Schwangerschaft und Stillzeit bei Morbus Crohn

Die Erstdiagnose einer chronisch entzündlichen Darmerkrankung (CED) erfolgt oft im jungen Erwachsenenalter. Für viele Patientinnen spielen daher Familienplanung und Schwangerschaft eine zentrale Rolle. Die European Crohn‘s and Colitis Organization (ECCO) hat 2022 eine neue Leitlinie zu Kinderwunsch, Schwangerschaft und Stillzeit herausgegeben [1]. In diesem Beitrag gehen wir auf die neuen Aspekte in Bezug auf Schwangerschaft bei Morbus Crohn ein.

Abstract

Inflammatory bowel disease (IBD) is often diagnosed in young adults. Starting a family is an important step in life and can be further complicated by Crohn’s disease. Therefore, family planning should be discussed with every patient early in the disease course. Counseling about the importance of disease remission and the safety of IBD medication during pregnancy can ameliorate the pregnancy outcome. Active disease during pregnancy can lead to adverse pregnancy outcomes such as preterm birth and low birthweight. To maintain disease remission most therapies should be continued despite the wish to have children. Only a few substances currently used to treat Crohn’s disease are contraindicated during pregnancy and should be stopped before conception. This includes Januskinase (JAK)-inhibitors and Methotrexate. Biologics including anti-TNF-therapy, anti-IL-12/anti-IL-23 and anti-integrin therapies should be continued during pregnancy.

Kernaussagen

• Eine frühzeitige und umfassende Beratung zu den Themen Familienplanung und Schwangerschaft beeinflusst den Schwangerschaftsausgang bei Patientinnen mit einem Morbus Crohn positiv.

• Die Remission der Erkrankung ist die wichtigste Voraussetzung, um unerwünschte Ereignisse in der Schwangerschaft zu verhindern.

• Während der Schwangerschaft sollte die Krankheitsaktivität regelmäßig durch Bestimmung von Calprotectin und CRP sowie – wenn verfügbar – mittels Darmsonografien überprüft werden.

• Eine Biologikatherapie sollte in der Schwangerschaft ab der 24. SSW nur bei stabiler Remission und auf ausdrücklichen Wunsch der Patientin pausiert werden.

• Die Wahl des Geburtsmodus sollte gemeinsam mit den Geburtshelfern und unter Einbezug des Patientinnenwunsches erfolgen. Nur bei ausgeprägtem perianalem Befall und rektovaginaler Fistel wird aus gastroenterologischer Sicht eine primäre Sectio empfohlen.

• Bei Biologikaexposition in utero muss im ersten Lebensjahr auf Lebendimpfungen verzichtet werden.

Schlüsselwörter

Familienplanung - Schwangerschaft - chronisch entzündliche Darmerkrankung - Morbus Crohn - Stillzeit

Keywords

family planning - pregnancy - inflammatory bowel disease - Crohn’s disease - breastfeeding

Publication History

Article published online:
29 December 2023

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