CENTER FOR INFLAMMATORY BOWEL DISEASES
Preconception, Pregnancy, and Postpartum Clinic Helps Women Optimize Reproductive Outcomes
Women with inflammatory bowel disease who are either contemplating pregnancy or have already become pregnant face many uncertainties, as well as known risks. They are more susceptible to adverse outcomes such as preterm birth. If their inflammation is uncontrolled, they are at increased risk of flares during pregnancy, which can lead to newborns who are small for gestational age, intrauterine growth restriction, preterm birth, and miscarriage. And, although many medications that are used to treat IBD are safe, providers and patients are often reluctant to continue with them during the pregnancy for fear of harming the fetus. To address these concerns, the Center for Inflammatory Bowel Diseases has established a multidisciplinary Preconception, Pregnancy, and Postpartum Clinic — one of only a handful in the world — in which a team that includes an IBD physician specializing in women’s health as well as a high-risk OBGYN collaborates with patients through preconception planning, pregnancy, and the postpartum period to alleviate fears, dispel misconceptions, and maximize outcomes. “This is a coordinated effort to make sure mom and baby do as well as they possibly can,” says Nirupama N. Bonthala, MD, health sciences associate clinical professor of medicine and director of Women’s Health in Inflammatory Bowel Disease for the Vatche and Tamar Manoukian Division of Digestive Diseases, who directs the clinic. “In addition to working closely with our patients, we are committed to educating their referring GI and OB providers so that everyone is on the same page.” At the clinic, women receive personalized guidance to ensure their IBD is well controlled prior to and during pregnancy, along with high-quality obstetrics care that includes close maternal-fetal medicine monitoring. Before becoming pregnant, patients can make an initial visit to discuss preconception concerns with Dr. Bonthala and her team, which includes a high-risk obstetrician, offering guidance to both the patient and her referring GI and OB providers on care during an upcoming pregnancy. Patients visit the multidisciplinary expert team at least once each trimester during the pregnancy, as well coming in for one postpartum visit. In addition to making a delivery plan and addressing any issues that come up during and after the pregnancy,
the clinic offers support that includes personalized dietary guidance, mental health care, and lactation support. When women with IBD are considering becoming pregnant, inevitably they want to know whether their IBD medications will be safe through the pregnancy 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 healthcare provider who doesn’t have experience in this area might recommend not taking it, just 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.” Many women with IBD also assume they will need to deliver by C-section when that is generally not the case, Dr. Bonthala adds. Some patients worry that their IBD will impact their ability to become pregnant. “Women’s health in general has been under-researched and under-evaluated, and unfortunately IBD is no exception,” Dr. Bonthala says. “Our goal is to dispel any misinformation and apply the best evidence to maximize outcomes for mom and baby.”
“In addition to working closely with our patients, we are committed to educating their referring GI and OB providers so that everyone is on the same page.”
Nirupama N. Bonthala, MD
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Beyond the Scope
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