Inflammatory bowel disease pregnancy

The antidiarrheal drugs are used cautiously in patients with severe hepatic impairment or inflammatory bowel disease Antidiarrheals are classified as Pregnancy Category B drugs and should be used cautiously during pregnancy and lactation. 

Acarbose is a glucopyranose derivative that acts by inhibiting intestinal a-gluco-sidase. This delays carbohydrate absorption and reduces the postprandial (1.5 hours after food) blood glucose levels and is used in combination with other sulfonyl-ureas. Acarbose may cause GI disturbances, flatulence, abdominal distortion, diarrhea, and pain. Acarbose should be avoided during pregnancy, as it affects the fetus. Acarbose is contraindicated in inflammatory bowel disease and hepatic dysfunction. 

NS AID, moderate or severe heart failure, patients with active peptic ulceration, ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, inflammatory bowel disease, uncontrolled hypertension, pregnancy, breastfeeding... 

Rajapakse RO, Korelitz BI, Zlatanic J, Baiocco PJ, Gleim GW. Outcome of pregnancies when fathers are treated with 6-mercaptopurine for inflammatory bowel disease. Am J Gastroenterol 2000 95(3) 684-8. 

Other Conditions. Other groups of individuals are considered to be at risk either from a marginal dietary deficiency or from an acquired deficiency secondary to disease. These groups would include female adolescents during pregnancy and lactation. Also affected may be patients with malabsorption syndrome, inflammatory bowel disease, alcoholic liver disease, and anorexia nervosa. A significant proportion of cases of sickle cell anemia have clinical signs and symptoms and some laboratory abnormalities of zinc deficiency. These patients respond well to zinc supplementation. ... 

Farraye FA. Pregnancy and nursing. In Peppercorn MA, ed. Therapy of Inflammatory Bowel Disease. New York, Marcel Dekker, 1990. 

Diarrhea, with or without abdominal pain and cramps, occurs in up to 30% of patients who take misoprostol. Apparently dose-related, it typically begins within the first 2 weeks after therapy is initiated and often resolves spontaneously within a week more severe or protracted cases may necessitate drug discontinuation. Misoprostol can cause clinical exacerbations of inflammatory bowel disease (see Chapter 38) and should be avoided in patients with this disorder. Misoprostol is contraindicated during pregnancy because it can increase uterine contractility. 

Teruel C, Lopez-San Roman A, Bermejo F, Taxonera C, Perez-Calle JL, Gisbert JP, Martin-Arranz M, Ponferrada A, Van Domselaar M, Algaba A, Estelles J, Lopez-Serrano P, Linares PM, Muriel A. Outcomes of pregnancies fathered by inflammatory bowel disease patients exposed to thiopurines. Am J Gastroenterol 2010 105(9) 2003-8. 

Teratogenicity In the infants of 476 Swedish women who reported using azathioprine in early pregnancy, mostly for inflammatory bowel disease, the rate of congenital malformations was 6.2%, compared with 4.7% among all infants born (adjusted OR = 1.41 95% Cl = 0.98, 2.04) [139 =]. Exposed infants were also more likely to be preterm, to weigh under 2500 g, and to be small for gestational age. 

Codeine and morphine should be used with caution in hypotension, hypothyroidism, asthma (avoid during an attack) and decreased respiratory reserve, shock, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, pregnancy and breastfeeding. They may precipitate coma in patients with hepatic impairment and as such, they should be avoided or a reduced dose used. In patients with renal impairment, the dose should be reduced or they should be avoided. If used in the elderly and debilitated, the dose should be reduced. 

---