If conception is planned, then every attempt should be made to achieve and maintain remission. Active Crohn's disease during pregnancy is associated with miscarriage, preterm delivery and fetal complications.
Management should include:
(1) smoking cessation if the woman smokes
(2) nutritional support especially for protein, folate, iron and vitamins
(3) MRI studies without contrast can be used if imaging studies are required
Medications that are contraindicated during pregnancy include:
(1) methotrexate
(2) sulphonamides
(3) tetracyclines
(4) thalidomide
Therapy with infliximab or other monoclonal antibodies:
(1) Therapy should be discontinued in the third trimester since IgG antibodies can cross the placenta, with potential fetal exposure.
(2) The patient should be monitored for tuberculosis and other infections.
The indications for surgery are the same as for a non-pregnant woman. In general surgery is safer for the fetus and mother than an ongoing critical illness. In general an ileostomy is preferred to a primary anastomosis since the risk for postoperative complications is lower.
Caesarian may be required if:
(1) there is active perianal disease.
(2) there is a history of perianal fistulas.
