Safety of UC Medications in Pregnancy
Many UC patients have questions regarding the safety of their medications during pregnancy. It is important that women with UC who are considering pregnancy discuss appropriate therapy with their physician. Below is a brief review of the current safety information of UC medications in pregnancy.
Safe
1) Sulfasalazine - Women taking sulfasalazine should take 2mg of folate/day to diminish the risk of neural tube defects
2) 5-ASA medications - Both oral and topical formulations safe in pregnancy
3) Corticosteroids - Possible increased risk of cleft lip and palate deformities when used in the first trimester; otherwise safe and benefits felt to outweigh risks
Likely safe
1) Azathioprine/6-mercaptopurine - Data from use in humans does not show an increased risk of fetal malformations or spontaneous abortions
2) Budesonide - There is limited data regarding the use of budesonide in pregnant IBD patients, however, experience from use in women with asthma during pregnancy suggests it is likely to be safe
3) Infliximab - No difference in rates of fetal malformations, miscarriage, obstetric or neonatal complications between infliximab exposed women and the general population
4) Adalimumab - Preliminary data in animals does not show an increased risk of fetal malformations or obstetric complications - studies in humans are ongoing
5) Cyclosporine - Information from use in transplant patients suggests it is safe in pregnancy
6) Loperamide - Felt to be of low risk but prolonged use is best avoided
Unlikely to be safe
1) Diphenoxylate - Known to cause birth defects in animals
2) Cholestyramine - While cholestyramine does not cause birth defects, it may result in deficiencies of fat soluble vitamins in the fetus or mother
3) Tacrolimus - Possible risk of fetal malformations and premature delivery based on studies in transplant patients
Contraindicated
1) Mycophenolate mofetil - High rates of fetal malformations and miscarriage in animal studies and research in transplant patients