@article{b14086a50a29461286f95d70dfdc5e12,
title = "The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy",
abstract = "Background & Aims The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy because the health of both the mother and the fetus must be considered. Methods A systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Results Consensus was reached on 29 of the 30 recommendations considered. Preconception counseling and access to specialist care are paramount in optimizing disease management. In general, women on 5-ASA, thiopurine, or anti-tumor necrosis factor (TNF) monotherapy for maintenance should continue therapy throughout pregnancy. Discontinuation of anti-TNF therapy or switching from combination therapy to monotherapy may be considered in very select low-risk patients. Women who have a mild to moderate disease flare while on optimized 5-ASA or thiopurine therapy should be managed with systemic corticosteroid or anti-TNF therapy, and those with a corticosteroid-resistant flare should start anti-TNF therapy. Endoscopy or urgent surgery should not be delayed during pregnancy if indicated. Decisions regarding cesarean delivery should be based on obstetric considerations and not the diagnosis of IBD alone, with the exception of women with active perianal Crohn's disease. With the exception of methotrexate, the use of medications for IBD should not influence the decision to breast-feed and vice versa. Live vaccinations are not recommended within the first 6 months of life in the offspring of women who were on anti-TNF therapy during pregnancy. Conclusions Optimal management of IBD before and during pregnancy is essential to achieving favorable maternal and neonatal outcomes.",
keywords = "5-Aminosalicylate, Anti-Tumor Necrosis Factor, Breast-feeding, Corticosteroid, Crohn's Disease, Inflammatory Bowel Disease, Lactation, Postpartum, Pregnancy, Thiopurine, Ulcerative Colitis",
author = "Nguyen, {Geoffrey C.} and Seow, {Cynthia H.} and Cynthia Maxwell and Vivian Huang and Yvette Leung and Jennifer Jones and Leontiadis, {Grigorios I.} and Frances Tse and Uma Mahadevan and {Van Der Woude}, {C. Janneke}",
note = "Funding Information: The CAG would like to thank Janssen Inc. and Shire Canada for their generous support of the guideline process. The consensus group thanks the following people for their contributions: Paul Sinclair (obtaining funding, providing administrative and technical support, and representing the CAG), Dr William Paterson (consensus meeting moderator), Louise Hope (logistics assistance), Pauline Lavigne and Steven Portelance (unaffiliated, editorial assistance), Cathy Yuan (Cochrane Group), Nicole Talsma and Susan Powelson (University of Calgary) (literature search assistance), and Dr Gideon Koren (University of Toronto, Toronto, Ontario, Canada; participation in the initial stages of the consensus process). CAG Statement This clinical practice guideline on the management of IBD in pregnancy has been developed under the direction of Drs Geoffrey C. Nguyen and Cynthia H. Seow, in accordance with the policies and procedures of the CAG and under the direction of CAG Clinical Affairs. It has been reviewed by the CAG Practice Affairs and Clinical Affairs Committees and the CAG Board of Directors. The clinical practice guideline was developed after a thorough consideration of the medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian and international panel composed of experts on this topic. The clinical practice guideline aims to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The clinical practice guideline is not intended to be a substitute for physicians using their individual judgment in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available, and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case. Supported by unrestricted grants to the Canadian Association of Gastroenterology by Shire Canada and Janssen, which had no involvement in any aspect of guideline development. Funding Information: Funding for the consensus meeting was provided by unrestricted grants to the CAG from Janssen Inc and Shire Canada. The CAG administered all aspects of the meeting, and the funding sources had no role in drafting or approving these guidelines. Funding Information: Funding Supported by unrestricted grants to the Canadian Association of Gastroenterology by Shire Canada and Janssen, which had no involvement in any aspect of guideline development. Publisher Copyright: {\textcopyright} 2016 AGA Institute.",
year = "2016",
month = mar,
day = "1",
doi = "10.1053/j.gastro.2015.12.003",
language = "English (US)",
volume = "150",
pages = "734--757.e1",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "3",
}