30th June 2023

Other long term medical conditions

Inflammatory bowel diseases and asthma are among the most common long term medical conditions found in pregnant women. Most of the time, good control pre-pregnancy is an indicator that the disease activity during pregnancy will be minimal.

The changes in immune system activity allow many autoimmune diseases to stabilise in pregnancy but can lead to a flare postpartum. Rheumatoid conditions, as well as multiple sclerosis, fall into this category. As before, the importance of staying on treatment that has minimised symptoms and halted disease progression should be discussed with women.

Crohn’s disease has no increased risk of exacerbation in pregnancy, but the presence of perianal disease may lead to a discussion about the risk of perineal trauma with vaginal birth. There is an increased incidence of active ulcerative colitis both in pregnancy and postpartum compared to the non-pregnant population.

Biologics

Biologic agents are increasingly used to initiate disease remission and to prevent progression. We have more evidence of the safety of many monoclonal antibodies and women should be counselled about their safety and efficacy. The main risk factor around their use is the risk to the neonate of immune suppression; live vaccines should be avoided for six months after birth – in the UK, these are the BCG and rotavirus vaccines.