UofT Faculty Members Collaborate on Supporting Pregnant Patients with IBD

November is Crohns and Colitis Awareness month, and the timing reminds us to consider how these conditions impact pregnancy. Following the successful Multidisciplinary Care in Inflammatory Bowel Disease “MC-IBD” Conference this year with over 70 participants - including gastroenterologists, obstetricians, colorectal surgeons, dieticians and nurses - discussed important updates regarding treatment for IBD and pregnancy care. Dr. Vivian Huang - Assistant Professor with the Department of Medicine at the University of Toronto, Clinician Investigator in the Division of Gastroenterology at Sinai Health, and Director of Preconception and Pregnancy in IBD clinical research program - co-leads the IBD and Pregnancy Program with Dr. Cynthia Maxwell - Professor with the Department of Obstetrics and Gynaecology at the University of Toronto and Division Head of Maternal-Fetal Medicine at Sinai Health.

Dr. Huang discusses the importance of patient and provider education on IBD and Pregnancy: “Women with IBD and their health care providers are often concerned about the impact of IBD and therapies on pregnancy outcomes, or about the impact of pregnancy on the course of their IBD. Our Mount Sinai Hospital Pregnancy IBD program offers consultation from Gastroenterology and High Risk Obstetrics/Maternal-Fetal Medicine, with education and counselling for the patients regarding pregnancy and IBD, to address some of the often unfounded worries and concerns, and to improve the care of these IBD patients. Our MC-IBD conference program offers collaborative education to clinicians and allied health professionals to improve or consolidate their knowledge regarding the interaction of IBD, therapies, and pregnancy. Our patients and referring providers have reported that they find the clinic and educational programs to be beneficial to them in managing IBD during pregnancy.”

"Patients often place the greatest concern on the effects of their medications on the developing fetus," said Dr. Maxwell, "and I believe that emerging evidence points to an array of treatment options that can be employed safely in pregnancy. Optimizing the pregnant person’s health is central to achieving optimal pregnancy outcome. This includes careful attention to exercise and nutrition, both of which can influence inflammation in the body, as well as adherence to a care plan that includes patient and provider input.”

For more information about this program, see the Preconception and Pregnancy in Inflammatory Bowel Disease Website.

The Sinai IBD and Pregnancy program also offers several educational and clinical research studies as described below:

• Prospective cohort following women with IBD preconception, during pregnancy, and post partum, and their infants up to three years, to better understand the impact of IBD on maternal and infant outcomes, and the impact of having IBD while pregnant on quality of life and mental health;
• Optimizing Maternal and Neonatal outcomes in IBD (OMNI) study looking at using remote monitoring of IBD disease activity with a home point of care stool test for inflammation to reduce risk of maternal disease flare in pregnancy;
• Anonymous survey regarding the use of pain medications, complimentary alternative medicine, and cannabis in patients with IBD before and during pregnancy;
• Anonymous survey regarding impact of COVID-19 on women with IBD considering pregnancy or who are pregnant; and,
• In the Pregnancy IBD Decision Aid (PIDA) study, we collaborate with other Canadian (UBC) and Australian (Liverpool Hospital) colleagues to develop and test an online decision aid for women with IBD regarding IBD and management of IBD in the preconception, pregnancy, and peripartum period.

The IBD and Pregnancy Team have also published a number of related articles recently, including those below:

• Gubatan J, Nielsen OH, Levitte S, Juhl CB, Maxwell C, Streett S, Habtezion A. Biologics During Pregnancy in Women With Inflammatory Bowel Disease and Risk of Infantile Infections: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2020;00:1–11. https://doi.org/10.14309.
• Leung KK, Tandon P, Govardhanam V, Maxwell C, Huang V. The Risk of Adverse Neonatal Outcomes With Maternal Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis. 2020 May 29:izaa122. doi: 10.1093/ibd/izaa122. Epub ahead of print. PMID: 32469057.
• Nielsen OH, Gubatan JM, Juhl CB, Streett SE, Maxwell C. Biologics for Inflammatory Bowel Disease and their Safety in Pregnancy: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2020 Sep 12:S1542-3565(20)31281-7. doi: 10.1016/j.cgh.2020.09.021. Epub ahead of print. PMID: 32931960.
• Tandon P, Govardhanam V, Leung K, Maxwell C, Huang V. Systematic review with meta-analysis: risk of adverse pregnancy-related outcomes in inflammatory bowel disease. Aliment Pharmacol Ther. 2020 Feb;51(3):320-333. doi: 10.1111/apt.15587. Epub 2020 Jan 7. PMID: 31912546.
• Tandon P, Lee EY, Maxwell C, Hitz L, Ambrosio L, Dieleman L, Halloran B, Kroeker K, Huang VM. Fecal Calprotectin May Predict Adverse Pregnancy-Related Outcomes in Patients with Inflammatory Bowel Disease. Dig Dis Sci. 2020 Jun 12. doi: 10.1007/s10620-020-06381-5. Epub ahead of print. PMID: 32533542.
• Tandon P, Leung K, Yusuf A, Huang VW. Noninvasive Methods For Assessing Inflammatory Bowel Disease Activity in Pregnancy: A Systematic Review. J Clin Gastroenterol. 2019 Sep;53(8):574-581. doi: 10.1097/MCG.0000000000001244. PMID: 31306343.

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