has partnered with the UCLA Center for Inflammatory Bowel Diseases to establish a multidisciplinary Preconception, Pregnancy, and Postpartum + IBD clinic. The clinic, among the first of its kind, provides patients with high-quality obstetrics care that includes maternal-fetal medicine monitoring, as well as personalized guidance to ensure their IBD is well controlled prior to and during pregnancy.
The clinic’s patients include women with IBD who are considering becoming pregnant and want to discuss preconception concerns, as well as pregnant women looking to set themselves up for the best outcome. “Part of what we do is to educate referring physicians about issues related to IBD and pregnancy, and to help co-manage the excellent care these patients are already receiving,” explains Ilina D. Pluym, MD, UCLA assistant clinical professor of OBGYN and the specialist in maternal-fetal medicine and high-risk pregnancies who co-directs the clinic with Nirupama Bonthala, MD, associate clinical professor of medicine in the UCLA Vatche and Tamar Manoukian Division of Digestive Diseases.
Dr. Pluym notes that for women with IBD, keeping their disease well controlled gives them the best chance for a successful pregnancy. “When the inflammation isn’t controlled, they are at increased risk of flares that can lead to miscarriage, preterm birth, and newborns who are small for gestational age — along with the maternal risks associated with IBD,” she says.
The new clinic leverages the depth and breadth of expertise both within the OBGYN department and throughout UCLA Health. “As maternal-fetal medicine specialists, our goal is to optimize the health and wellness of the maternal-fetal dyad,” says Christina S. Han, MD, UCLA clinical professor of OBGYN and chief of the Division of Maternal-Fetal Medicine. “We are fortunate here at UCLA to have world-class experts who are willing and able to serve as our partners in the care of these patients. With any comorbidity of pregnancy, the multidisciplinary approach significantly benefits our patients, the health care team, and our learners.”
Dr. Bonthala notes that one of the most common concerns among women with IBD who are pregnant or considering pregnancy is whether they can safely take their IBD medications through the gestation period and during breastfeeding. “It’s natural to have some doubt about whether staying on a medication is keeping the baby safe, and in some cases a well-intentioned provider who doesn’t have experience in this area might recommend not taking it because of that doubt,” Dr. Bonthala says. “As a result, I have had patients who are flaring terribly by the time they come to see me.”
Dr. Pluym points out that most IBD medications, including suppositories and biologic infusions, can be safely continued. “Everyone wants to err on the side of caution and stop their medications, thinking that’s the safest approach,” she says. “But not taking the medication and flaring as a result is actually the greatest risk for the baby.”
Many women with IBD also assume they will need to deliver by C-section when that is rarely the case, Dr. Pluym adds. They worry about the safety of colonoscopy and imaging tests. Women who are considering pregnancy often wonder whether their IBD will affect their ability to become pregnant. While well-controlled IBD shouldn’t impact the chances of conceiving, as part of their preconception counseling the clinic’s patients are advised that they should see an infertility specialist after 6-12 months of unsuccessfully trying to become pregnant.
Patients visit the multidisciplinary clinic at least once per trimester during the pregnancy, as well as returning for a postpartum visit. During the pregnancy, they are monitored for any indications of pre-term labor, preeclampsia, fetal growth restriction, or other complications, as well as for signs of IBD-related flares. Other experts are called on as needed — including colorectal surgeons; family planning physicians for issues related to complex contraception; and allied health professionals for dietary guidance, mental health care, and lactation support. To guide research aiming to improve patient outcomes, the clinic is building a database on all pregnant IBD patients who have been seen at UCLA over the last decade.
Dr. Pluym notes that with close monitoring to ensure their disease is well controlled, the vast majority of women with IBD will have healthy pregnancy outcomes. “IBD is one of the more common conditions a maternal-fetal medicine specialist sees,” she says. “As long as there is good planning and counseling, these patients are likely to do well.”