Kernaussagen
Chronisch-entzündliche Darmerkrankungen (CED) manifestieren sich meist im jungen Erwachsenenalter
– in einem Zeitraum, in dem auch die Familienplanung stattfindet. Häufig sind CED-Patienten
jedoch unsicher angesichts zahlreicher Fragen zum Thema Kinderwunsch, Schwangerschaftsverlauf
und der Prognose des Kindes. Eine mögliche Vererbung der CED, eventuelle angeborene
Abnormalitäten des Kindes und die befürchtete medikationsbedingte Teratogenität stellen
häufig geäußerte Sorgen dar und beeinflussen damit auch die Familienplanung. Deutlich
geringer ist demgegenüber die Angst der meisten CED-Patientinnen vor negativen Auswirkungen
der Schwangerschaft auf die eigene Krankheit.
Das Bekanntwerden einer Schwangerschaft bei einer Patientin mit Morbus Crohn oder
Colitis ulcerosa sollte von den beteiligten Ärzten positiv reflektiert werden, weil
sowohl das krankheitsspezifische als auch das therapieassoziierte Schwangerschaftsrisiko
gering sind. Ziel ist daher eine Remission oder eine niedrige Krankheitsaktivität
vor und während der Schwangerschaft.
Literatur
- 1
Mountifield R, Bampton P, Prosser R. et al .
Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality
affects family planning decisions.
Inflamm Bowel Dis.
2009;
15
720-725
- 2
Timmer A, Kemptner D, Bauer A. et al .
Determinants of female sexual function in inflammatory bowel disease: a survey based
cross-sectional analysis.
BMC Gastroenterol.
2008;
8
45
- 3
Heetun Z S, Byrnes C, Neary P, O’Morain C.
Review article: Reproduction in the patient with inflammatory bowel disease.
Aliment Pharmacol Ther.
2007;
26
513-533
- 4
Mahadevan U, Sandborn W J, Li D K. et al .
Pregnancy outcomes in women with inflammatory bowel disease: a large community-based
study from Northern California.
Gastroenterol.
2007;
133
1106-1112
- 5
Stephansson O, Larsson H, Pedersen L. et al .
Congenital abnormalities and other birth outcomes in children born to women with ulcerative
colitis in Denmark and Sweden.
Inflamm Bowel Dis [in press].
- 6
Fonager K, Sørensen H T, Olsen J. et al .
Pregnancy outcome for women with Crohn’s disease: a follow-up study based on linkage
between national registries.
Am J Gastroenterol.
1998;
93
2426-2430
- 7
Dominitz J A, Young J C, Boyko E J.
Outcomes of infants born to mothers with inflammatory bowel disease: a population-based
cohort study.
Am J Gastroenterol.
2002;
97
641-648
- 8
Nielsen M J, Nørgaard M, Holland-Fisher P, Christensen L A.
Self-reported antenatal adherence to medical treatment among pregnant women with Crohn‘s
disease.
Aliment Pharmacol Ther.
2010;
32
49-58
- 9
Zelinkova Z, Mensink P B, Dees J. et al .
Reproductive wish represents an important factor influencing therapeutic strategy
in inflammatory bowel diseases.
Scand J Gastroenterol.
2010;
45
46-50
- 10
Nørgård B, Czeizel A E, Rockenbauer M. et al .
Population-based case control study of the safety of sulfasalazine use during pregnancy.
Aliment Pharmacol Ther.
2001;
15
483-486
- 11
Colombel J F, Brabant G, Gubler M C. et al .
Renal insufficiency in infant: side-effect of prenatal exposure to mesalazine?.
Lancet.
1994;
344
620-621
- 12
Østensen M.
Antirheumatische Therapie und Reproduktion. Einfluss auf Fertilität, Schwangerschaft
und Stillzeit.
Z Rheumatol.
2006;
65
222-224
- 13
Beaulieu D B, Ananthakrishnan A N, Issa M. et al .
Budesonide induction and maintenance therapy for Crohn’s disease during pregnancy.
Inflamm Bowel Dis.
2009;
15
25-28
- 14
Platzek T, Bochert G.
Dose-response relationship of teratogenicity and prenatal toxic risk estimation of
6-mercaptopurine riboside in mice.
Teratog Carcinog Mutagen.
1996;
16
169-181
- 15
Francella A, Dyan A, Bodian C. et al .
The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease:
a retrospective cohort study.
Gastroenterol.
2003;
124
9-17
- 16
Kozlowski R D, Steinbrunner J V, MacKenzie A H. et al .
Outcome of first-trimester exposure to low-dose methotrexate in eight patients with
rheumatic disease.
Am J Med.
1990;
88
589-592
- 17
Martínez Lopez J A, Loza E, Carmona L.
Systematic review on the safety of methotrexate in rheumatoid arthritis regarding
the reproductive system (fertility, pregnancy, and breastfeeding).
Clin Exp Rheumatol.
2009;
27
678-684
- 18
Schaefer C, Weber-Schoendorfer C.
Pharmakotherapie in der Schwangerschaft.
Internist.
2009;
50
455-465
- 19
Bar Oz B, Hackman R, Einarson T, Koren G.
Pregnancy outcome after cyclosporine therapy during pregnancy: a meta-analysis.
Transplantation.
2001;
71
1051-1055
- 20
Katz J A, Antoni C, Keenan G. et al .
Outcome of pregnancy in women receiving infliximab for the treatment of Crohn's disease
and rheumatoid arthritis.
Am J Gastroenterol.
2004;
99
2385-2392
- 21
Hoffmann J C, Preiss J C, Autschbach F. et al .
S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn.”
Z Gastroenterol.
2008;
46
1094-1146
- 22
Matok I, Gorodischer R, Koren G. et al .
The safety of metoclopramide use in the first trimester of pregnancy.
N Engl J Med.
2009;
360
2528-2535
- 23
Matok I, Gorodischer R, Koren G. et al .
The safety of H2-blockers use during pregnancy.
J Clin Pharmacol.
2010;
50
81-87
- 24
Gill S K, O'Brien L, Einarson T R, Koren G.
The safety of proton pump inhibitors in pregnancy: a meta-analysis.
Am J Gastroenterol.
2009;
104
1541
- 25
Angelucci E, Cesarini M, Vernia P.
Inadvertent conception during concomitant treatment with infliximab and methotrexate
in a patient with Crohn‘s disease: is the game worth the candle?.
Inflamm Bowel Dis.
2010;
16
1641-1642
- 26
Cappell M S, Colon V J, Sidhom O A.
A study at 10 medical centers of the safety and efficacy of 48 flexible sigmoidoscopies
and 8 colonoscopies during pregnancy with follow-up of fetal outcome and with comparison
to control groups.
Dig Dis Sci.
1996;
41
2353-2361
- 27
Nguyen G C, Boudreau H, Harris M L, Maxwell C V.
Outcomes of obstetric hospitalizations among women with inflammatory bowel disease
in the United States.
Clin Gastroenterol Hepatol.
2009;
7
329-334
- 28
Ilnyckyji A, Blanchard J F, Rawsthorne P, Bernstein C N.
Perianal Crohn’s disease and pregnancy: role of the mode of delivery.
Am J Gastroenterol.
1999;
94
3274-3278
- 29
Polito 2nd
J M, Rees R C, Childs B. et al .
Preliminary evidence for genetic anticipation in Crohn‘s disease.
Lancet.
1996;
347
798-800
- 30
Dotan I, Alper A, Rachmilewitz D. et al .
The effect of inflammatory bowel disease during pregnancy on long-term health and
illness in children of IBD patients – a multicenter Israeli study.
DDW.
2009;
Poster 84
PD Dr. med. Niels Teich
Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten
Funkenburgstraße 19
04105 Leipzig
eMail: teich@igvs.de
